title: A cross-sectional study of parental awareness of and reasons for lack of health insurance among minority children, and the impact on health, access to care, and unmet needs.
abstract: BACKGROUND
  Minority children have the highest US uninsurance rates; Latino and African-American children account for 53 % of uninsured American children, despite comprising only 48 % of the total US child population. The study aim was to examine parental awareness of and the reasons for lacking health insurance in Medicaid/CHIP-eligible minority children, and the impact of the children's uninsurance on health, access to care, unmet needs, and family financial burden.
  
  
  METHODS
  For this cross-sectional study, a consecutive series of uninsured, Medicaid/CHIP-eligible Latino and African-American children was recruited at 97 urban Texas community sites, including supermarkets, health fairs, and schools. Measures/outcomes were assessed using validated instruments, and included sociodemographic characteristics, uninsurance duration, reasons for the child being uninsured, health status, special healthcare needs, access to medical and dental care, unmet needs, use of health services, quality of care, satisfaction with care, out-of-pocket costs of care, and financial burden.
  
  
  RESULTS
  The mean time uninsured for the 267 participants was 14 months; 5 % had never been insured. The most common reason for insurance loss was expired and never reapplied (30 %), and for never being insured, high insurance costs. Only 49 % of parents were aware that their uninsured child was Medicaid/CHIP eligible. Thirty-eight percent of children had suboptimal health, and 2/3 had special healthcare needs, but 64 % have no primary-care provider; 83 % of parents worry about their child's health more than others. Unmet healthcare needs include: healthcare, 73 %; mental healthcare, 70 %; mobility aids/devices, 67 %; dental, 61 %; specialty care, 57 %; and vision, 46 %. Due to the child's health, 35 % of parents had financial problems, 23 % cut work hours, and 10 % ceased work. Higher proportions of Latinos lack primary-care providers, and higher proportions of African-Americans experience family financial burden.
  
  
  CONCLUSIONS
  Half of parents of uninsured minority children are unaware that their children are Medicaid/CHIP-eligible. These uninsured children have suboptimal health, impaired access to care, and major unmet needs. The child's health causes considerable family financial burden, and one in 10 parents ceased work. The study findings indicate urgent needs for better parental education about Medicaid/CHIP, and for improved Medicaid/CHIP outreach and enrollment.
authors.affiliation: Medica Research Institute, MR-CW105, P.O. Box 9310, Minneapolis, MN, 55440-9310, USA. glenn.flores@medica.com.
authors.forename: Glenn
authors.identifier: http://orcid.org/0000-0001-8117-945X
authors.initials: G
authors.lastname: Flores
authors.affiliation: Department of Clinical Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA.
authors.forename: Hua
authors.initials: H
authors.lastname: Lin
authors.affiliation: Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX, 75219, USA.
authors.forename: Candy
authors.initials: C
authors.lastname: Walker
authors.affiliation: Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA.|Children's Health System of Texas, Dallas, TX, 75235, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Portillo
authors.affiliation: Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Henry
authors.affiliation: Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA.
authors.forename: Marco
authors.initials: M
authors.lastname: Fierro
authors.affiliation: Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Massey
mesh_terms: D001741:Black or African American; D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000191:economics* / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000208:ethnology / Q000706:statistics & numerical data; D054525:Minority Health / Q000592:standards*; D010290:Parents / Q000523:psychology; D012959:Socioeconomic Factors; D013781:Texas / Q000208:ethnology
keywords: Adolescent; African-Americans; Child; Hispanic Americans; Medically uninsured; Public health