title: Language proficiency and the enrollment of Medicaid-eligible children in publicly funded health insurance programs.
abstract: OBJECTIVE
  The purpose of the study was to examine the effect of language proficiency on enrollment in a state-sponsored child health insurance program.
  
  
  METHODS
  1055 parents of Medicaid-eligible children, who were enrolled in a state-sponsored child health insurance program, were surveyed about how they learned about the state program, how they enrolled their children in the program, and perceived barriers to Medicaid enrollment. We performed weighted chi2 tests to identify statistically significant differences in outcomes based on language. We conducted multivariate analyses to evaluate the independent effect of language controlling for demographic characteristics.
  
  
  RESULTS
  Almost a third of families did not speak English in the home. These families, referred to as limited English proficiency families, were significantly more likely than English-proficient families to learn of the program from medical providers, to receive assistance with enrollment, and to receive this assistance from staff at medical sites as compared to the toll-free telephone information line. They were also more likely to identify barriers to Medicaid enrollment related to "know-how"--that is, knowing about the Medicaid program, if their child was eligible, and how to enroll. Differences based on language proficiency persisted after controlling for marital status, family composition, place of residence, length of enrollment, and employment status for almost all study outcomes.
  
  
  CONCLUSIONS
  This study demonstrates the significant impact of English language proficiency on enrollment of Medicaid-eligible children in publicly funded health insurance programs. Strong state-level leadership is needed to develop an approach to outreach and enrollment that specifically addresses the needs of those with less English proficiency.
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, USA. feinberg@state.ma.us
authors.forename: Emily
authors.initials: E
authors.lastname: Feinberg
authors.forename: Katherine
authors.initials: K
authors.lastname: Swartz
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.forename: Jane
authors.initials: J
authors.lastname: Gardner
authors.forename: Deborah Klein
authors.initials: DK
authors.lastname: Walker
mesh_terms: D000385:Aid to Families with Dependent Children / Q000706:statistics & numerical data*; D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data; D003144:Communication Barriers; D004608:Eligibility Determination; D005006:Ethnicity / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007802:Language; D008404:Massachusetts; D008484:Medicaid / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D013221:State Health Plans; D014481:United States; D019472:Universal Health Insurance