To get more kids health care, train their neighbors to navigate insurance maze

Nearly 5 million children are uninsured in the United States, and researchers think they’ve found a new strategy to get them coverage: enlist their neighbors to help.

Paying low-income parents to help other low-income parents navigate the red tape of public insurance programs turns out to be a surprisingly effective, and cost-efficient, way to get more kids enrolled in health care, according to a study published Thursday in Pediatrics.

Researchers divided 237 uninsured African-American and Latino families in Texas into two groups. One set of families got help from trained “parent mentors” to enroll their kids in Medicaid or the Children’s Health Insurance Program. The other just saw traditional outreach material, such TV ads and posters with hotline numbers.

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The parent mentors successfully insured 95 percent of children they worked with, while just 68 percent of children in the control group got insured. Not only that: The mentors secured coverage more than twice as fast, and were more adept at renewing coverage and improving access to medical and dental care. Parents who worked with the mentors also reported higher satisfaction with their child’s care.

Coverage rates in both groups rose slightly after the study period ended, but even two years after the intervention, the parent mentor group remained better off: All the children in that group were insured, compared to three quarters of children in the control group.

“There are many obstacles and hassles to [enrolling in] these programs,” said Dr. Glenn Flores, a health policy researcher at the Medica Research Institute in Minneapolis and lead author of the study. “So we reasoned, who would know about how to best help parents navigate through the insuring of their children than other parents who already have experience doing it — particularly those from the same neighborhoods, with similar racial and ethnic backgrounds.”

Alma Baltazar -- Medicaid enrollment
Kim Leeson for STATBaltazar, with four of her eight children, outside her Dallas home.

One such parent is Alma Baltazar, a mother of eight who first enrolled her family in the Texas Medicaid program in the 1990s after her husband lost his job.

She found the process confusing; in fact, she wasn’t even sure at first that she qualified.

“The only thing I heard about government help or welfare was on the TV, and I thought, ‘Do they have this in my state?’ I didn’t really know if there was help out there,” she said.

When she did make it to a state office to apply, “the lady was so mean and rude, which made me feel more ashamed to be asking them for help,” Baltazar said. “It was intimidating.”

A friend finally steered her through the process. So Baltazar was eager to offer similar help to other families during the research project, which was carried out between 2011 and 2015.

Another parent mentor, Sunshine Mendez, said some of the parents she worked with were told their families didn’t qualify for public insurance because they were undocumented — even though they were applying for coverage for children born in the United States.

Some 12 percent of Latino children in the US are uninsured, compared to 8 percent of African-American and Asian children and 5 percent of white children.

Training and paying the parent mentors to guide these families cost an average of $637 per year, the study found.

But because the insured children were significantly more likely to visit primary care doctors for immunizations and chronic conditions like asthma, they avoided some expensive emergency room visits and hospitalizations. When families are uninsured, these costs are often ultimately paid for by hospitals, private insurance companies, and taxpayers. The researchers calculated that the parent mentor program resulted in an annual societal savings of $6,045 for each child insured.

Based on these findings, Flores estimates that the program could save as much as $11.5 billion annually if it reached all minority children in the United States, and $20 billion if it were extended to all eligible uninsured children regardless of race or ethnicity.

“This trial is exactly the type of policy-relevant information that we need right now to inform decisions at the state level,” said Dr. Lisa Simpson, a pediatrician and president of AcademyHealth, a professional society for health services research and policy.

“Many states are trying to figure out how to reach all the eligible but uninsured children,” Simpson said.

The study is especially timely, Simpson said, because the Children’s Health Insurance Program, which is jointly funded by the federal government and the states, is set to expire next year unless Congress renews it.

Researchers hope to launch new trials of parent mentor programs in multiple states. They’re also eager to experiment with training mentors for uninsured adults.

“What is so elegant,” Flores said, “is that you are reducing insurance disparities, creating jobs, and putting money back into the communities that need it the most.”

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