Emergency department-based health insurance enrollment for children: does linkage lead to insurance retention and utilization?
OBJECTIVE
Although 40% of emergency departments (EDs) report having an insurance linkage program, no studies have evaluated the long-term success of these programs. This study aimed to examine insurance retention and utilization by children initially referred to insurance by our ED insurance linkage program.


METHODS
We retrospectively examined insurance records of all uninsured children successfully enrolled in public insurance by the insurance linkage program established in our suburban academic ED between 2004 and 2009. Emergency department-enrolled children were matched by age, sex, program, and year of enrollment to a control group of children from the same county who were enrolled in non-ED settings. Wilcoxon signed rank and χ tests were used to compare enrollment and claims variables.


RESULTS
Emergency department-enrolled children retained insurance for longer, had a higher reenrollment rate, and were higher users of insurance. The average length of enrollment for ED children was 734 days versus 597 days in the control group. Eighty percent of the ED cohort reenrolled in insurance after initial eligibility expiration versus 64% of the control group. Children enrolled via the ED averaged 26 claims (vs 12 claims) and $20,087 (vs $5216) in hospital charges per year of enrollment. This higher utilization was reflected in increased primary care, specialty care, ED visits, inpatient, and mental health claims in the ED group.


CONCLUSIONS
Emergency department-based insurance enrollment programs have the potential to improve access to health care for children. Policies aimed at expanding insurance enrollment among the uninsured population, including the Affordable Care Act, may consider the ED's potential as an effective enrollment site.
From the *Stanford University School of Medicine, Stanford, CA; †Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA; ‡Los Angeles County Department of Health Services, Los Angeles; and §San Mateo County Health System Health Coverage Unit, Redwood City, CA.
Mia
M
Kanak
Lori
L
Rutman
Elizabeth A
EA
Pirrotta
Mary
M
Giammona
Marmi
M
Bermudez
Nancy E
NE
Wang
D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act; D011320:Primary Health Care / Q000191:economics*; D015397:Program Evaluation; D012189:Retrospective Studies; D014481:United States