Impact of Enrolling in Health Insurance on Low-Income Children that Enrolled for a Medical Reason

Impact of Enrolling in Health Insurance on Low-Income Children that Enrolled for a Medical Reason Prepared for: Prepared by Moira Inkelas and Patricia Barreto May 2009 The University of California at Los Angeles Abstract The Los Angeles Healthy Kids program is a county-based health insurance program providing coverage for children in families with household income below 300 percent of the federal poverty level who are ineligible for Healthy Families and Medi-Cal. Children enrolled for a medical reason may have more urgent and specialized medical needs. This special study seeks to compare the experience of children that enrolled in Healthy Kids for a medical reason with the general Healthy Kids population, those who enrolled without indicating a current health care need. The client survey was conducted in two waves (baseline and follow-up) among 474 children ages 12–72 months with a response rate of 86 percent. Children were included in the “enrolled for a medical reason” category if they enrolled because the child was sick or needed medical care, needed a prescription medicine that the family could not afford or if their parent gave a medical reason in response to the following question: “Was there any other important reason that the child was enrolled in Healthy Kids?” A two sided t-test was used to compare responses at baseline and follow-up for children who did and who did not enroll for a medical reason. Children enrolling for a medical reason reported a range of common conditions including allergies, anemia, asthma, cough/cold, stomach problems, ear/eye infection, fever, and rash as their reason for enrollment. A large portion (67 percent) of parents of children enrolled for a medical reason report enrolling because the child needed a prescription medication that the family could not afford. This study found that access to care for children enrolling for a medical reason and those not enrolling for a medical reason substantially improved one year after enrollment in Healthy Kids. Thus, enrollment in health insurance is associated with improved access to timely health care and, particularly for those enrolled for a medical reason, lower out-of-pocket health care costs. However, families of children enrolled for a medical reason face persistent barriers in accessing subspecialty care and demonstrate persistent higher use of emergency department services compared with those not enrolled for a medical reason. 1 Introduction The Los Angeles Healthy Kids program is a county-based health insurance program providing coverage for children in families with household income below 300 percent of the federal poverty level (FPL) who are ineligible for Healthy Families and Medi-Cal. The enrollees are largely low income undocumented immigrant children, but include some children above the income level for Healthy Families (250 percent of the FPL). The program was created in 2003 and initially covered children 0–5 years of age. In 2004, the Healthy Kids was expanded to cover older children, ages 6 through 18, as well. Medical coverage is intended to improve access for acute illnesses, chronic care, and quality preventive care. Children with current perceived medical conditions may have more urgent and specialized medical needs. This special study seeks to compare the experience of children that enrolled in Healthy Kids with a concern for a specific health condition to the general Healthy Kids population, those that enrolled without indicating a current health care need. Background Children with acute or chronic conditions or chronic conditions with acute exacerbation (e.g. asthma), may face special challenges in accessing health care services1 (Chen and Newacheck 2006; Jeffrey and Newacheck 2007). The nature of the condition may require timely access to subspecialty care, medical equipment, specialized therapies including occupational and physical therapy, access to after hour services or emergency services, and need for intensive health education. Families of children with acute or chronic conditions may face additional out-of-pocket costs for medications and equipment (Chen and Newacheck 2006). Transportation for children with certain conditions may present unique challenges to families and lack of transportation may be a significant barrier to timely access to care in case of an urgent health care need (Yu et al. 2004). Health insurance is designed to improved access to timely health care and lower out-of-pocket health care costs. However, the impact of obtaining health insurance may vary depending on the families particular needs at enrollment; prior studies suggest that children with chronic conditions benefit from health insurance expansions in terms of continuity with primary care, selected quality measures, and parental concerns about ability to meet the child’s medical needs (Szilagyi et al. 2007). In addition, the quality of health services obtained using