Improving access to children's health care in Seattle and King County: Did we make a difference?

Objectives. We evaluated the first two years of a $1 million per year three-year local outreach and access improvement initiative in King County, Washington. The initiative uses culturally-tailored community-based outreach approaches to enroll uninsured children into public health coverage and assure that they receive medical and dental care.

Methods. We tracked the number of children newly enrolled in Medicaid and SCHIP by county outreach staff and contracting community agencies in 2007 and 2008. We compared the rate of uninsurance among children and adults in King County in 2006 and 2008 using the Washington State Population Survey (based on the Current Population Survey). We shared data from the county health department with the state Medicaid agency to determine the percentage of newly enrolled children who had been to a doctor or to a dentist.

Results. 4,463 children were enrolled in Medicaid or SCHIP coverage in King County in 2007 and 2008 through the county initiative. In 2006, the state survey showed that 4.4% of children in King County were uninsured and in 2008, 4.5% were uninsured; by comparison, the rate of uninsurance among adults rose from 11.4% in 2006 to 13.9% in 2008. 89% of a sample of children enrolled in 2007 completed at least one primary care medical visit and 60% completed at least one dental visit.

Conclusions. A comprehensive culturally-specific community-based outreach effort that uses a health education approach to inform low-income parents about the benefits and availability of health coverage can enroll thousands of uninsured children into Medicaid and SCHIP, although it may not be able to reduce the overall rate of uninsurance. Nonetheless, the rate of uninsurance among children was held flat from 2006 to 2008, during an economic recession, while the uninsurance rate among adults increased markedly. The health education approach used in this outreach effort was associated with a higher percentage of children accessing medical and dental care than historical and statewide percentages. More precise and frequent measures of uninsurance are needed to evaluate coverage expansions.