Health insurance coverage is the single most important factor in accessing timely health care. Increasingly, families are choosing between “filling prescriptions and filling their fridge,” according to Risa Lavizzo-Mourey, MD, president of the Robert Wood Johnson Foundation. Today, there are 46 million uninsured individuals in the United States, and the numbers continue to grow each year. Latinos are more likely than any other racial or ethnic group to lack health insurance coverage. More than 20 percent of Latino children in the United States have no public or private health insurance. An Institute of Medicine report released May 21, 2002, noted, “increased health insurance coverage would likely reduce racial and ethnic disparities in the use of appropriate health care services.”
The Maternal and Child Health Consortium (MCHC), a community-based social services organization, works to improve access to high quality health care for women and children in Chester County, Pa. MCHC’s programs include: Healthy Start, a federally funded program designed to reduce infant mortality and low birthweight; bilingual (Spanish/English) prenatal and parenting education; medical interpreter training; Cross Cultural Caring, professional development training to improve cultural competence of health and human service providers; and a health insurance enrollment initiative.
An estimated 45,000 Chester County residents are without health insurance. Families that meet eligibility guidelines may apply for subsidized health insurance including Medicaid, or the Children’s Health Insurance Program (CHIP). Low-income uninsured children typically live in two-parent, working households and have little contact with the welfare system. According to the 2004 State of the Child report by Pennsylvania Partnerships for Children, 2,029 more children are enrolled in CHIP and 1,167 in Medicaid (comparing December 2000 to December 2003) in Chester County. This is good news; however, MCHC continues to see hundreds of families each year without insurance.
MCHC’s Health Insurance Enrollment Initiative is part of a comprehensive strategy to reduce financial, language, or cultural barriers to care for women and their children. This Initiative grew out of our Healthy Start program, where each year more than 75 percent of newly enrolled Healthy Start clients have no health insurance. In 2005, 1,289 uninsured adults and children obtained Medicaid or SCHIP health insurance as a result of MCHC’s efforts.
A recent study, published in Pediatrics, reported that community-based case managers increase public insurance enrollment of uninsured Latino children by “providing information about the types of available insurance programs and eligibility requirements, working with parents to complete and submit application forms, and expediting final coverage decisions by State agencies. They also acted as family advocates when children were inappropriately deemed ineligible for insurance or had coverage inappropriately discontinued” (Pediatrics, 116 (6), December 6, 2005, pp. 1433-41.)
Our staff of a dozen bilingual and bicultural outreach workers and case managers form the core of this enrollment effort. The focus of the effort is to increase awareness of available subsidized health coverage for pregnant women, children and adults through outreach and education; enrollment of women and children into Medicaid or SCHIP and to advocate for long term systems change through working with providers to screen and enroll uninsured women and children into coverage.
MCHC also works to mobilize the community to address the issue of health insurance for working families. MCHC chairs the Chester County Children’s Health Insurance Coalition, and coordinates an annual legislative breakfast, held during Cover the Uninsured Week. The breakfast brings together legislators, community agencies, and local philanthropies to identify challenges and potential solutions to reducing the number of uninsured families in the county.
A strong public-private funding partnership supports this work including private foundations, United Way, and the federal Healthy Start program (Department of Health and Human Services). For more information go to http://www.ccmchc.org.