Want to get more kids insured? Moms pitching moms looks like a winning bet

Word of mouth from a fellow parent in one’s own community can be pretty powerful.

When it carries information that leads you to enroll your child in Medicaid or the Children’s Health Insurance Program (CHIP), it can go a long way toward reducing disparities in insurance coverage.

That’s one of the findings of a recently published study in Health Affairs, which examined what happens when parents who have children enrolled in CHIP or Medicaid mentor other parents in their communities. The impact was striking: parent mentors were 95 percent effective in getting parents to enroll their children, compared to 69 percent for traditional methods.

“This is just such a powerful but elegantly simple intervention,” said Dr. Glenn Flores, the lead study author and director of the Health Services Research Institute at Connecticut Children’s Medical Center. “It’s an investment in communities that need it most.”

With the 2018 CHIP funding extension providing $120 million in outreach and enrollment grants, the strategy could help reduce children’s health insurance disparities throughout the country, Flores said.

Coverage gap a 'major public health problem'

Despite recent gains, Latino children still have the highest rates of uninsurance among all children nationwide. And there hasn’t been a lot of evidence on effective strategies for narrowing that gap.   

That gap is a “major public health problem” since lack of insurance is connected with poorer health, delayed immunizations, less access to specialty care, more emergency department visits, higher rates of hospitalization and even death, according to the Health Affairs study.  

For the controlled trial, which ran from 2011 through 2015 and included 155 uninsured children, researchers partnered with community sites such as small businesses, housing projects and the YMCA. There, they screened thousands of kids to find the uninsured among them.  

Initially, the community was wary of the outside effort, but support from local businesses and organizations helped overcome the distrust, Flores said.

Researchers recruited and screened parent mentors from places such as a primary care clinic, school and through referrals. They tried to match them with parents of uninsured kids by zip code “to promote neighborhood relationships, social support, and (through stipends to parent mentors) economic investment in underserved communities.”  

These parent mentors received training on how to help families enroll and renew coverage. They also learned the importance of  the role of pharmacists and subspecialists and the value

in asking question of physicians, Flores said.  

“We also taught them to address a family’s social determinants of health,” he said. That meant talking to people about how factors such as housing, food insufficiency and domestic violence shape overall health and wellbeing.

Meanwhile, the control group of families did not receive any additional outreach other than the programs’ standard promotions, which included bilingual radio, television and newspaper ads and messages on public transit. (There were 75 children in the control group and 80 in the intervention group).

Along with the higher rates of coverage, the families connected to the parent mentors also had lower-out-of-pocket spending on health care. And, two years after the intervention ended, 100 percent of those children were still covered, compared to 70 percent in the control group.

Why did this work?

Using Latino community health workers, often called promotoras, is a well-known outreach strategy that has been used throughout the country.

Parent mentors, though, are a special category of community health workers — and the interventions are even more personal, Flores said. Along with sharing language and culture, these workers also have kids enrolled in the same types of coverage they’re promoting. That’s a powerful combination, he said.

“They’re from the same community as the participant, and they’re bringing their own personal experience to the table,” he said. “That’s a real leg up from the typically community health worker.”

Parents tend to respect other parents who have been through an experience themselves, said Flores, drawing on his observations as a pediatrician. He didn’t understand parents’ challenges on topics such as sleep issues in quite the same way — until he became a parent himself.

In the current political climate, the fact that these messages were coming from peers also helped assuage parents’ potential fears surrounding enrollment in government programs, even though all of the children in this intervention were legally eligible to enroll in CHIP or Medicaid.

Still, strangers knocking on their door could be worrying to some parents, Flores said. “They might think it’s ICE and run the other way.”

The money is there

Flores said he’s always been troubled by the fact that “we have these wonderful programs” to insure children and yet the uninsured gap persists.

“There’s a huge disconnect,” he said.

Parents may misinterpret the income cut-off. Paperwork can be a barrier. And there might be misinformation circulating within communities — even among people attempting to help, he said.

The researchers did note some limitations on their findings, pointing out that they conducted the trial in an urban area and the participants were predominantly Mexican American.

The researchers intentionally picked Texas since the state has led the country in their uninsurance rates.

“We figured, if we could do this in Texas, we could do it anywhere,” he said.

Historically, the main obstacle to expanding these kinds of programs is funding. But, thanks to the CHIP authorization bill, there’s $120 million newly available for outreach efforts like this.

“It’s rare that it comes together so nicely,” Flores said. “It’s an investment in communities that need it the most.”

[Photo by Frank Hayes via Flickr.]