Impact of Enrolling in Health Insurance on Low-Income Children that Enrolled for a Medical Reason

The Los Angeles Healthy Kids program is a county-based health insurance program providing coverage for children in families with household income below 300 percent of the federal poverty level who are ineligible for Healthy Families and Medi-Cal. Children enrolled for a medical reason may have more urgent and specialized medical needs. This special study seeks to compare the experience of children that enrolled in Healthy Kids for a medical reason with the general Healthy Kids population, those who enrolled without indicating a current health care need. The client survey was conducted in two waves (baseline and follow-up) among 474 children ages 12–72 months with a response rate of 86 percent. Children were included in the “enrolled for a medical reason” category if they enrolled because the child was sick or needed medical care, needed a prescription medicine that the family could not afford or if their parent gave a medical reason in response to the following question: “Was there any other important reason that the child was enrolled in Healthy Kids?” A two sided t-test was used to compare responses at baseline and follow-up for children who did and who did not enroll for a medical reason. Children enrolling for a medical reason reported a range of common conditions including allergies, anemia, asthma, cough/cold, stomach problems, ear/eye infection, fever, and rash as their reason for enrollment. A large portion (67 percent) of parents of children enrolled for a medical reason report enrolling because the child needed a prescription medication that the family could not afford. This study found that access to care for children enrolling for a medical reason and those not enrolling for a medical reason substantially improved one year after enrollment in Healthy Kids. Thus, enrollment in health insurance is associated with improved access to timely health care and, particularly for those enrolled for a medical reason, lower out-of-pocket health care costs. However, families of children enrolled for a medical reason face persistent barriers in accessing subspecialty care and demonstrate persistent higher use of emergency department services compared with those not enrolled for a medical reason.