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James A. Gordon, MD, MPA, Jennifer A. Emond, MS and Carlos A. Camargo, Jr, MD, DrPH

All of the authors are with the Department of Emergency Medicine, Massachusetts General Hospital, Boston. James A. Gordon is also with the Institute for Health Policy, Massachusetts General Hospital/Partners HealthCare System, Boston, and Harvard Medical School, Boston. Carlos A. Camargo, Jr, is also with the Channing Laboratory, Brigham and Women’s Hospital, Boston, the Institute for Health Policy, and Harvard Medical School.

Correspondence: Requests for reprints should be sent to James A. Gordon, MD, MPA, Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St, Clinics 115, Boston, MA 02114 (e-mail: jgordon3{at}partners.org).

Objectives. We evaluated emergency department (ED)–based outreach for the State Children’s Health Insurance Program (SCHIP).

Methods. We conducted a multicenter trial among uninsured children ( 18 years) who presented to 5 EDs in 2001 and 2002. On-site staff enrolled consecutive subjects for a control period followed by an intervention period during which staff handed out SCHIP applications to the uninsured. The primary outcome was state-level confirmation of insured status at 90 days.

Results. We followed 223 subjects (108 control, 115 intervention) by both phone interview and state records. Compared to control subjects, those receiving a SCHIP application were more likely to have state health insurance at 90 days (42% vs 28%; P<.05; odds ratio [OR]=3.8; 95% confidence interval [CI]=1.7, 8.6). Although the intervention effect was prominent among 118 African Americans (50% insured after intervention vs 31% of controls, P<.05), lack of family enrollment in other public assistance programs was the primary predictor of intervention success (OR=3.7; 95% CI=1.6, 8.4).

Conclusions. Handing out insurance applications in the ED can be an effective SCHIP enrollment strategy, particularly among minority children without connections to the social welfare system. Adopted nationwide, this simple strategy could initiate insurance coverage for more than a quarter million additional children each year.

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