A Randomized, Controlled Trial of the Effectiveness of Community-Based Case Management in Insuring Uninsured Latino Children

Latino children run the highest risk of being uninsured in the United States; 21 percent lack health insurance. The State Children's Health Insurance Program (SCHIP) was founded in 1997 to provide coverage to uninsured children. Past studies have estimated that over half of uninsured children (5 million children) are eligible for Medicaid or SCHIP but are not benefiting from it; thus, ways to increase enrollment and outreach are an urgent necessity. This study is the first randomized, controlled research to compare traditional SCHIP and Medicaid outreach with alternative strategies to increase insurance enrollment of hard-to-reach Latino children. Study participants included 275 uninsured Latino children and their families in the greater Boston area. The intervention group consisted of 139 participants who were assigned randomly to a community-based case management group in which they were assigned individual bilingual female case managers to provide information, help complete applications, interact with program officers, etc. One hundred thirty six participants were assigned to a control group in which they received traditional Medicaid/SCHIP case management, including direct mailings, newspaper inserts, door-to-door canvassing of target neighborhoods, bilingual flyers and other outreach efforts.

Children receiving community-based case management were 8 times more likely to obtain health insurance than control children and were enrolled more quickly (within approximately 3 months versus 4.5 months). Intervention group children also were more likely to be continuously insured throughout the 1-year follow up period. Parents of intervention children were more satisfied with the process than control parents (80% of intervention parents reported being "very satisfied" compared to 29% of control parents) while intervention parents were more likely to be "very dissatisfied" with the process.

These statistics suggest that community-based management could be highly effective in increasing enrollment of Latino children in insurance programs. In Texas and Florida, which have high numbers of uninsured Latino children, such outreach has the potential to enroll more than a million children in health care programs. This research did not examine cost-effectiveness of the intervention and it is recommended that this should be studied in the future.