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Medicaid Enrollment and Health Services Access by Latino Children in Inner-city Los Angeles
Neal Halfon, MD, MPH;
David L. Wood, MD, MPH;
R. Burciaga Valdez, PhD, MHSA;
Margaret Pereyra, MPH;
Naihua Duan, PhD
JAMA. 1997;277(8):636-641.
Abstract
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Objectives.
—To understand the role of parental immigration status on Medicaid enrollment and access to health services for young Latino children.
Design.
—A cross-sectional household survey of the parents of inner-city Latino children.
Setting.
—South Central and East Los Angeles, Calif, 1992.
Population.
—Children 12 to 36 months old and their parents from 817 Latino families.
Main Outcome Variables.
—Continuous Medicaid enrollment, continuity of care, deferral of care, and number of visits.
Methods.
—Univariate analysis, logistic and linear regression by demographic and socioeconomic characteristics, residency status, and language use.
Results.
—Children were primarily born in the United States (96%), but most parents were not citizens (80%). Only 40.0% of eligible children had continuous Medicaid coverage since birth, 18.6% had never been insured, and 20.7% had received episodic Medicaid coverage. Continuous Medicaid coverage was negatively associated with either the caregiver (odds ratio [OR],0.32; 95% confidence interval [CI], 0.19-0.56) or their partner (OR=0.33, 95% CI=0.20-0.55) working. Residency status, language preference, and length of US residency were not associated with continuous Medicaid enrollment. Insurance coverage was associated with more physician visits, greater continuity of care, and fewer deferrals of care.
Conclusion.
—While most (84%) young Latino children in inner-city Los Angeles were eligible for Medicaid, a substantial proportion (39.3%) have episodic or no coverage. Insurance status and provider type were more consistently associated with access rather than residency and language preference. In the aftermath of California's Proposition 187 and federal welfare reform, insurance status and access are likely to worsen for these young children unless the wave of anti-immigration sentiments is held in check.
Author Affiliations
From the RAND Health Sciences Program, Santa Monica, Calif (Drs Halfon, Wood, Valdez, and Duan); Departments of Community Health Sciences (Dr Halfon and Ms Pereyra) and Health Services (Dr Valdez), School of Public Health, and the Department of Pediatrics, School of Medicine, University of California, Los Angeles (Dr Halfon); and the Speilberg Pediatric Research Center, Ahmanson Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, Calif (Dr Wood and Ms Pereyra).
Footnotes
Presented at the first annual meeting of the Academic Pediatric Societies, San Diego, Calif, May 4, 1995.
Reprints: Neal Halfon, MD, MPH, Center for Healthier Children, Families, and Communities, UCLA School of Public Health, 10833 Le Conte Ave, Los Angeles, CA 90095-1772.
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