9.6 million US children (13%) have no health insurance, and dramatic racial/ethnic disparities exist in lacking coverage. In contrast to only 7% of white children being uninsured, 20% of Latino and 12% of African- American children are uninsured, and Latino and African-American children account for 57% of uninsured children, although comprising only 37% of all US children. Numerous studies show that being uninsured has a profound negative impact on children's health, healthcare, and mortality. Evidence suggests, however, that insuring uninsured children results in significantly improved health and healthcare. But about 70% of uninsured US children (6 million) are eligible for but not enrolled in Medicaid or the Children's Health Insurance Program (CHIP), so innovative strategies are needed to insure more children and eliminate disparities. The proposed study would be the first randomized controlled trial comparing the effectiveness of parent mentors (PMs) to traditional Medicaid/CHIP outreach and enrollment in insuring uninsured minority children. The primary study aims are to evaluate whether PMs are more effective and more cost-effective than traditional Medicaid/CHIP outreach and enrollment in insuring eligible, uninsured Latino and African-American children. The secondary aim is to determine whether uninsured children who obtain health insurance experience improvements in healthcare access, health status, use of services, and other health outcomes. Subjects will be 300 uninsured Latino and African-American children eligible for but not enrolled in Medicaid/CHIP and residing in Dallas County, where 90% of uninsured children (166,013) are Latino or African-American. Subjects will be randomized to PMs or a control group receiving traditional Medicaid/CHIP outreach. PMs are experienced parents who have at least 1 child currently covered by Medicaid/CHIP. PMs will undergo a 2-day intensive training session, and will be paired with intervention subjects and their families, for whom they will provide information on program eligibility, help families complete and submit insurance applications, act as a Medicaid/CHIP liaison, and assist in maintaining coverage. Controls will receive no intervention other than standard Medicaid/CHIP outreach. Primary outcomes will include obtaining health insurance, coverage continuity, the time interval to obtain coverage, parental satisfaction with the process of obtaining insurance, and costs;secondary outcomes will include access to care, health status, use of services, quality of life, quality of care, parental satisfaction, financial burden, and missed school and parental work days. Subjects will be contacted monthly for 1 year to monitor outcomes by a blinded assessor. Achievement of the study aims has the potential to be a significant contribution to reducing racial/ethnic disparities, empowering minority communities, providing economic revitalization through employment of minority parents, and advancing knowledge, practice, and child health policy. If successful, this intervention could serve as a national model for insuring uninsured children and reducing racial/ethnic disparities in insurance coverage.

Public Health Relevance

Having no health insurance coverage has a profoundly negative impact on children's health, healthcare, and mortality, but almost 10 million US children (13%) are uninsured, and dramatic racial/ethnic disparities exist in insurance coverage. The study aims are to evaluate whether Parent Mentors (parents who already have a child covered by Medicaid or the Children's Health Insurance Program [CHIP]) are more effective and more cost-effective than traditional Medicaid/CHIP approaches to insuring eligible, uninsured Latino and African- American children, and to determine whether minority uninsured children who obtain health insurance experience improvements in healthcare access, health status, use of services, and other health outcomes. If successful, this innovative intervention has the potential to have a major impact on reducing racial/ethnic disparities, empowering minority communities, providing economic revitalization through employment of minority parents, and advancing knowledge, practice, and child health policy;this intervention also could serve as a national model for insuring uninsured children and reducing racial/ethnic disparities in childhood insurance coverage.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD066219-05
Application #
8675750
Study Section
Community-Level Health Promotion Study Section (CLHP)
Program Officer
Bures, Regina M
Project Start
2010-09-09
Project End
2015-05-31
Budget Start
2014-06-01
Budget End
2015-05-31
Support Year
5
Fiscal Year
2014
Total Cost
$529,338
Indirect Cost
$183,348
Name
University of Texas Sw Medical Center Dallas
Department
Pediatrics
Type
Schools of Medicine
DUNS #
800771545
City
Dallas
State
TX
Country
United States
Zip Code
75390