Childless Adults: Barriers to Enrollment in Public Health Coverage

Author/Editor: Aviva Goldstein

This new Fund-supported report is a qualitative study of uninsured New Yorkers who are eligible for public coverage but are not enrolled. Beyond its groundbreaking work exploring the specific barriers faced by New York’s 500,000 eligible but uninsured childless adults, the report describes their unique challenges and recommends strategies to improve their participation in public health insurance. Its findings are relevant to the recently enacted federal health care reform law, which expands eligibility for public coverage and will provide New York with significantly enhanced federal financial support for the enrollment of eligible childless adults into Medicaid.

Childless adults often assume they are not eligible for public health insurance. Given the widespread emphasis on enrolling children and families, many childless adults, especially men, assume that public programs are only for families; others assume that having a job of any kind will disqualify them. Further, many have fluctuating income because they work intermittently or seasonally. These individuals may be eligible one month and ineligible the next, and so they opt out rather than subject themselves to accusations of fraud or to discontinuity of care. This study, which involved interviews with professionals working closely with this population and focus groups with the childless adults themselves, suggests ways to lessen obstacles faced by this population in obtaining health insurance, including:

• Increase facilitated enrollment targeting childless adults and add training on reaching and assisting these individuals;
• Implement the 12-month continuous eligibility requirement for adults and advocate for the elimination of reporting requirements for changes in eligibility during that period;
• Create a buy-in option for Family Health Plus for those with incomes above the subsidized eligibility level;
• Consider mechanisms for using an annual average of income for eligibility; and
• Make better use of available electronic documentation to minimize burden on applicants of providing documentation.

Prepared by Aviva Goldstein for the National Center for Law and Economic Justice with grant support from the Fund, Childless Adults complements another recent Fund-supported report by The New York Immigration Coalition, Mutual Responsibility: A Study of Uninsured Immigrants’ Perspectives on Health Insurance in New York City, which examines barriers to enrollment among immigrants in New York.

Copyright: 2010
Published: 04.06.2010

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• Childless Adults: Barriers to Enrollment in Public Health Coverage (163KB)