Determinants of public and private insurance enrollment among Medicaid-eligible children

BACKGROUND. Many Medicaid-eligible children are not enrolled in Medicaid an d are not covered by private insurance. Reducing persistent lack of insuran ce for children requires a better understanding of why Medicaid-eligible ch ildren do not participate. RESEARCH QUESTIONS. Does the availability of free or low-cost medical servi ces substitute for Medicaid or private insurance enrollment among Medicaid- eligible children? Does the availability and affordability of insurance cov erage, particularly the offer of employer-sponsored insurance (ESI) and the presence of managed care, affect child insurance coverage? RESEARCH DESIGN. We use data from the National Health Interview Survey for 1994 and 1995, supplemented with county level measures of insurance and pro vider supply, to estimate a multinomial choice model of insurance coverage among children identified as Medicaid-eligible. We focus on county supply o f public hospitals and community/migrant health centers (C/MHC); and the av ailability and cost of ESI. We control for child and parent characteristics . RESULTS. A positive effect of C/MHC supply is found on Medicaid enrollment, but no evidence is found of substitution between lowcost providers and Med icaid or private coverage. Local availability of ESI and private HMO penetr ation increased private insurance enrollment CONCLUSIONS. Local community providers can play an important role in outrea ch and enrollment for Medicaid. Availability and cost of ESI constrain priv ate coverage for Medicaid-eligible children. Policies that encourage offers of insurance coverage:by employers, decrease premiums, and encourage adopt ion of managed care could have important positive effects on coverage for t his population.