Study of Children's Health Insurance Lapses and Discontinuities to Gain better Access through Policy Solutions (Study of C.H.I.L.D. G.A.P.S.)

BACKGROUND: Uninsured children are more likely to have unmet healthcare needs. Gaps in coverage often go unnoticed but can jeopardize access to necessary healthcare services. Less is known about the extent to which different coverage gap lengths affect access to healthcare for vulnerable children. PROBLEM: Among children in Oregon's food stamp population presumed eligible for publicly-financed health insurance, over 25% had gaps in health insurance coverage during a one-year period. PURPOSE: To examine the association between children's health insurance coverage gaps of different lengths and parental reports of children's access to healthcare services. METHODS: Cross-sectional analysis of statewide primary data collected from low-income families in Oregon's food stamp population. OUTCOMES: Children most likely to have a coverage gap during the previous year were over age 14, Hispanic, had an employed parent, had household income between 133-185% of the federal poverty level, and/or had an uninsured parent. After adjusting for these demographic characteristics, children with a coverage gap greater than 6 months were more likely to have unmet healthcare needs compared to children with continuous coverage (OR 8.875, 95% CI 5.710-13.794). In other access measures, children with a gap of more than 6 months were the same or worse off than children who had never been insured. POLICY IMPLICATIONS: Many states require a period of uninsurance prior to qualification for public insurance This policy forces a coverage gap that may be impacting children's continuous access to necessary services. Findings from this study contributed to the Governor's “Healthy Kids” initiative in Oregon.