Interim Evaluation Report: Congressionally Mandated Evaluation of the State Children’s Health Insurance Program. 3. Subgroup Differences


a. Differences by Income and Education

Awareness of both Medicaid and SCHIP programs appears to increase with income. For uninsured children in the very poorest income group--at or below 50 percent of the federal poverty level (FPL)--18 percent had parents who had not heard of Medicaid, while 53 percent had parents who had not heard of the SCHIP program in their state. At the same time, interest in enrolling appears highest (at 91 percent) among these poorest families (see Figure 3). Considerable levels of misperception about eligibility were found across the income spectrum, with misconceptions more common among higher-income families (Figure 3). The trends are similar when the data are stratified by level of parents' education; that is, less highly educated parents are less aware of the programs than more educated parents but are more willing to enroll their uninsured children. Parents' education also seems to be associated with how the application processes are perceived. Less educated parents are more likely to perceive the application processes as difficult and less likely to view them as easy. These patterns are not surprising, considering that low levels of education are associated with illiteracy and numerous related problems.

Figure 3: Perceptions of Eligibility for and Attitudes Toward Enrolling in Medicaid/SCHIP Programs, by Household Income

Early 2001

Figure 3: Perceptions of Eligibility for and Attitudes Toward Enrolling in Medicaid/SCHIP Programs, by Household IncomeSource: Urban Institute tabulations of SLAITS National Survey of CSHCN, Preliminary Data File.*Indicates group is significantly different from the <50% FPL group at the 0.05 level.

b. Differences by Race, Ethnicity and Language 35

Awareness of Medicaid and SCHIP programs varies widely by race, ethnicity and language group. Low-income uninsured Hispanic children whose parents were interviewed in Spanish are the least likely to have parents who have heard of Medicaid and/or SCHIP, and believe the application processes are easy. Specifically, the parents of these children are 20 percentage points less likely to have heard of SCHIP, and 15 to 20 percentage points more likely to believe that the Medicaid application process is difficult. At least three-quarters of the low-income uninsured children in every race and ethnicity group have parents who say they would enroll their uninsured child in Medicaid or SCHIP if they were told that their child was eligible. However, interest in enrolling children in Medicaid and SCHIP is about 10 to 15 percentage points lower for white children, compared to Hispanic children and black children; in addition, white children are the least likely to have parents who believe they are eligible for coverage.

That the lowest levels of basic awareness, and the most negative perceptions of the application processes, were found among parents who were interviewed in Spanish suggests the need to develop outreach strategies targeted to the Hispanic community, particularly in states with large numbers of uninsured children in this ethnic group. 36

Indeed, focus groups of Hispanic families in California, Florida, and Texas voiced concerns that they were not being targeted effectively by SCHIP outreach efforts and that more materials needed to be developed in Spanish.

35. As described in Kenney et al. (2002), we examined four subgroups of children categorized by their race/ethnicity and the language in which the interview was conducted. The four mutually exclusive groups are: non-Hispanic white (referred to as "white"), non-Hispanic black (referred to as "black"), Hispanic/Spanish language interview, and Hispanic/English language interview. No separate estimates are presented for children of other races because of size and representativeness concerns about these subsamples in this preliminary data set.

36. In 2002, HHS launched an effort to provide information booklets to Spanish-speaking parents whose children may be eligible for coverage through the State Children's Health Insurance Program and Medicaid. The booklets, written in Spanish and English on alternating pages, explain the importance of having health insurance and address common questions about program eligibility. State agencies and other organizations can use the bilingual booklets in their efforts to reach eligible children in the Hispanic community.

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