Language Proficiency and the Enrollment of Medicaid-Eligible Children in Publicly Funded Health Insurance Programs
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Objectives: The purpose of the study was to examine the effect of language proficiency on enrollment in a state-sponsored child health insurance program. Methods: 1055 parents of Medicaid-eligible children, who were enrolled in a state-sponsored child health insurance program, were surveyed about how they learned about the state program, how they enrolled their children in the program, and perceived barriers to Medicaid enrollment. We performed weighted χ2 tests to identify statistically significant differences in outcomes based on language. We conducted multivariate analyses to evaluate the independent effect of language controlling for demographic characteristics. Results: Almost a third of families did not speak English in the home. These families, referred to as limited English proficiency families, were significantly more likely than English-proficient families to learn of the program from medical providers, to receive assistance with enrollment, and to receive this assistance from staff at medical sites as compared to the toll-free telephone information line. They were also more likely to identify barriers to Medicaid enrollment related to “know-how”—that is, knowing about the Medicaid program, if their child was eligible, and how to enroll. Differences based on language proficiency persisted after controlling for marital status, family composition, place of residence, length of enrollment, and employment status for almost all study outcomes. Conclusions: This study demonstrates the significant impact of English language proficiency on enrollment of Medicaid-eligible children in publicly funded health insurance programs. Strong state-level leadership is needed to develop an approach to outreach and enrollment that specifically addresses the needs of those with less English proficiency.
- Selden TM, Banthin JS, Cohen JC. Medicaid's problem children: Eligible but not enrolled. Health Affairs 1998;17:192–200.
- Smith VK. CHIP program enrollment December 2000, Publication # 4005.Washington, DC: Kaiser Commission on Medicaid and the Uninsured, 2001.
- Ellis E, Smith V. Medicaid enrollment in 50 States.Washington, DC: The Kaiser Commission on Medicaid and the Uninsured, 2000.
- Feld P, Matlock C, Sandman D. Insuring the children of New York City's low-income families: Focus group findings on barriers to enrollment in Medicaid and Child Health Plus. New York: The Commonwealth Fund, 1998.
- Lake Snell Perry & Associates. Barriers to Medi-Cal enrollment and ideas for improving enrollment: Findings from eight focus groups with parents of potentially eligible children. Menlo Park, CA: Kaiser Family Foundation, 1998.
- Barents Group LLC. Building trust and developing effective SCHIP/Medicaid outreach to immigration children: Highlights of the immigration workshop. Washington, DC: Health Care Financing Administration, 1999.
- Carpenter MB, Kavanagh L. Outreach to children: Moving from enrollment to ensuring access. Arlington, VA: National Center for Education in Maternal and Child Health, 1998.
- Dunbar JL, Sloane HI, Mueller CD. Implementation of the State Children's Health Insurance Program: Outreach, enrollment, and provider participation in rural areas. Bethesda, MD: The Project HOPE Walsh Center for Rural Health Analysis, 1999.
- Dutton M, Katz S, Pennington A. Using community groups and student volunteers to enroll uninsured children in Medicaid and Child Health Plus. NewYork: Children's Defense Fund-New York, 2000.
- Health Resources and Services Administration and Health CareFinancing Administration. Reaching our children:Acompendium of outreach models. Washington, DC: Health Resources and Services Administration and Health Care Financing Administration, 1999.
- Mickey M. CHIP outreach and enrollment: A view from the states. Washington, DC: American Public Human Services Association, 1999.
- Schwalberg R, Hill I, Bellamy H, Gallagher J. Making child health coverage a reality: Lessons from case studies of Medicaid and CHIP outreach and enrollment strategies, Publication #2160.Washington, DC: Kaiser Commission on Medicaid and the Uninsured, 1999.
- Sieban I, Rosenberg TJ, Bazile Y. The role of WIC centers and small businesses in enrolling uninsured children in Medicaid and Child Health Plus. New York: Medical Health and Research Association of New York City, 2000.
- Avruch S, Machlin S, Bonin P, Ullman F. The demographic characteristics of Medicaid-eligible uninsured children. Am J Public Health 1998;88:445–7.
- Selden TM, Banthin JS, Cohen JW. Waiting in the wings: Eligibility and enrollment in the State Children's Health Insurance Program. Health Affairs 1999;18:126–33.
- Weinick RM, Weigers ME, Cohen JW. Children's health insurance, access to care, and health status: New findings. Health Affairs 1998;17:127–36.
- Perry M, Kennel S, Valdez RB, Chang C. Medicaid and children: Overcoming barriers to enrollment. Findings from a national survey. Washington, DC: Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation, 2000.
- U.S. Census Bureau. Mapping Census 2000: The Geography of U.S. Diversity: Census 2000 Special Reports (CENSR/01–1). Available at http://www.census.gov/population/www/cen2000/ atlas.html.
- Office of Minority Health. National standards for culturally and linguistically appropriate services in health care. Washington DC, 2000. Available at http://www.omhrc.gov/ CLAS/finalcultural1a.htm.
- U.S. Census Bureau. Census 1990 Survey. Available at http:// www.census.gov/population/socdemo/ language/table1.txt.
- U.S. Census Bureau. Census 2000 Supplementary Survey. Available at http://www.census.gov/c2ss/www/Products/Rank/ OtherLangG.htm.
- Weinick RM, Kraus NA. Racial/ethnic differences in children's access to care. Am J Public Health 2000;90:1771–4.
- Kirkman-Liff B, Mondragon D. Language of interview: Relevance for research of southwest Hispanics.AmJ Public Health 1991;81:1339–1404.
- Hampers LC, Cha S, Gutglass DJ, Binns HJ, Krug SE. Language barriers and resource utilization in a pediatric emergency department. Pediatrics 1999;103:1253–6.
- Lewis M, Rachelefsky G, Lewis C, Leake B, Richards W. The termination of a randomized clinical trial for poor Hispanic children. Arch Pediatr Adolesc Med 1994;148:364–7.
- Hughes D, Cart C, Moreno M, Ng S, Vogel S, McCarter V. Parents' views of children's health insurance programs:Asurvey of denied applicants for Kaiser Permanente's Child Health Plan. San Francisco: The Center for Children's Access to Health Care, Institute for Health Policy Studies, University of California, San Francisco, 2001.
- Halfon N, Inkelas M, Newacheck PW. Enrollment in the State Child Health Insurance Program:Aconceptual framework for evaluation and continuous quality improvement. Milbank Q 1999;77:181–204.
- Haley JM, Zuckerman S. Health insurance, access, and use: Massachusetts tabulations from the 1997 National Survey of American Families. Washington, DC: The Urban Institute, 2000.
- Stata Corporation. Stata, 6.0 ed. College Station, TX, 1996.
- Diehr P, Madden CW, Cheadle A, Martin DP, Patrick DL, Skillman S. Will uninsured people volunteer for voluntary health insurance? Experience from Washington State. Am J Public Health 1996;86:529–32.
- Halfon N, Inkelas M, Wood D. Nonfinancial barriers to care for children and youth. Annu Rev Public Health 1995;16:447–72.
- Madden CW, Cheadle A, Diehr P, Martin DP, Patrick DL, Skillman S. Voluntary public health insurance for low-income families: The decision to enroll. J Health Politics, Policy, Law 1995;20:956–71.
- Newacheck PW, Hughes DC, Stoddard JJ. Chidren's access to primary care: Differences by race income and insurance status. Pediatrics 1996;97:26–32.
- Horner D, Lazarus W, Morrow B. Express lane eligibility: How to enroll large groups of eligible children in Medicaid and CHIP. Washington, DC: Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation, December, 1999.
- Annie E. Casey Foundation. 2000 KIDSCOUNTData Online. Baltimore, MD: Annie E. Casey Foundation, 2000. Available at http://www.aecf.org/kidscount/kc2001.
- Brick JM, Flores-Cervantes I, Wang K, Hankins T. Evaluation of the use of data on interuption in telephone service. Proceedings of the Survey Research Methods Section of the American Statistical Association 1999:376–81.
- Hall J, Kenney G, Shapiro G, Flores-Cervantes I. Bias from excluding households without telephones in random digit dialing surveys: Results of two surveys. Proceedings from the Survey Research Methods Section of the American Statistical Association 1999:382–87.
- Keeter S. Estimating telephone noncoverage bias from a phone survey. Public Opinion Q 1995;59:196–217.
- Language Proficiency and the Enrollment of Medicaid-Eligible Children in Publicly Funded Health Insurance Programs
Maternal and Child Health Journal
Volume 6, Issue 1 , pp 5-18
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers-Plenum Publishers
- Additional Links
- access to care
- health insurance
- limited English proficiency (LEP)
- Industry Sectors
- Author Affiliations
- 1. Harvard School of Public Health, Boston, Massachusetts
- 2. Massachusetts Department of Public Health, Boston, Massachusetts
- 3. Harvard Medical School, Boston, Massachusetts