Medicaid-eligible children who don't enroll: Health status, access to care, and implications for Medicaid enrollment

We estimate that 17% of Medicaid-eligible children in the United States are uninsured, with 27% covered by private insurance. Uninsured children have become a target for state outreach and enrollment efforts. However, the eff ort may not be a worthwhile use of resources if these children have suffici ent access to primary care and are able to enroll in Medicaid should seriou s health problems arise. This analysis of health status, access to care, an d use of preventive and other services suggests otherwise. Although the uni nsured Medicaid-eligible children are slightly healthier than their enrolle d counterparts, they face reduced access to care and lower rates of service use. After controlling for health status and other characteristics, we fin d that being uninsured increases the likelihood of being without a usual so urce of care by eight percentage points, and increases reporting of unmet n eeds by seven percentage points. Being uninsured also decreases by nine per centage points the proportion of children with any health provider visits, and increases by 12 percentage points the proportion with family out-of-poc ket expenses exceeding $500. These findings lend support to the hypothesis that the enrollment process is onerous for some families. Targeted efforts to enroll uninsured Medicaid-eligible children could help in reducing the e ffect of barriers and reducing differences in access to care.