Greater outreach efforts, including simpler application forms and more opportunities for direct application assistance, are needed to enroll more poor families who don't speak English at home in State Medicaid health insurance programs, according to a study that was supported in part by the Agency for Healthcare Research and Quality (HS10207). These limited English proficiency (LEP) families, who account for one-third of the Medicaid-eligible children in this study, were much more likely than English-proficient families to learn about the Massachusetts Medicaid program from medical providers, to receive assistance with enrollment (65 vs. 33 percent), and to receive this help from staff at medical sites (as well as family and friends) instead of from the State's toll-free telephone information line.
LEP families also were more likely than English-proficient families to identify barriers to Medicaid enrollment related to "know-how," that is, knowing about the Medicaid program; finding out if their child was eligible; and getting information about how to enroll. The three most frequently cited individual barriers to enrollment were not knowing if a child was eligible for coverage under Medicaid (63 percent), the belief that Medicaid was only for people on welfare (33 percent), and not knowing how to sign up (31 percent).
Two enrollment procedures particularly difficult for LEP families were completing the application process without assistance and providing written documentation to complete a partially filled-out application. These differences were based on language proficiency and persisted after controlling for marital status, family composition, place of residence, length of enrollment, and employment status.
These findings were based on a telephone survey of 1,055 parents of Medicaid-eligible (but unenrolled) children in Massachusetts. Emily Feinberg, Sc.D., of the Harvard School of Public Health, and colleagues asked parents how they learned about the Medicaid program, how they enrolled their children, and their perceived barriers to enrollment. The researchers evaluated the independent effect of language on enrollment after controlling for demographic characteristics.
See "Language proficiency and the enrollment of Medicaid-eligible children in publicly funded health insurance programs," by Dr. Feinberg, Katherine Swartz, Ph.D., Alan M. Zaslavsky, Ph.D., and others, in the March 2002 Maternal and Child Health Journal 6(1), pp. 5-18.