摘要：Objectives. We identified factors associated with levels of knowledge about Medicaid eligibility rules and perceived Medicaid enrollment barriers. Methods. Community health center patients who were parents of children potentially eligible for Medicaid (n=901) were interviewed in person during their clinic visit between April and December 1999. Results. Individuals reporting physical health problems were more likely to be misinformed as were non-Hispanic Black individuals, compared with non-Hispanic White individuals. In states where more policies had been enacted to simplify Medicaid enrollment procedures, individuals were less likely to be misinformed. Individuals reporting mental health problems, those with less education, and women were more likely to perceive Medicaid enrollment barriers. Prior experience in Medicaid was associated with both a reduced risk of perceiving Medicaid enrollment barriers and being misinformed. Conclusions. Findings highlight target groups for whom additional outreach and additional simplification policies may be most needed. Medicaid is the primary program by which poor children in the United States obtain health insurance. In 1997, the Balanced Budget Act created the State Children’s Health Insurance Program, which allows states to subsidize private insurance coverage or extend Medicaid coverage to children in families with increasingly higher income levels. Without health insurance, many children lack needed access to services, which results in lower rates of immunizations 1 ; higher emergency room use 2 ; increased incidence of preventable diseases 3 ; and more common speech, hearing, and behavioral problems. 4– 6 Despite the importance of insurance to children’s access to health care and health, approximately 20% of children potentially eligible for public programs are not enrolled. 7, 8 Understanding the factors associated with this phenomenon is paramount to improving financial access to health care for this population of children. Because of the importance of adequate preventive and acute care services in early life, identifying and addressing barriers to Medicaid enrollment is a central concern for health care policymakers. Parents play a central role in children’s receipt of health insurance. Thus, it is important to understand their knowledge of and attitudes about the enrollment process. Prior research has shown that insufficient knowledge about Medicaid and the State Children’s Health Insurance Program and perceived enrollment barriers (e.g., difficulties filling out the application, lack of access to transportation) can hinder participation. 9– 11 However, little is known about the characteristics of parents who lack needed information and who perceive greater difficulties with the enrollment process. Only 1 published study has documented individuals who lack needed information. This study of 143 parents in 2 clinical settings found that welfare beneficiaries who had children with chronic health care conditions showed limited knowledge of public assistance programs. 12 The study focused on a limited geographic region and did not assess factors that might be associated with perceived enrollment barriers. We were interested in assessing levels of knowledge and perceived enrollment barriers in the low-income population, whose members are often Medicaid eligible. A low-income child who is not eligible for Medicaid at 1 moment is likely to be eligible at some point in the near future because of common fluctuations in income and frequent changes in eligibility rules. 13 We used a sample of community health center patients to examine several individual-level factors (e.g., education, reported health problems) as well as state efforts to simplify the Medicaid enrollment process and their association with individuals’ being misinformed about Medicaid program rules and perceiving greater Medicaid enrollment barriers. Assessing misinformation and enrollment barriers in a sample of low-income families is important to identifying parents who may benefit from additional outreach and simplification policies to promote children’s appropriate enrollment in the Medicaid program.
