Published online January 2, 2007
PEDIATRICS Vol. 119 No. 1 January 2007, pp. 60-68 (doi:10.1542/peds.2006-1726)
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ARTICLE

Low-Income Uninsured Children With Special Health Care Needs: Why Aren't They Enrolled in Public Health Insurance Programs?

Jennifer Haley, MA and Genevieve Kenney, MA, PhD

Urban Institute Health Policy Center, Washington, DC

OBJECTIVE. We examined potential barriers to enrollment in public programs among low-income children with special health care needs who are uninsured. Barriers considered include parents not knowing about the Medicaid and State Children's Health Insurance programs, not believing that their child is eligible for public coverage, not perceiving the enrollment processes as easy, and not wanting to enroll their child in a public program.

METHODOLOGY. The source of data is the 2001 National Survey of Children With Special Health Care Needs. A series of 5 questions about the child's health needs, known as the Children With Special Health Care Needs Screener, was used to identify children with special health care needs. Uninsurance is defined as having no insurance coverage at the time of the survey. Low-income families are defined as those with household incomes below 200% of the federal poverty level. The analytic sample consists of 968 low-income uninsured children with special health care needs. We examined the socioeconomic and demographic characteristics of the sample, the reasons the children lack coverage, and the awareness and perception measures, both individually and combined as a summary measure.

RESULTS. Many low-income parents with uninsured children with special health care needs do not have full information about Medicaid and State Children's Health Insurance programs or do not have positive perceptions of the application processes. Although 93.5% had heard of at least 1 of the 2 programs, only 54.6% believed that their child was eligible for public coverage, and just 48.1% believed that the application processes were easy. Almost all said that they would enroll their child if told he or she was eligible for public coverage.

CONCLUSIONS. Understanding why uninsured children with special health care needs do not participate in public programs is important, because these programs have the potential to cover almost all of this population. Initiatives to increase enrollment should yield real dividends given that the vast majority of low-income uninsured children with special health care needs have parents who say they would enroll their children in public coverage.

Key Words: uninsured • children • health insurance • enrollment • children with special health care needs • low-income

Abbreviations: SHCN—special health care needs • CSHCN—children with special health care needs • SCHIP—State Children's Health Insurance Program • FPL—federal poverty level

Accepted Sep 15, 2006.


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