摘要：Objectives. We identified characteristics of Oregon children who were eligible for the Oregon Health Plan (OHP), the state's combined Medicaid–Children's Health Insurance Program (CHIP), but were not enrolled in January 2005. We also assessed whether parents’ confusion regarding their children's status affected nonenrollment. Methods. We conducted cross-sectional analyses of linked statewide Food Stamp Program and OHP administrative databases (n = 10 175) and primary data from a statewide survey (n = 2681). Results. More than 20% of parents with children not administratively enrolled in OHP reported that their children were enrolled. Parents of 11.3% of children who were administratively enrolled reported that they were not. Eligible but unenrolled children had higher odds of being older, having higher family incomes, and having employed and uninsured parents. Conclusions. These findings reveal an important discrepancy between administrative data and parent-reported access to public health insurance. This discrepancy may stem from transient coverage or confusion among parents and may result in underutilization of health insurance for eligible children. Medicaid and the Children's Health Insurance Program (CHIP) have extended health insurance coverage to millions of low-income children throughout the United States. 1 , 2 An estimated 40% of US children are enrolled in Medicaid or CHIP for their health insurance coverage. 3 This number is expected to rise as families unable to afford employer-sponsored coverage turn to public offerings. 3 – 5 Medicaid expansion has been central to the recent national health care debate. 6 Yet national statistics estimate that at least two thirds of uninsured children are eligible for public insurance but are not enrolled, 2 , 7 even though many of these eligible but uninsured children participate in other public programs (e.g., food stamps). 8 , 9 A lack of continuous health insurance adversely affects a child's health. 10 – 19 Medicaid and CHIP expansions were included in almost all recent US health insurance reform proposals; thus, understanding why currently eligible children are not continuously enrolled in these programs is essential. 20 , 21 The complexity of enrollment processes and a lack of aggressive retention efforts have sidelined many eligible children. 21 These findings, coupled with proven administrative cost savings, have led many states to implement streamlined or simultaneous enrollment (also known as express lane eligibility) processes. 21 , 22 To inform such efforts in Oregon, we identified low-income families who enrolled their children in the Food Stamp Program but not in the Oregon Health Plan (OHP; Oregon's combined Medicaid–CHIP program) and parents who understood their child's coverage status to be different from what was reported by the state. We examined characteristics that were unique to children who were eligible for public health insurance but were not enrolled. Secondarily, we described children with insurance status discrepancies and compared this subgroup with those clearly enrolled in public insurance programs.
