Parent mentors highly effective at providing Latino children with health insurance coverage

Latino children have the highest uninsured rate in the United States. However, new study findings in the March issue of Health Affairs show parent mentors are highly effective at providing uninsured Latino children with health insurance coverage.

"Our randomized trial testing the power of a simple intervention program that trained Latino parents to mentor other Latino parents rigorously documents that we can truly help eliminate disparities in insurance coverage, while improving access to healthcare, care quality, and parental satisfaction, and reducing families' out-of-pocket healthcare costs and financial burden," says the study's lead author Dr. Glenn Flores, professor and associate chair of research in the Department of Pediatrics at UConn School of Medicine and chief research officer at Connecticut Children's Medical Center.

Even though one in four children in the U.S. is Latino, equivalent to more than 18.2 million, they continue to be the most uninsured, accounting for one-third of all uninsured children nationally. Currently, Latino children have the highest uninsurance rate of any U.S. racial/ethnic group of children, at 7.9 percent, compared with 4.1 percent of white, 5 percent of Asian, and 5.5 percent of African-American children.

"Lack of health insurance in children is a tremendous health disparity that urgently needs to be addressed, especially in the highly impacted Latino community," says Flores. "When children are uninsured, they are at much higher risk of poorer health, lack of healthcare access, more trips to the emergency room and hospitalizations, and sadly, premature death."

Flores and his research team evaluated this innovative intervention program after their team's prior study showed community health workers were more effective than traditional outreach and enrollment methods used by the state Medicaid and Children's Health Insurance Programs (CHIP).

This randomized, controlled, community-based trial testing the new Kids' HELP (Health Insurance by Educating Lots of Parents) intervention program included 155 uninsured Latino children under 18 years old eligible for Medicaid or CHIP in Texas, along with their parents. The intervention employed trained and paid bilingual Latino parent mentors with personal experience and success navigating Medicaid or CHIP coverage for their own children.

At one year follow-up, 95 percent of Latino children assigned a parent mentor obtained health insurance, compared with only 69 percent of children in the control group, who received the state's traditional health insurance outreach and enrollment methods. Those in the parent mentor program also got their coverage much faster, at an average of two months, versus five months for controls.

Parent mentors taught parents about available insurance programs, helped them complete and submit applications, contacted and acted as a family liaison with Medicaid and CHIP, assisted families with finding medical and dental homes for their children, and helped them to address any social determinants of health in the household, including food insufficiency, housing problems, and poverty.

In addition, the study found children in the parent mentor group gained greater healthcare access to preventive care visits, primary care providers, and specialists. Plus, parents had significantly lower out-of-pocket spending, and were three times less likely to report financial problems due to their child's medical bills. The quality of well-child and specialty care also was much better, and the program saved $698 annually per child insured.

The intervention additionally was highly effective in teaching parents how to maintain their children's coverage. Two years after families stopped having parent mentors, 100 percent of children in the parent mentor group were insured, thanks to knowledge and skills gained from the parent mentoring program.

"Our highly successful Kids' HELP program holds great promise for insuring more Latino children, and even other racial or ethnic groups in other states and nationally, while eliminating health disparities," says Flores. "Parent mentors are such an exciting intervention because they insure more children, improve healthcare access and quality, reduce families' financial stress, create jobs, reinvest dollars in underserved communities, and save money."

Because of these study findings and other work by Flores and his team on parent mentors, CHIP reauthorization legislation approved by the federal government in January 2018 makes organizations that employ parent mentors eligible to receive part of $120 million in grants for CHIP outreach and enrollment, so all 50 states and D.C. have the opportunity to fund and implement parent mentor programs.