Maternal and Child Health Journal

, Volume 10, Issue 6, pp 517–525 | Cite as

Do Access Experiences Affect Parents’ Decisions to Enroll Their Children in Medicaid and SCHIP? Findings from Focus Groups with Parents

  • Ian Hill
  • Holly Stockdale
  • Marilynn Evert
  • Kathleen Gifford
Original paper


Objective: The Covering Kids and Families (CKF) program seeks to expand health insurance coverage for children by supporting community-based outreach and enrollment. For the evaluation of CKF, researchers conducted focus groups to explore parents’ experiences accessing health care for their children, and to assess whether these experiences affected decisions to enroll their children in Medicaid or the State Children’s Health Insurance Program (SCHIP). Methods: In May and June 2003, 13 focus groups were conducted in 5 cities—Everett, MA; Denver, CO; Los Angeles, CA; Mena, AR; and San Antonio, TX. In each community, groups were conducted with parents of children insured under Medicaid or SCHIP and parents of uninsured children. Three groups were conducted with Spanish-speaking parents in two communities—Denver and Los Angeles. Results: Access to primary care was considered good by most parents with children in Medicaid and SCHIP. Among parents of uninsured children, there was more variation in perceptions of access to care. For parents of both uninsured and insured children, access to dentists and specialists was more problematic. Spanish-speaking families reported numerous barriers to care due to language differences and perceived discrimination. All focus group participants said that they placed great value on health insurance. Conclusion: Even when parents encountered problems accessing care, very few indicated that this discouraged them from enrolling their children into Medicaid or SCHIP, or from renewing their children’s public coverage.


Medicaid SCHIP Access Enrollment Renewal 



The authors would like to thank Linda Bilheimer of the Robert Wood Johnson Foundation for her ongoing support in the conduct of the Covering Kids and Families Evaluation. We would also like to sincerely thank the local CKF grantees in our study communities for their help in recruiting our parent sample. Finally, we are indebted to the many parents who took part in our focus groups, for their time, honesty, and insights into how well systems of care are meeting the needs of their children.


  1. 1.
    Dubay L, Hill I, Kenney G. Five things everyone should know about SCHIP. Assessing the new federalism issue brief series A, No. A-55. Washington, DC: The Urban Institute, 2002.Google Scholar
  2. 2.
    Hill I. Charting new courses for children’s health insurance. Policy and practice. Washington, DC: The American Public Human Services Association, 2000.Google Scholar
  3. 3.
    Cohen Ross D, Hill I. Enrolling eligible children and keeping them enrolled. The future of children, vol. 13, no. 1. Los Altos, California: The David and Lucille Packard Foundation, 2003.Google Scholar
  4. 4.
    The Urban Institute. Going Without: America’s Uninsured children. Princeton, New Jersey: The Robert Wood Johnson Foundation, 2005.Google Scholar
  5. 5.
    Dubay L, Haley J, Kenney G. Children’s eligibility for medicaid and SCHIP: A View from 2000. Washington, DC: The Urban Institute. Assessing the New Federalism Policy Brief B-41, 2002.Google Scholar
  6. 6.
    Kenney G, Haley J, Tebay A. Familiarity with medicaid and SCHIP programs grows and interest in enrolling children is High. Snapshots of America’s Families III, No. 2. The Urban Institute, 2003.Google Scholar
  7. 7.
    Blumberg S, O’Connor K, Kenney G. Unworried parents of well children: A Look at uninsured children who reportedly don’t need health insurance. Pediatrics 2005;(1162):345–51.Google Scholar
  8. 8.
    Evert M, Dopkeen J, Smith VK. The robert wood Johnson foundation covering kids initiative assessment project: Final Report. Lansing, Michigan: Health Management Associates, Inc., 2001.Google Scholar
  9. 9.
    Newacheck PW, Pearl M, Hughes DC, Halfon N. The role of medicaid in ensuring children’s access to care. JAMA 1998;280:1789–93.CrossRefPubMedGoogle Scholar
  10. 10.
    Lave JR, Keane CR, Lin CJ, Ricci EM, Amersbach G, LaVallee CP. Impact of a children’s health insurance program on newly enrolled children. JAMA 1998;279:1820–25.CrossRefPubMedGoogle Scholar
  11. 11.
    Marquis MS, Long SH. Reconsidering the effect of medicaid on health care services use. Health ser res 1996;30:791–808.Google Scholar
  12. 12.
    Rosenbach ML. The impact of medicaid on physician use by low-income children. Am J Pub Health 1989;79:1220–26.PubMedCrossRefGoogle Scholar
  13. 13.
    Short PF, Lefkowitz DC. Encouraging preventive service for low-income children: The effect of expanding medicaid. Med Care 1992;30:766–80.CrossRefPubMedGoogle Scholar
  14. 14.
    Kempe A, Beaty BL, Crane LA, Stokstad J, Barrow J, Belman S, Steiner JF. Changes in access, utilization, and quality of care after enrollment into a state child health insurance plan. Pediatrics 2005;115:364–71.CrossRefPubMedGoogle Scholar
  15. 15.
    Slifkin RT, Freeman VA, Silberman P. Effect of the North Carolina State children’s health insurance program on beneficiary access to care. Arch Pediatr Adolesc Med 2002;156:1223–29.PubMedGoogle Scholar
  16. 16.
    Halfon N, Wood DL, Valdez RB, Pereyra M, Duan N. medicaid enrollment and health services access by latino children in inner-city Los Angeles. JAMA 1997;277:636–41.CrossRefPubMedGoogle Scholar
  17. 17.
    Hill I, Harrington M, Hawkes C. Final cross-cutting report on the findings from ten State site visits: Congressionally mandated evaluation of SCHIP. Princeton, New Jersey: Mathematica Policy Research, Inc, 2003.Google Scholar
  18. 18.
    Bellamy H, Schwalberg R, Borzsak D, Dunbar J, Bostko C, Hart J, Perry M, Dulio A. Findings from the state children’s health insurance program focus groups. Washington, DC: Health Systems Research, Inc, 2002.Google Scholar
  19. 19.
    Cunningham PJ, Kemper P. Ability to get medical care for the Uninsured? JAMA 1998;280(10):921–27.CrossRefPubMedGoogle Scholar
  20. 20.
    Norton SA, Lipson DJ. Portraits of the safety net: The market, policy environment, and safety net response. Washington, DC: The urban institute, 1998.Google Scholar
  21. 21.
    Holahan J, Suzuki S. Medicaid managed care payment methods and capitation rates in 2001. Washington, DC: The Urban Institute, 2003.Google Scholar
  22. 22.
    Morgan, DL. Focus groups as qualitative research. Newbury Park, CA: Sage, 1997.Google Scholar
  23. 23.
    Krueger, RA. Analyzing and reporting focus group results. Thousand Oaks, CA: Sage, 1998.Google Scholar
  24. 24.
    Smith VK, Ramest R, Gifford K, Ellis E, Wachino V, O’Malley M. States respond to fiscal pressure: A 50-State Update of State medicaid spending growth and cost containment actions. Washington, DC: The Kaiser Commission on Medicaid and the Uninsured, 2004.Google Scholar
  25. 25.
    Holahan J, Bovbjerg R, Coughlin T, Hill I, Ormond B, Zuckerman S. State responses to budget crisis in 2004: An overview of ten States. Washington, DC: The Kaiser Commission on Medicaid and the Uninsured, 2004.Google Scholar
  26. 26.
    Hill I, Stockdale H, Courtot B. Squeezing SCHIP: States use flexibility to respond to the ongoing budget crisis. Washington, DC: The Urban Institute. Assessing the New Federalism Policy Brief No. A-65, 2004.Google Scholar
  27. 27.
    Cohen Ross D, Cox L. Beneath the Surface: Barriers threaten to slow progress on expanding health coverage of children and families. A 50-State Update on eligibility, enrollment, renewal, and cost sharing policies in medicaid and SCHIP. Washington, DC: The Kaiser Commission on Medicaid and the Uninsured, 2004.Google Scholar
  28. 28.
    Hill I, Sullivan J, Courtot B. Responding to SCHIP enrollment caps: Covering kids and families initiatives demonstrate flexibility. Princeton, New Jersey: Mathematica Policy Research, Inc., 2005.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Ian Hill
    • 1
  • Holly Stockdale
    • 2
  • Marilynn Evert
    • 3
  • Kathleen Gifford
    • 4
  1. 1.The Urban InstituteWashingtonUSA
  2. 2.National Opinion Research CenterWashingtonUSA
  3. 3.Health Management Associates, Inc.TallahasseeUSA
  4. 4.Health Management Associates, Inc.IndianapolisUSA

Personalised recommendations