A randomized, controlled trial of the effectiveness of community-based case management in insuring uninsured Latino children

Background. Lack of health insurance adversely affects children's health. Eight million US children are uninsured, with Latinos being the racial/ethnic group at greatest risk for being uninsured. A randomized, controlled trial comparing the effectiveness of various public insurance strategies for insuring uninsured children has never been conducted. Objective. To evaluate whether case managers are more effective than traditional methods in insuring uninsured Latino children. Design. Randomized, controlled trial conducted from May 2002 to August 2004. Setting and Participants. A total of 275 uninsured Latino children and their parents were recruited from urban community sites in Boston. Intervention. Uninsured children were assigned randomly to an intervention group with trained case managers or a control group that received traditional Medicaid and State Children's Health Insurance Program ( SCHIP) outreach and enrollment. Case managers provided information on program eligibility, helped families complete insurance applications, acted as a family liaison with Medicaid/SCHIP, and assisted in maintaining coverage. Main Outcome Measures. Obtaining health insurance, coverage continuity, the time to obtain coverage, and parental satisfaction with the process of obtaining insurance for children were assessed. Subjects were contacted monthly for 1 year to monitor outcomes by a researcher blinded with respect to group assignment. Results. One hundred thirty-nine subjects were assigned randomly to the intervention group and 136 to the control group. Intervention group children were significantly more likely to obtain health insurance ( 96% vs 57%) and had similar to 8 times the adjusted odds ( odds ratio: 7.78; 95% confidence interval: 5.20-11.64) of obtaining insurance. Seventy-eight percent of intervention group children were insured continuously, compared with 30% of control group children. Intervention group children obtained insurance significantly faster ( mean: 87.5 vs 134.8 days), and their parents were significantly more satisfied with the process of obtaining insurance. Conclusions. Community-based case managers are more effective than traditional Medicaid/SCHIP out-reach and enrollment in insuring uninsured Latino children. Case management may be a useful mechanism to reduce the number of uninsured children, especially among high-risk populations.