Why Are So Many Eligible Children Still Uninsured? The Perspectives of Parents of Uninsured African-American Children

Background – 9 million US children lack health insurance, although 2/3 are eligible for Medicaid and CHIP. Little is known about barriers to enrollment for the eligible uninsured, especially for African-American (AA) children. Methods – Focus groups were conducted of parents of uninsured AA children from 2 Dallas communities with high proportions of such children. Focus groups were audiotaped, transcribed, and analyzed using grounded theory. Results – 9 parents in 2 focus groups had a mean age of 34, 33% were unemployed, and the median family income was $6k. Parents reported 66 barriers to enrollment. Obstacles included confusion and lack of knowledge about Medicaid/CHIP (“They don't tell you how much you've got to earn”), hassles with the application/renewal process (“I turned in my application on time and it's been 3 months now”), and problems with Medicaid offices (“The people at the desk treat you like it's their money,” and “I send in paperwork early, but it's lost”), and Medicaid/CHIP healthcare providers (“I don't want to feel like a number, like she's on Medicaid or CHIP and she can wait”). Parents stated that parent mentors and case managers could be effective in insuring uninsured children (mentors would “already know the ropes”). Conclusions – Parents reported confusion and lack of knowledge about Medicaid/CHIP and identified many hassles with the application and renewal processes. Parents also reported problems with Medicaid /CHIP healthcare providers. These findings indicate that current Medicaid/CHIP outreach and enrollment efforts are not effectively reaching eligible, uninsured AA children.