Maternal and Child Health Journal

, Volume 6, Issue 1, pp 5-18

First online:

Language Proficiency and the Enrollment of Medicaid-Eligible Children in Publicly Funded Health Insurance Programs

  • Emily FeinbergAffiliated withHarvard School of Public HealthMassachusetts Department of Public Health
  • , Katherine SwartzAffiliated withHarvard School of Public Health
  • , Alan M. ZaslavskyAffiliated withHarvard Medical School
  • , Jane GardnerAffiliated withHarvard School of Public Health
  • , Deborah Klein WalkerAffiliated withMassachusetts Department of Public Health

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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.

access to care Medicaid SCHIP health insurance children limited English proficiency (LEP)