A methodology for identifying difficult to locate uninsured children eligible for Medicaid in a large metropolitan county

Purpose: To develop a systematic method of locating uninsured populations of children living in a 3-million person county who are eligible for Medicaid in order to develop strategies to increase current enrollment and reduce barriers to accessing healthcare.

Methods: Multiple population-based data sources were used to profile and identify neighborhoods with an increased likelihood of housing large numbers of uninsured, income-eligible (<200% FPL) children aged 0-18 years. Emergency department (ED) discharge data were used to identify communities where high numbers of uninsured children who were treated and discharged from an ED reside. Census data were used to identify neighborhoods with large income-eligible populations, and overlaid with ED data using GIS mapping techniques. Target neighborhoods were identified. A one-month representative sample of the point locations of children currently receiving benefits was extracted from the Medicaid case data system and overlaid with target neighborhoods to identify those with low enrollment saturation.

Results: Roughly 37% of all children 0-18 years were determined to be income-eligible for Medicaid (n=304,000), with 140,000 currently enrolled (46%). The ten neighborhoods with the highest number of uninsured income-eligible children were identified and further profiled. Demographic, economic and social characteristics were examined, as well as potential barriers and available community resources. Community focus groups were used to identify barriers and strategies to enroll these children in Medicaid.

Conclusions: This methodology could be replicated in other large communities to identify hidden pockets of uninsured income-eligible children. Community input was essential in the development of targeted enrollment strategies.