A Randomized Trial of Effects of Parent Mentors on Insuring Minority Children

9.6 million US Children (13%) have no health insurance, Latino and African-American children account for 57% of uninsured children, although comprising only 37% of all US Children. Studies show that being uninsured has a negative impact on children's health, healthcare, and mortality, however, insuring children results in improved health and healthcare. About 70% of uninsured US children (6 million) are eligible for but not enrolled in Medicaid or the Children's Health Insurance Program (CHIP), innovative strategies are needed to insure more children and eliminate disparities. This is the first randomized controlled trial comparing the effectiveness of parent mentors (PMs) to traditional Medicaid/CHIP outreach and enrollment in insuring uninsured minority children. The primary study aims are to evaluate whether PMs are more effective and more cost-effective than traditional Medicaid/CHIP outreach and enrollment in uninsured children. The secondary aim is to determine whether children who obtain health insurance experience improvements in healthcare access, health status, use of services, and other health outcomes.

Subjects will be 300 Dallas County uninsured and Medicaid/CHIP eligible Latino and African-American children (90% of insured children) and their parent/guardian. Subjects will be randomized to PMs or a control group receiving traditional Medicaid/CHIP outreach. PMs are experienced parents who have a child currently covered by Medicaid/CHIP. PMs will undergo intensive training, and will be paired with intervention subjects and their families, for whom they will provide information on Medicaid/CHIP eligibility, help complete/submit insurance applications, act as a liaison, and assist in maintaining coverage. Primary outcomes will include obtaining health insurance, coverage continuity, time interval to obtain coverage, parental satisfaction with the process of obtaining insurance and costs; secondary outcomes will include access to care, health status, use of services, quality of life, Parental satisfaction, financial burden, and missed school/parental work days. Subjects will be contacted monthly for 1 year to monitor outcomes by a blinded assessor. Achievement of study aims has the potential to contribute to reducing racial/ethnic disparities, and advancing knowledge and practice of child health policy. This intervention could serve as a national model for insuring uninsured children and reducing racial/ethnic disparities in insurance coverage.