Do Access Experiences Affect Parents' Decisions to Enroll Their Children in Medicaid and SCHIP? Findings from Focus Groups with Parents
Matern Child Health JDOI 10.1007/s10995-006-0145-4ORIGINAL PAPERDo Access Experiences Affect Parents’ Decisions to Enroll TheirChildren in Medicaid and SCHIP? Findings from Focus Groupswith ParentsIan Hill·Holly Stockdale·Marilynn Evert·Kathleen GiffordCSpringer Science+Business Media, LLC 2006AbstractObjective: The Covering Kids and Families(CKF) program seeks to expand health insurance cover-age for children by supporting community-based outreachand enrollment. For the evaluation of CKF, researchers con-ducted focus groups to explore parents’ experiences access-ing health care for their children, and to assess whetherthese experiences affected decisions to enroll their childrenin Medicaid or the State Children’s Health Insurance Pro-gram (SCHIP).Methods: In May and June 2003, 13 focusgroups were conducted in 5 cities—Everett, MA; Denver,CO; Los Angeles, CA; Mena, AR; and San Antonio, TX.In each community, groups were conducted with parentsof children insured under Medicaid or SCHIP and parentsof uninsured children. Three groups were conducted withSpanish-speaking parents in two communities—Denver andLos Angeles.Results: Access to primary care was consideredgood by most parents with children in Medicaid and SCHIP.Among parents of uninsured children, there was more vari-I. Hill ()The Urban Institute,Washington, DC, USAe-mail: ihill@ui.urban.orgH. StockdaleNational Opinion Research Center,Washington, DC, USAe-mail: Stockdale-holly@norc.orgM. EvertHealth Management Associates, Inc.,Tallahassee, FL, USAe-mail: mevert@hlthmgt.comK. GiffordHealth Management Associates, Inc.,Indianapolis, IN, USAe-mail: mevert@hlthmgt.comation in perceptions of access to care. For parents of bothuninsured and insured children, access to dentists and spe-cialists was more problematic. Spanish-speaking familiesreported numerous barriers to care due to language differ-ences and perceived discrimination. All focus group partic-ipants said that they placed great value on health insurance.Conclusion: Even when parents encountered problems ac-cessing care, very few indicated that this discouraged themfrom enrolling their children into Medicaid or SCHIP, orfrom renewing their children’s public coverage.KeywordsMedicaid.SCHIP.Access.Enrollment.RenewalIntroductionSince the late 1980s, national and state policymakers haveundertaken significant efforts to broaden health insurancecoverage for low-income children. Beginning with a series ofexpansions of Medicaid eligibility for pregnant women andchildren, these efforts culminated in 1997 with the creationof the State Children’s Health Insurance Program (SCHIP).At a time when there were approximately 10 million chil-dren without health insurance in the United States, SCHIPgave states $40 billion over 10 years to expand coverage tolow-income children. Since then, aggressive outreach effortsand dramatic eligibility simplifications have fueled strongrates of enrollment in both SCHIP and Medicaid [1–3]; thenumber of children without health insurance declined bynearly 2 million and the rate of uninsurance fell from 23to 16 percent [4]. Yet, despite this reduction, nearly 8 mil-lion children remained uninsured in 2002 even though morethan half of these children were estimated to be eligible forMedicaid or SCHIP coverage [5]. Therefore, it is im-Springer Matern Child Health Jportant to understand the reasons why children are notbeing enrolled into the programs for which they areeligible.Recent research demonstrates that knowledge gaps amongparents partially explain why low-income children remainwithout health insurance. For example, a 2003 study showedthat nearly 30 percent of low-income parents had not heard ofSCHIP and 40 percent did not understand that their childrencould be eligible for health coverage even if they were notenrolled in welfare [6]. Additionally, an estimated 7 percentof uninsured children lack coverage because their parents donot think they need it [7].However, little research to date has explored whether ac-cess barriers also influence parents’ decisions about whetheror not to participate in Medicaid and SCHIP. In other words,could some portion of uninsured children live in familiesthat have had prior negative experiences attempting to ac-cess care under Medicaid and SCHIP, so negative that theydiscouraged these parents from enrolling their eligible chil-dren in the programs? One study suggests that this might bethe case; an assessment of the Robert Wood Johnson Foun-dation Covering Kids Initiative found that some parents’negative experiences accessing care in their local commu-nities undermined their confidence in Medicaid and SCHIP,thereby dissuading them from enrolling their children intothese programs [8].However, the vast majority of the research literature hasfound the reverse relationship—that Medicaid and SCHIPhave beneficial effects on acces
