文章基本信息

标题：Medicaid Enrollment Gap Length and Number of Medicaid Enrollment Periods Among US Children
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作者：Alan E. Simon ; Kenneth C. Schoendorf
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：9
页码：e55-e61
DOI：10.2105/AJPH.2014.301976
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined gap length, characteristics associated with gap length, and number of enrollment periods among Medicaid-enrolled children in the United States. Methods. We linked the 2004 National Health Interview Survey to Medicaid Analytic eXtract files for 1999 through 2008. We examined linkage-eligible children aged 5 to 13 years in the 2004 National Health Interview Survey who disenrolled from Medicaid. We generated Kaplan-Meier curves of time to reenrollment. We used Cox proportional hazards models to assess the effect of sociodemographic variables on time to reenrollment. We compared the percentage of children enrolled 4 or more times across sociodemographic groups. Results. Of children who disenrolled from Medicaid, 35.8%, 47.1%, 63.5%, 70.8%, and 79.1% of children had reenrolled in Medicaid by 6 months, 1, 3, 5, and 10 years, respectively. Children who were younger, poorer, or of minority race/ethnicity or had lower educated parents had shorter gaps in Medicaid and were more likely to have had 4 or more Medicaid enrollment periods. Conclusions. Nearly half of US children who disenrolled from Medicaid reenrolled within 1 year. Children with traditionally high-risk demographic characteristics had shorter gaps in Medicaid enrollment and were more likely to have more periods of Medicaid enrollment. Medicaid provided health insurance for approximately one third of children younger than 18 years in 2010. 1 However, many children experience gaps in Medicaid enrollment. Some children have gaps in Medicaid enrollment because they gain health insurance coverage from another source, but more than half of children become uninsured during these gaps, despite half of those remaining eligible for Medicaid. 2 Gaps in health insurance and in Medicaid coverage specifically have been shown to negatively affect child health 3,4 as well as shift care from ambulatory settings to more costly emergency departments and inpatient days. 5 Gaps in Medicaid enrollment among children have been previously described, although rarely using nationally representative data or even data from multiple states. 6,7 Research using Medicaid data from 2005 to 2007 suggests that, among children enrolled in Medicaid at the beginning of 2005, 41.1% were continuously enrolled through 2007, 27.1% disenrolled and reenrolled, and 31.8% disenrolled and did not return to Medicaid by the end of 2007. 7 Another recent study showed that, between 2000 and 2004, among children who disenrolled from Medicaid 6 months before, 28.1% had reenrolled in Medicaid and 28.9% had acquired other health insurance. 8 However, although some studies have reported on gaps in Medicaid enrollment among children, the characteristics of children who have gaps and the characteristics of those with shorter as compared with longer gaps in Medicaid coverage have not been described. Similarly, other studies have examined the enrollment and disenrollment patterns of children for insurance in general 2,9–12 and for Medicaid specifically. 7 However, previous studies have not identified the characteristics of children with multiple entrances to and exits from Medicaid over a prolonged period. There has been great interest in trying to develop policies to enroll and retain Medicaid-eligible children in the Medicaid programs. 13 Understanding the lengths of Medicaid gaps—as well as the sociodemographic and health characteristics of children with continuous enrollment, shorter gaps, longer gaps, and frequent enrollments and disenrollments—could provide valuable information for states intending to design programs to retain Medicaid-eligible children in Medicaid programs and to reenroll Medicaid-eligible children who have become uninsured. We used a nationally representative sample of children and tracked Medicaid enrollment patterns among children across 10 years to examine 2 specific issues. First, we examined sociodemographic and health characteristics for children with longer versus shorter gaps in Medicaid enrollment. Second, to identify children at greater risk for multiple enrollment periods, we examined the percentage of children with 4 or more enrollment periods in Medicaid within selected sociodemographic and health characteristic groups.