Uncertain health insurance coverage and unmet children's health care needs.
OBJECTIVE
The State Children's Health Insurance Program (SCHIP) has improved insurance coverage rates. However, children's enrollment status in SCHIP frequently changes, which can leave families with uncertainty about their children's coverage status. We examined whether insurance uncertainty was associated with unmet health care needs.


METHODS
We compared self-reported survey data from 2,681 low-income Oregon families to state administrative data and identified children with uncertain coverage. We conducted cross-sectional multivariate analyses using a series of logistic regression models to test the association between uncertain coverage and unmet health care needs.


RESULTS
The health insurance status for 13.2% of children was uncertain. After adjustments, children in this uncertain "gray zone" had higher odds of reporting unmet medical (odds ratio [OR] =1.73; 95% confidence interval [CI]=1.07, 2.79), dental (OR=2.41; 95% CI=1.63, 3.56), prescription (OR=1.64, 95% CI=1.08, 2,48), and counseling needs (OR=3.52; 95% CI=1.56, 7.98), when compared with publicly insured children whose parents were certain about their enrollment status.


CONCLUSIONS
Uncertain children's insurance coverage was associated with higher rates of unmet health care needs. Clinicians and educators can play a role in keeping patients out of insurance gray zones by (1) developing practice interventions to assist families in confirming enrollment and maintaining coverage and (2) advocating for policy changes that minimize insurance enrollment and retention barriers.
Oregon Health and Science University, Department of Family Medicine, 3181 Sam Jackson Park Road, Mailcode: FM, Portland, OR 97239, USA. devoej@ohsu.edu
Jennifer E
JE
DeVoe
Moira
M
Ray
Lisa
L
Krois
Matthew J
MJ
Carlson
D000293:Adolescent; D002648:Child; D002669:Child Welfare / Q000191:economics* / Q000706:statistics & numerical data; D002675:Child, Preschool; D004608:Eligibility Determination / Q000191:economics / Q000379:methods; D005260:Female; D005522:Food Services / Q000191:economics / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D009922:Oregon; D011203:Poverty; D013221:State Health Plans / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D014481:United States