title: Disruptions in insurance coverage: patterns and relationship to health care access, unmet need, and utilization before enrollment in the State Children's Health Insurance Program.
abstract: BACKGROUND
  The numbers and types of disruptions in insurance that children experience and the effects of these disruptions on health care measures have not been well characterized.
  
  
  OBJECTIVE
  Our goals were to (1) describe the number and patterns of insurance disruptions within a population of children newly enrolling into the State Children's Health Insurance Program and (2) assess the relationship among insurance disruptions and sociodemographic characteristics of these children and their families to specific measures of access to care, unmet need, and health care utilization during the year before enrollment.
  
  
  METHODS
  We conducted telephone interviews in families with children newly enrolling in the State Children's Health Insurance Program. Families reported on measures for each of the 12 months preceding enrollment. They were grouped by number of insurance disruptions in the year before enrollment: continuously uninsured, > or = 2 disruptions, 1 disruption, or continuously insured.
  
  
  RESULTS
  Of 920 families contacted, 739 (80%) completed the interview and 710 had useable data. Thirty-five percent reported being continuously uninsured, 42% were intermittently insured (> or = 2 disruptions: 28%; 1 disruption: 14%), and 23% were continuously insured during the previous year. The most common patterns of change were between privately insured and uninsured (49%) and Medicaid and uninsured (40%). The continuously uninsured were more likely to be Hispanic and older in age. Multivariate modeling confirmed a gradient between greater insurance disruption and less access to care, less utilization, and greater unmet medical need. Using the continuously uninsured as a reference group, the adjusted odds ratio for having a medical home varied from 2.5 for those with > or = 2 disruptions to 4.5 for the continuously insured and from 1.9 to 3.2, respectively, for using any regular/routine care. The odds ratio for unmet need for a prescription medication was 0.9 for > or = 2 disruptions and 0.5 for those with continuous insurance coverage.
  
  
  CONCLUSIONS
  There was significant disruption in insurance coverage in the year before State Children's Health Insurance Program enrollment. Most of these disruptions took the form of children previously enrolled in either Medicaid or private insurance becoming uninsured. Increasing numbers of disruptions were associated with less routine care and greater unmet medical need. These findings suggest that disruptions in insurance coverage for children should be minimized with the adoption of policies regarding continuous eligibility criteria for Medicaid and streamlining transitions between Medicaid, the State Children's Health Insurance Program, and private insurance.
authors.affiliation: Department of Pediatrics, University of Colorado Health Sciences Center, Denver, Colorado, USA. steve.federico@dhha.org
authors.forename: Steven G
authors.initials: SG
authors.lastname: Federico
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.forename: Brenda
authors.initials: B
authors.lastname: Beaty
authors.forename: Lori
authors.initials: L
authors.lastname: Crane
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003120:Colorado; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D007348:Insurance, Health; D007407:Interviews as Topic; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D015397:Program Evaluation; D044469:Racial Groups