Medicaid enrollment and health services access by Latino children in inner-city Los Angeles
N. Halfon, D. L. Wood, R. B. Valdez, M. Pereyra and N. Duan
RAND Health Sciences Program, Santa Monica, CA, USA.
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
antiimmigration sentiments is held in check.
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