Medicaid Disenrollment Patterns Among Children Coming into Contact with Child Welfare Agencies

Area of Science:

• Health Services Research
• Child Welfare Studies
• Public Health Policy

Background:

• Children in the child welfare system are a vulnerable population with significant healthcare needs.
• Medicaid is a crucial source of health insurance for these children, but coverage continuity is a concern.

Purpose of the Study:

• To investigate the duration of Medicaid coverage retention among children in the child welfare system.
• To identify factors associated with Medicaid disenrollment in this population.

Main Methods:

• Linked national survey data of children with abuse/neglect histories to Medicaid claims from 36 states.
• Utilized a Cox proportional hazards model to analyze time to first Medicaid disenrollment over a 4-year period.

Main Results:

• 50% of children retained Medicaid coverage throughout the 4-year study period.
• Disenrollments were most common in the fourth year.
• Increased risk of insurance loss was associated with ages 3-5 years and rural residence.
• Fee-for-service Medicaid and non-managed care arrangements were linked to lower disenrollment risk.

Conclusions:

• A substantial proportion of children in child welfare settings maintain Medicaid coverage for extended periods.
• Targeted interventions are needed to ensure continuous health insurance access for this high-risk group.
• Promoting health insurance enrollment is critical for assuring necessary services for vulnerable children.