Simplifying Medicaid renewal forms may decrease coverage gaps in children’s health insurance

VANCOUVER, British Columbia — The likelihood that a child was dropped from Medicaid significantly correlated with the reading level at which health insurance documents were written, study findings suggested, with coverage loss increasing with each increasing grade-level used.

"This finding is troubling because studies have shown even small gaps in Medicaid coverage may lead to delayed access to health care for children," Susmita Pati, MD, MPH, a pediatric researcher at The Children's Hospital of Philadelphia, said at the 2010 Pediatric Academic Societies Annual Meeting today.

Pati and colleagues from the University of Pennsylvania conducted a retrospective cohort study using Medicaid renewal application and child eligibility data from 2001 to 2002. The researchers compared the literacy level of Medicaid renewal applications in all 50 states using a software program (Readability Studio, Oleander Software) and found that 92% of applications were written at or above fifth-grade reading level.

However, 40 million Americans read below the fifth-grade level, contributing to the 90 million who do not have adequate health literacy, according to Pati. She suggested that parents’ inability to fill out forms may account for brief coverage lapses common among many Medicaid-eligible children.

Despite the fact that 46 states had reading level guidelines for Medicaid information, applications in 21 of these states failed to meet guidelines on any of three literacy tests (Flesch-Kincaid, New Fog, FORCAST), Pati said. Among the 17 states with applications that met criteria on at least one of these literacy tests, none met guidelines set forth by all three.

Proportional hazard regression models using data from seven states that archived Medicaid applications in 2002 revealed that a child’s risk for disenrollment during a 24-month period increased 46.9% for every grade-level increase in application language.

“To improve retention, efforts to address literacy-barriers to the renewal process merit consideration,” Pati said. – by Nicole Blazek

For more information:

Pati S. #1690.2. Presented at: 2010 Pediatric Academic Societies Annual Meeting; May 1-4, 2010; Vancouver, British Columbia.

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