Literacy-related barriers affect retention in Medicaid program for children: Research

Difficulty filling out forms could lead to gaps in insurance coverage for children

Simplifying Medicaid renewal applications may help families keep their children enrolled in the government health insurance program, resulting in better medical care, according to research to be presented Saturday, May 1 at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.

Many studies have shown that literacy-related barriers affect retention in the Medicaid program. This study compared the reading level of the Medicaid renewal applications in all 50 states and looked at the effect of reading level on child retention.

Results showed that 92 percent of applications were written at or above the fifth-grade reading level. In addition, 46 states had reading level guidelines for Medicaid information, but 46 percent of these states failed to meet their own guidelines.

Researchers also found that the risk of a child getting dropped from coverage went up significantly with each grade level increase in the language used in the Medicaid renewal application.

Given that 90 million American adults have inadequate health literacy - 40 million of whom read below a fifth-grade reading level - it is likely that many caregivers of children enrolled in Medicaid have difficulty completing renewal applications, the researchers noted. This inability to fill out the forms may explain, in part, the brief (usually one to three months) lapses in insurance coverage that are common among Medicaid-eligible children. These gaps have been associated with delays in obtaining medical care, including missed preventive visits and unfilled prescriptions.

"This finding is troubling because studies have shown even small gaps in Medicaid coverage may lead to delayed access to health care for children," said Susmita Pati, MD, MPH., lead author of the study and a pediatric researcher at The Children's Hospital of Philadelphia. "This study shows that the literacy level of the applications is one factor that contributes to a child getting dropped from coverage and, in turn, to poor outcomes."