Kids' HELP (Kids' Health Insurance by Educating Lots of Parents): A Randomized Controlled Trial of the Effects of Parent Mentors on Insuring Uninsured Minority Children

Background

6 million US children are uninsured; 2/3 are Medicaid/CHIP-eligible, and major racial/ethnic disparities exist. No study has examined if Parent Mentors (PMs) are effective in insuring uninsured children.

Objective

Conduct an RCT of the effects of PMs on insuring uninsured Latino (L) and African-American (AA) children.

Methods

Medicaid/CHIP-eligible L and AA children/parents were recruited at 97 Dallas community sites, then randomized to PMs or a control group getting traditional Medicaid/CHIP outreach. PMs were experienced parents with ≥1 Medicaid/CHIP-covered child who got 2 days of training, then helped families for 1 year with Medicaid/CHIP eligibility, applications, retaining coverage, and medical homes. Outcomes were obtaining coverage, time to coverage, parent satisfaction, cost effectiveness, and 10 healthcare measures, assessed monthly for 1 year by a blinded assessor.

Results

49,361 screened parents yielded 267 subjects (L:65%; AA:35%). PMs were significantly (P<.05) more effective than traditional Medicaid/CHIP methods in insuring subjects (95 vs. 60%; adjusted RR=2.4), and achieving faster coverage (median=58 vs. 115 days), parent satisfaction (83 vs. 62% very satisfied/satisfied,) and coverage renewal (84 vs. 59%). The PM group was significantly less likely to have suboptimal health (35 vs. 53%), parents worry about kids’ health (52 vs. 70%), deferred medical (15 vs. 30%) or dental (16 vs. 37%) care, and unmet medical (15 vs. 30%), preventive (5 vs. 23%), or dental (16 vs. 37%) needs; and more likely to have PCPs (80% vs. 61%) and lower out-of-pocket costs. Controls significantly more often had specialty referral problems (75 vs. 24%), dissatisfaction with their child’s doctor (16 vs. 7%), and a need for extra income for medical costs (21% vs. 12%). After PM cessation, PM kids had significantly higher insurance retention (74 vs. 40%). PMs cost $44.37/child/month, but saved $1,428/child insured.

Conclusions:  PMs are significantly more effective than traditional Medicaid/CHIP outreach and enrollment in insuring uninsured minority children, obtaining insurance faster, producing parental satisfaction, renewing insurance, maintaining long-term coverage, reducing parental worry, decreasing unmet medical and oral healthcare needs, obtaining a PCP, and reducing out-of-pocket costs of care. The PM intervention is relatively inexpensive, costing approximately $44 per patient per month, but is cost-effective, yielding savings of $1,428 per insured child.

Implications for Policy and Practice:  Given that 4.2 million US children are uninsured and Medicaid/CHIP eligible, and 56% are Latino or African-American, these findings suggest that implementing the Kids’ HELP PM intervention nationally (instead of traditional outreach and enrollment) could yield savings of over $1.6 billion.