How Medicaid and the State Children's Health Insurance Program can do a better job of insuring uninsured children: the perspectives of parents of uninsured Latino children.
BACKGROUND
Eight and a half million US children are uninsured, despite the 1997 enactment of the State Children's Health Insurance Program (SCHIP) with $39 billion in funding, and Latinos continue to be the most uninsured racial/ ethnic group, with 24% (3 million) uninsured. Why SCHIP and Medicaid have not been more successful insuring uninsured children is unclear.


OBJECTIVE
To identify reasons why parents are unable to insure uninsured Latino children in a state where all low-income children are eligible for insurance.


METHODS
Bilingual focus groups of parents of uninsured Latino children from Boston communities with the highest proportion of uninsured Latino children.


RESULTS
The 30 parents interviewed in 6 focus groups had a mean age of 39 years; 63% never graduated high school and 33% were US citizens. The mean age of their children was 12 years, and the median annual family income was $9120. Parents reported 52 barriers to insuring children. Major obstacles included lack of knowledge about the application process and eligibility (especially misconceptions about work, welfare, and immigration), language barriers, immigration issues, income, hassles, pending decisions, family mobility, misinformation from insurance representatives (being told insurance is too expensive and parents must work), and system problems (including lost applications, discrimination, and excessive waits). Parents universally agreed case managers would be helpful in insuring uninsured children.


CONCLUSIONS
Even in a state where all low-income children are eligible for health insurance, current SCHIP and Medicaid outreach and enrollment are not effectively reaching uninsured Latino children. Parents need better information about programs, eligibility, and the application process, and a more efficient, user-friendly system.
Flores
Glenn
G
Center for the Advancement of Underserved Children, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Abreu
Milagros
M
Brown
Vanessa
V
Tomany-Korman
Sandra C
SC
D002648:Child; D017144:Focus Groups; D006630:Hispanic or Latino; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008404:Massachusetts; D008484:Medicaid; D017057:Medically Uninsured / Q000208:ethnology*; D010290:Parents / Q000523:psychology*; D012959:Socioeconomic Factors