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Parents' Language Barrier May Prevent Eligible Children from Receiving Government - Sponsored Health Insurance, Says Study

PITTSBURGH, June 26, 2000 — More than five million children who are eligible for Medicaid - the federal/state health insurance program for certain low-income and needy people - are not on the program’s rolls, and a University of Pittsburgh study suggests that parents’ unfamiliarity with the English language could be a major factor. The results of the study of more than 12,000 families with children under the age of 21 were presented today at the annual meeting of the Association for Health Services Research in Los Angeles.

"In comparing the populations of children who are enrolled in Medicaid with those who are eligible but not enrolled, we found the most significant difference was language related," said Chyongchiou J. Lin, Ph.D., assistant professor of Health Services Administration at the University of Pittsburgh Graduate School of Public Health (GSPH), and principal investigator of the study.

Among Medicaid-eligible children, 29 percent of Hispanics were uninsured, compared with 19 percent white, 17 percent African-American and 12 percent Asian/Pacific or other. Of the group of non-enrolled eligible Hispanics, 75 percent chose to be interviewed in Spanish, suggesting to researchers that difficulty with the English language may be responsible for non-enrollment.

"While we cannot say definitively that the parents of eligible children not enrolled in Medicaid do not speak English, the study results do show that a significant number of individuals in this group feel more comfortable communicating in Spanish," Dr. Lin said. "Because Medicaid enrollment applications are fairly complicated, it is possible that someone with a limited ability to speak English would also have a limited understanding of the enrollment procedure."

Also significant was the finding that Medicaid-enrolled children are more likely to live with female single parents. Conversely, most of those who are Medicaid-eligible but not enrolled are members of two-parent families with at least one parent working full time.

"More than 25 percent of the families surveyed have employer-sponsored health insurance but are not taking advantage of it, and they are not enrolling their children in Medicaid," said Dr. Lin. "Single parents are more apt to seek out social services, such as Medicaid, for their children."

A second study presented by Dr. Lin and her team at the GSPH, this time among children eligible for the State Children’s Health Insurance Program (SCHIP), had somewhat different results. Established under the Balanced Budget Act of 1997, SCHIP (formerly known as CHIP) provides insurance to children of families with incomes too high to qualify for Medicaid, but too low to afford private health insurance.

SCHIP is a state/federal partnership that gives states three options for covering uninsured children: designing a new children's health insurance program; expanding current Medicaid programs; or a combination of both strategies.

Using data collected just before enrollment began for SCHIP, this study compares those presumptively eligible for SCHIP and insured through other programs with those who were uninsured. The study produced results that will serve as a baseline for future evaluation of SCHIP.

Significant in the SCHIP results was the insurance status of parents.

"If the parents are uninsured, then the children are more likely to be uninsured, especially if they have no access to employer-sponsored health insurance," said Dr. Lin.

Among the SCHIP-eligible population, the uninsured are more likely than the insured to have unmet medical needs and to depend on sources other than a doctor’s office -- such as the emergency room -- for the care they do seek, according to investigators.

Other factors more prevalent among uninsured SCHIP-eligible children than among insured SCHIP-eligible children include a lower family income and residence in the areas of the U.S. that have lower population density and per-capita income.

"Nearly one fourth of SCHIP-eligible children were not enrolled in any health insurance program at the time of our study," said Dr. Lin. "When the SCHIP program is evaluated after several years of operation, we hope to see that this percentage is greatly reduced. If it is not, then our study will be a valuable tool in showing where enrollment efforts need to be concentrated."

Both the Medicaid study and the SCHIP study were conducted using data from the 1996-97 Community Tracking Study Household Survey, which sampled 60,446 individuals residing in 60 randomly selected communities throughout the U.S. The two studies conducted by the University of Pittsburgh focused on the 12,422 families with children under the age of 21. The SCHIP study used information on the eligibility for each state’s SCHIP program, and the Medicaid study used eligibility criteria from the individual state Medicaid programs.

Data was collected by the Center for Studying Health System Change under the sponsorship of the Robert Wood Johnson Foundation, which also sponsored the University of Pittsburgh studies.

Established in 1948, the GSPH at the University of Pittsburgh is world-renowned for contributions that have influenced public health practices and medical care for millions of people. It is the only fully accredited school of public health in the Commonwealth of Pennsylvania and is one of the top-ranked schools of public health in the United States.

For more information about the GSPH at the University of Pittsburgh, access the school’s website at

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