Online Program

Prospective Observational Study Documents that CHIP and Medicaid Coverage Substantially Improve the Health and Healthcare of Uninsured Children and Save Money

Tuesday, November 3, 2015 : 4:30 p.m. - 4:55 p.m.

Glenn Flores, MD, Department of Pediatrics, Division of General Pediatrics, University of Texas Southwestern Medical Center and Children's Health System of Texas, Dallas, TX
Candice Walker, PhD, UT Southwestern, Dallas, TX
Hua Lin, PhD, Department of Pediatrics, Division of General Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
Janet Currie, Center for Health and Well-Being, Woodrow Wilson School of Public and International Affairs, Princeton University
Rick Allgeyer, Texas Health and Human Services Commission
Tony Fierro, UT Southwestern, Dallas, TX
Alberto Portillo, UT Southwestern, Dallas, TX
Monica Henry, UT Southwestern, Dallas, TX
Kenneth Massey, UT Southwestern, Dallas, TX

CHIP requires Congressional reauthorization in 9/15, but no studies have prospectively examined CHIP/Medicaid’s impact on uninsured children.


Prospectively assess CHIP/Medicaid’s impact on uninsured children.


This prospective observational study of uninsured Medicaid/CHIP-eligible minority children compared children obtaining coverage vs. those remaining uninsured. Subjects were recruited at 97 Dallas sites, and 11 outcomes monitored monthly for 1 year.


49,361 screened parents yielded 267 subjects. Compared with the uninsured(N=82), children obtaining Medicaid/CHIP(N=155) were significantly(P<.05) less likely to have suboptimal health(52 vs. 28%); parental worry about children’s health(70% vs. 58%); no usual source of preventive care(13 vs. 4%); no PCP(57 vs. 19%); unmet needs for overall(52 vs. 11%), specialty(63 vs. 18%), and dental(52 vs. 18%) care; and specialty-referral problems(100% vs. 22%). The uninsured had higher mean out-of-pocket costs for doctor($213 vs. 37) and sick-care($255 vs. 24) visits, and more parental reports that the doctor didn’t spend enough time with children(15 vs. 6%) or take time to understand children’s needs(26 vs. 11%). Uninsured children had higher mean costs for ED visits($729 vs. 574), hospitalizations($2,309 vs. 227), ICU stays($5,908 vs. 581), and parental wage loss for missed work due to childrens’s illness($4,046 vs. 537). CHIP/Medicaid saved $11,073/insured child, with mean healthcare costs=$12,992/uninsured vs. $1,919/insured child(P<.01).


CHIP/Medicaid coverage of uninsured children significantly improves health, access, and parent satisfaction, and reduces unmet needs, out-of-pocket costs, and family financial burden. Given savings of $11,073/uninsured child covered by CHIP/Medicaid, the US could save >$44 billion through CHIP/Medicaid coverage of the 4 million eligible uninsured children.

Learning Areas:

Administer health education strategies, interventions and programs
Conduct evaluation related to programs, research, and other areas of practice
Diversity and culture
Program planning
Provision of health care to the public
Public health or related research

Learning Objectives:
Describe how CHIP and Medicaid Coverage impact the health and healthcare of uninsured children and save money.

Keyword(s): Maternal and Child Health, Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am PI of the project and Director, Division of General Pediatrics; Professor of Pediatrics, Clinical Sciences, and Public Health; The Judith and Charles Ginsburg Chair in Pediatrics; Director, Academic General Pediatrics Fellowship, at UT Southwestern and Children's Health System of Texas; and Director, APA Research in Academic Pediatrics Initiative on Diversity (RAPID).
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.