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Barriers to Enrollment in a State Child Health Insurance Program

  • Allison Kempe
    Correspondence
    Address correspondence to Allison Kempe, MD, MPH, The Children's Hospital, 1056 E. 19th Ave, Box B032, Denver, CO 80218
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  • Brenda L. Renfrew
    Affiliations
    From the Departments of Pediatrics (AK, BLR, JSJ), Preventive Medicine and Biometrics (AK, JFS), and General Internal Medicine (JFS), University of Colorado Health Sciences Center, the Colorado Department of Public Health and Environment (DC), and Child Health Advocates (JB), Denver, Colo.
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  • Jennifer Barrow
    Affiliations
    From the Departments of Pediatrics (AK, BLR, JSJ), Preventive Medicine and Biometrics (AK, JFS), and General Internal Medicine (JFS), University of Colorado Health Sciences Center, the Colorado Department of Public Health and Environment (DC), and Child Health Advocates (JB), Denver, Colo.
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  • Darci Cherry
    Affiliations
    From the Departments of Pediatrics (AK, BLR, JSJ), Preventive Medicine and Biometrics (AK, JFS), and General Internal Medicine (JFS), University of Colorado Health Sciences Center, the Colorado Department of Public Health and Environment (DC), and Child Health Advocates (JB), Denver, Colo.
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  • Jennifer S. Jones
    Affiliations
    From the Departments of Pediatrics (AK, BLR, JSJ), Preventive Medicine and Biometrics (AK, JFS), and General Internal Medicine (JFS), University of Colorado Health Sciences Center, the Colorado Department of Public Health and Environment (DC), and Child Health Advocates (JB), Denver, Colo.
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  • John F. Steiner
    Affiliations
    From the Departments of Pediatrics (AK, BLR, JSJ), Preventive Medicine and Biometrics (AK, JFS), and General Internal Medicine (JFS), University of Colorado Health Sciences Center, the Colorado Department of Public Health and Environment (DC), and Child Health Advocates (JB), Denver, Colo.
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      Objective.—To identify barriers to enrollment into Colorado's Child Health Insurance Plan (CHP+) for non-Hispanic (NH), Hispanic (H), and uninsured families.
      Design.—Telephone survey of 1) random samples of families who requested an application but did not complete it (N = 273 NH, N = 159 H) and 2) families with uninsured children identified by random-digit-dial statewide surveys (N = 165).
      Results.—Major reasons for not enrolling included 1) got other insurance (NH 16.5%; H 27.2% P < .01), 2) thought household income was too high to qualify (NH 21.0%; H 11.9% P = .01), and 3) paperwork (NH 13.4%; H 14.7%, P = NS). Of those who thought their income was too high (N = 76, 17.6%), 58.5% appeared eligible based on reported income. Of uninsured families, only 41.7% had heard of CHP+. Of those who had never applied, major remediable reasons included not knowing enough about the program (20.9%) and thinking household income was too high (9.3%).
      Conclusions.—Effective marketing and education to increase awareness of CHP+ and ensure understanding of eligibility are critical to the success of the program.

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