When Parents Lose Health Coverage, Children Become Uninsured According To Statewide Survey

02/21/11  Portland, Ore.

When parents lose their health care coverage, their children can also become uninsured, a statewide survey of Oregon families has found.

Researchers at Oregon Health & Science University and the Office for Oregon Health Policy and Research conducted the survey to see what happened to children after the 2003 cutbacks in the Oregon Health Plan.

The study, published recently in the online edition of Health Services Research, found that in 2003, Oregon cut coverage for adults in its Medicaid program, called the Oregon Health Plan (OHP). Shortly after the cutbacks, more than 50,000 low-income adults lost their coverage. Although the state’s changes were designed to only affect adults, the study found that children who appeared to be eligible lost their coverage due to confusion around eligibility.

As states cutback on providing public insurance for adults, policy makers need to be aware of the potential impact on children,” said the study’s principal investigator, Jennifer DeVoe, M.D., D.Phil., research assistant professor of family medicine, OHSU School of Medicine.

In recent national debates about the reauthorization of the State Children’s Health Insurance Program, policy-makers have raised questions about why so many eligible children are not enrolled in public programs. “One of the main reasons that eligible children in Oregon lost their coverage was due to confusion about how the system changes affected coverage for families,” DeVoe said.

After parents lost coverage, children were eligible to remain covered because the State Children's Health Insurance Program (SCHIP) provides coverage to children, but not parents, in families up to 185 percent of the federal poverty level. Families must, however, re-enroll their children every six months or the coverage lapses. The changes in adult Oregon Health Plan coverage rules and the re-enrollment requirements are potentially confusing to many families. In all the confusion, parents can easily believe their children are no longer eligible and they might not try to apply again.

According to DeVoe, “Public and private health insurance programs have frequent rule changes, which often leave families without insurance coverage. Whether these are intentional or unintentional consequences, all children benefit from a more comprehensive and sustainable health insurance system.”

In surveys of 2,681 households that received food stamps, researchers asked about children’s health insurance coverage and whether adults in the house had recently lost their OHP coverage. It was found that:

* Low-income children were 44 percent more likely to be uninsured at the time of the interview if an adult had lost OHP coverage.
* Loss of parents’ coverage was associated with breaks in children’s insurance. Children were 79 percent more likely to experience gaps in insurance coverage during the previous 12 months if adults in the household lost OHP than if no adults lost OHP.

“As a family physician, I am particularly concerned about how unstable patterns of insurance and coverage loss among both children and parents affect access to healthcare for everyone in the family,” DeVoe said.

The study was funded by U.S. Department of Health & Human Services, Health Resources and Services Administration and the Agency for Healthcare Research and Quality.