Uninsured Children Eligible for Medicaid or CHIP
Conditions
Keywords
minority health, child, Medicaid
Brief summary
The Kids' HELP trial rigorously documented that a Parent Mentor intervention results in multiple benefits: more children are insured faster, children's access to healthcare and parental satisfaction improve, quality of well-child care is enhanced, thousands of dollars are saved per child, jobs are created, disparities are eliminated, and the intervention potentially could save our nation billions of dollars.
Detailed description
Background: Six million US children are uninsured, despite two-thirds being eligible for Medicaid/Children's Health Insurance Program (CHIP), and minority children are at especially high risk. The most effective way to insure uninsured children, however, is unclear. Methods: We conducted a randomized trial of the effects of parent mentors (PMs) on insuring uninsured minority children. PMs were experienced parents with \>=1 Medicaid/CHIP-covered child who received 2 days of training, then assisted families for 1 year with insurance applications, retaining coverage, medical homes, and social needs; controls received traditional Medicaid/CHIP outreach. The primary outcome was obtaining insurance 1 year post-enrollment.
Interventions
BEHAVIORALParent Mentors
After random assignment to the Parent Mentor group, minority low-income parents of Medicaid/CHIP eligible children met with Parent Mentors to receive instruction and help on completing, submitting applications for, and maintaining Medicaid/CHIP coverage for their child.
Sponsors
University of Texas Southwestern Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
No minimum to 18 Years
Healthy volunteers
Yes
Inclusion criteria
1. The parent/guardian is a primary caretaker of a least one child 0-18 years old who currently has no health insurance 2. The parent/guardian self-identifies the uninsured child as Hispanic/Latino, African-American/Black, or both 3. The uninsured child is eligible for either Medicaid or CHIP 4. The parent/guardian is willing to be contacted monthly by telephone, or in the form of a home visit (if no functioning telephone is present in the household).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Children With Health Insurance | One year after enrollment | A study child is considered insured once official written notification of insurance is confirmed, either through an electronic or hard copy of the state coverage letter, or via verification from the Texas Health and Human Services Center. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Days From Study Enrollment to Obtaining Coverage | One year after enrollment | Zero time (the point at which the maneuver is imposed) is the data and time of study enrollment. Occurrence of the main outcome event is the date and time of official notification that the child is insured. |
| Parental Satisfaction With the Process of Obtaining Coverage for Child | One year after enrollment | Parental satisfaction is assessed both using a five-point Likert-scale and open-ended questions |
| Intervention Cost-Effectiveness Ratio (ICER) | One year after enrollment | The difference in total costs between the intervention group and controls |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Intervention: Parent Mentors Families assisted for one year with insurance applications, retaining coverage, medical homes, and social needs by experienced parents (Parent Mentors) with at least one Medicaid/CHIP-covered child who received two days of training. | 123 |
| Control: No Intervention Families received traditional Medicaid/CHIP outreach | 114 |
| Total | 237 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Loss of Medicaid/CHIP eligibility | 37 | 26 |
| Overall Study | Lost to Follow-up | 3 | 2 |
| Overall Study | Withdrawal by Subject | 9 | 15 |
Baseline characteristics
| Characteristic | Intervention: Parent Mentors | Control: No Intervention | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 123 Participants | 114 Participants | 237 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 7 years | 7 years | 7 years |
| Number of months child had been uninsured | 6 participants | 8 participants | 7 participants |
| Race/Ethnicity, Customized African-American/Black | 43 Participants | 39 Participants | 82 Participants |
| Race/Ethnicity, Customized Latino | 80 Participants | 75 Participants | 155 Participants |
| Region of Enrollment United States | 123 participants | 114 participants | 237 participants |
| Sex: Female, Male Female | 72 Participants | 47 Participants | 119 Participants |
| Sex: Female, Male Male | 51 Participants | 67 Participants | 118 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Number of Children With Health Insurance
A study child is considered insured once official written notification of insurance is confirmed, either through an electronic or hard copy of the state coverage letter, or via verification from the Texas Health and Human Services Center.
Time frame: One year after enrollment
Population: 237 included in primary analysis: 123 from the intervention group (37 excluded due to loss of Medicaid/CHIP eligibility, 3 were lost to follow-up, and 9 withdrew prior to one-year follow-up); and 114 from the control group (26 due to loss of Medicaid/CHIP eligibility, 2 were lost to follow-up, and 15 withdrew prior to one-year follow-up)
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Intervention: Parent Mentors | Number of Children With Health Insurance | Child obtained health insurance | 117 Participants |
| Intervention: Parent Mentors | Number of Children With Health Insurance | Child did not obtain health insurance | 6 Participants |
| Control: No Intervention | Number of Children With Health Insurance | Child obtained health insurance | 78 Participants |
| Control: No Intervention | Number of Children With Health Insurance | Child did not obtain health insurance | 36 Participants |
Secondary
Intervention Cost-Effectiveness Ratio (ICER)
The difference in total costs between the intervention group and controls
Time frame: One year after enrollment
Population: 237 included in primary analysis: 123 from the intervention group (37 excluded due to loss of Medicaid/CHIP eligibility, 3 were lost to follow-up, and 9 withdrew prior to one-year follow-up); and 114 from the control group (26 due to loss of Medicaid/CHIP eligibility, 2 were lost to follow-up, and 15 withdrew prior to one-year follow-up)
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Intervention: Parent Mentors | Intervention Cost-Effectiveness Ratio (ICER) | ICU stays- total cost | 74,742 Dollars |
| Intervention: Parent Mentors | Intervention Cost-Effectiveness Ratio (ICER) | ED visits- total cost | 60,885 Dollars |
| Intervention: Parent Mentors | Intervention Cost-Effectiveness Ratio (ICER) | Hospitalizations- total cost | 58,431 Dollars |
| Intervention: Parent Mentors | Intervention Cost-Effectiveness Ratio (ICER) | PM stipends- total cost | 53,838 Dollars |
| Intervention: Parent Mentors | Intervention Cost-Effectiveness Ratio (ICER) | PM travel and supplies- total cost | 5,195 Dollars |
| Intervention: Parent Mentors | Intervention Cost-Effectiveness Ratio (ICER) | PM training sessions and meetings- total cost | 1411.61 Dollars |
| Intervention: Parent Mentors | Intervention Cost-Effectiveness Ratio (ICER) | Program coordinator salary- total cost | 25,350 Dollars |
| Intervention: Parent Mentors | Intervention Cost-Effectiveness Ratio (ICER) | Wage loss/other costs of caring for sick child | 12,985 Dollars |
| Intervention: Parent Mentors | Intervention Cost-Effectiveness Ratio (ICER) | Total for all costs | 291,426 Dollars |
| Control: No Intervention | Intervention Cost-Effectiveness Ratio (ICER) | Total for all costs | 454,647 Dollars |
| Control: No Intervention | Intervention Cost-Effectiveness Ratio (ICER) | PM training sessions and meetings- total cost | 0 Dollars |
| Control: No Intervention | Intervention Cost-Effectiveness Ratio (ICER) | ED visits- total cost | 62,730 Dollars |
| Control: No Intervention | Intervention Cost-Effectiveness Ratio (ICER) | Wage loss/other costs of caring for sick child | 33,589 Dollars |
| Control: No Intervention | Intervention Cost-Effectiveness Ratio (ICER) | Hospitalizations- total cost | 81,537 Dollars |
| Control: No Intervention | Intervention Cost-Effectiveness Ratio (ICER) | Program coordinator salary- total cost | 0 Dollars |
| Control: No Intervention | Intervention Cost-Effectiveness Ratio (ICER) | PM stipends- total cost | 0 Dollars |
| Control: No Intervention | Intervention Cost-Effectiveness Ratio (ICER) | ICU stays- total cost | 277,094 Dollars |
| Control: No Intervention | Intervention Cost-Effectiveness Ratio (ICER) | PM travel and supplies- total cost | 0 Dollars |
Secondary
Number of Days From Study Enrollment to Obtaining Coverage
Zero time (the point at which the maneuver is imposed) is the data and time of study enrollment. Occurrence of the main outcome event is the date and time of official notification that the child is insured.
Time frame: One year after enrollment
Population: 237 included in primary analysis: 123 from the intervention group (37 excluded due to loss of Medicaid/CHIP eligibility, 3 were lost to follow-up, and 9 withdrew prior to one-year follow-up); and 114 from the control group (26 due to loss of Medicaid/CHIP eligibility, 2 were lost to follow-up, and 15 withdrew prior to one-year follow-up)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Intervention: Parent Mentors | Number of Days From Study Enrollment to Obtaining Coverage | 62 Days |
| Control: No Intervention | Number of Days From Study Enrollment to Obtaining Coverage | 140 Days |
Secondary
Parental Satisfaction With the Process of Obtaining Coverage for Child
Parental satisfaction is assessed both using a five-point Likert-scale and open-ended questions
Time frame: One year after enrollment
Population: 121 from the intervention group (37 excluded due to loss of Medicaid/CHIP eligibility, 3 were lost to follow-up, 9 withdrew prior to one-year follow-up, 2 did not answer); and 113 from the control group (26 due to loss of Medicaid/CHIP eligibility, 2 were lost to follow-up, 15 withdrew prior to one-year follow-up, and 1 did not answer).
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Intervention: Parent Mentors | Parental Satisfaction With the Process of Obtaining Coverage for Child | 2- Parent unsatisfied with process | 5 Participants |
| Intervention: Parent Mentors | Parental Satisfaction With the Process of Obtaining Coverage for Child | 4- Parent satisfied with process | 33 Participants |
| Intervention: Parent Mentors | Parental Satisfaction With the Process of Obtaining Coverage for Child | 3- Parent uncertain about process | 12 Participants |
| Intervention: Parent Mentors | Parental Satisfaction With the Process of Obtaining Coverage for Child | 5- Parent very satisfied with process | 69 Participants |
| Intervention: Parent Mentors | Parental Satisfaction With the Process of Obtaining Coverage for Child | 1- Parent very unsatisfied with process | 2 Participants |
| Control: No Intervention | Parental Satisfaction With the Process of Obtaining Coverage for Child | 5- Parent very satisfied with process | 28 Participants |
| Control: No Intervention | Parental Satisfaction With the Process of Obtaining Coverage for Child | 1- Parent very unsatisfied with process | 13 Participants |
| Control: No Intervention | Parental Satisfaction With the Process of Obtaining Coverage for Child | 2- Parent unsatisfied with process | 10 Participants |
| Control: No Intervention | Parental Satisfaction With the Process of Obtaining Coverage for Child | 3- Parent uncertain about process | 17 Participants |
| Control: No Intervention | Parental Satisfaction With the Process of Obtaining Coverage for Child | 4- Parent satisfied with process | 45 Participants |