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AJPH First Look, published online ahead of print Jan 30, 2008
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March 2008, Vol 98, No. 3 | American Journal of Public Health 478-484
© 2008 American Public Health Association
DOI: 10.2105/AJPH.2007.117408

RESEARCH AND PRACTICE

Longitudinal Patterns of Health Insurance Coverage Among a National Sample of Children in the Child Welfare System

Ramesh Raghavan, MD, PhD, Gregory A. Aarons, PhD, Scott C. Roesch, PhD and Laurel K. Leslie, MD, MPH

Ramesh Raghavan is with the George Warren Brown School of Social Work and the Department of Psychiatry, School of Medicine, Washington University, St Louis, Mo. Gregory A. Aarons is with the Child and Adolescent Services Research Center, Rady Children’s Hospital, San Diego, Calif, and the Department of Psychiatry, University of California, San Diego. Scott C. Roesch is with the Department of Psychology, San Diego State University, San Diego. Laurel K. Leslie is with Tufts University New England Medical Center, Boston, Mass.

Correspondence: Requests for reprints should be sent to Ramesh Raghavan, Washington University in St Louis, Campus Box 1196, One Brookings Dr, St Louis, MO 63130 (e-mail: raghavan{at}wustl.edu).

Objectives. We sought to describe health insurance coverage over time among a national sample of children who came into contact with child welfare or child protective services agencies.

Methods. We used data from 4 waves of the National Survey of Child and Adolescent Well-Being to examine insurance coverage among 2501 youths. Longitudinal insurance trajectories were identified using latent class analyses, a technique used to classify individuals into groupings of observed variables, and survey-weighted logistic regression was used to identify variables associated with class membership.

Results. We identified 2 latent insurance classes—1 contained children who gained health insurance, and the other contained children who stably maintained coverage over time. History of sexual abuse, and race/ethnicity other than White, Black, and Hispanic, were associated with membership in the "gainer" class. Foster care placement and poorer health status were associated with membership in the "maintainer" class. Caregiver characteristics were not associated with class membership.

Conclusions. The majority of children in child welfare had stable health insurance coverage over time. Given this vulnerable population’s dependence upon Medicaid, protection of existing entitlements to Medicaid is essential to preserve their stable insurance coverage.






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