Health Insurance Discontinuities Among Adolescents Leaving Foster Care

Ramesh Raghavan, Peichang Shi, Gregory A. Aarons, Scott C. Roesch, J. Curtis McMillen

    Research output: Contribution to journalArticle

    Abstract

    Purpose: To determine whether adolescents who lose Medicaid entitlements when they leave foster care are subsequently able to secure employer-sponsored or student health insurance coverage. Methods: This was a 2-year follow-up study of a cohort of 404 adolescents leaving foster care in eight counties in a midwestern state. We conducted survival analysis to study predictors of time to first insurance loss, and logistic regression analysis to determine factors associated with insurance reacquisition, among these youth. Results: A total of 206 adolescents (51%) left foster care during follow up, of whom 138 (67%) lost health insurance coverage within a mean of 3 months of leaving foster care. Those who regained coverage (34; 17% of those leaving foster care) did so after a mean period of 8 months spent without insurance. Hazard of insurance loss was lower for employed adolescents (HR = .5; 95% CI = .4-.7; p < .0001), but only half of all adolescents leaving foster care reported being able to secure employment. Student health insurance did not reduce hazard of insurance loss. Boys had significantly lower odds of regaining insurance compared with girls (OR = .2, SE = .5, p = .003). Conclusions: Most youth leaving the child welfare system seem unable to transition to other forms of health insurance coverage. Even those that do acquire coverage, do so after an inordinate period of time. Enacting existing extensions of Medicaid coverage until age 21 for foster care youth is necessary to provide the resources to address the considerable health and mental health needs among these youth.

    Original languageEnglish (US)
    Pages (from-to)41-47
    Number of pages7
    JournalJournal of Adolescent Health
    Volume44
    Issue number1
    DOIs
    StatePublished - Jan 1 2009

    Fingerprint

    Health Insurance
    Insurance
    Insurance Coverage
    Medicaid
    Students
    Aftercare
    Survival Analysis
    Child Welfare
    Mental Health
    Logistic Models
    Regression Analysis
    Health

    Keywords

    • Child welfare
    • Foster care
    • Health insurance
    • Medicaid

    ASJC Scopus subject areas

    • Pediatrics, Perinatology, and Child Health
    • Public Health, Environmental and Occupational Health
    • Psychiatry and Mental health

    Cite this

    Health Insurance Discontinuities Among Adolescents Leaving Foster Care. / Raghavan, Ramesh; Shi, Peichang; Aarons, Gregory A.; Roesch, Scott C.; McMillen, J. Curtis.

    In: Journal of Adolescent Health, Vol. 44, No. 1, 01.01.2009, p. 41-47.

    Research output: Contribution to journalArticle

    Raghavan, R, Shi, P, Aarons, GA, Roesch, SC & McMillen, JC 2009, 'Health Insurance Discontinuities Among Adolescents Leaving Foster Care', Journal of Adolescent Health, vol. 44, no. 1, pp. 41-47. https://doi.org/10.1016/j.jadohealth.2008.08.008
    Raghavan, Ramesh ; Shi, Peichang ; Aarons, Gregory A. ; Roesch, Scott C. ; McMillen, J. Curtis. / Health Insurance Discontinuities Among Adolescents Leaving Foster Care. In: Journal of Adolescent Health. 2009 ; Vol. 44, No. 1. pp. 41-47.
    @article{26b6f00569e14ed3a635530839087476,
    title = "Health Insurance Discontinuities Among Adolescents Leaving Foster Care",
    abstract = "Purpose: To determine whether adolescents who lose Medicaid entitlements when they leave foster care are subsequently able to secure employer-sponsored or student health insurance coverage. Methods: This was a 2-year follow-up study of a cohort of 404 adolescents leaving foster care in eight counties in a midwestern state. We conducted survival analysis to study predictors of time to first insurance loss, and logistic regression analysis to determine factors associated with insurance reacquisition, among these youth. Results: A total of 206 adolescents (51{\%}) left foster care during follow up, of whom 138 (67{\%}) lost health insurance coverage within a mean of 3 months of leaving foster care. Those who regained coverage (34; 17{\%} of those leaving foster care) did so after a mean period of 8 months spent without insurance. Hazard of insurance loss was lower for employed adolescents (HR = .5; 95{\%} CI = .4-.7; p < .0001), but only half of all adolescents leaving foster care reported being able to secure employment. Student health insurance did not reduce hazard of insurance loss. Boys had significantly lower odds of regaining insurance compared with girls (OR = .2, SE = .5, p = .003). Conclusions: Most youth leaving the child welfare system seem unable to transition to other forms of health insurance coverage. Even those that do acquire coverage, do so after an inordinate period of time. Enacting existing extensions of Medicaid coverage until age 21 for foster care youth is necessary to provide the resources to address the considerable health and mental health needs among these youth.",
    keywords = "Child welfare, Foster care, Health insurance, Medicaid",
    author = "Ramesh Raghavan and Peichang Shi and Aarons, {Gregory A.} and Roesch, {Scott C.} and McMillen, {J. Curtis}",
    year = "2009",
    month = "1",
    day = "1",
    doi = "10.1016/j.jadohealth.2008.08.008",
    language = "English (US)",
    volume = "44",
    pages = "41--47",
    journal = "Journal of Adolescent Health",
    issn = "1054-139X",
    publisher = "Elsevier USA",
    number = "1",

    }

    TY - JOUR

    T1 - Health Insurance Discontinuities Among Adolescents Leaving Foster Care

    AU - Raghavan, Ramesh

    AU - Shi, Peichang

    AU - Aarons, Gregory A.

    AU - Roesch, Scott C.

    AU - McMillen, J. Curtis

    PY - 2009/1/1

    Y1 - 2009/1/1

    N2 - Purpose: To determine whether adolescents who lose Medicaid entitlements when they leave foster care are subsequently able to secure employer-sponsored or student health insurance coverage. Methods: This was a 2-year follow-up study of a cohort of 404 adolescents leaving foster care in eight counties in a midwestern state. We conducted survival analysis to study predictors of time to first insurance loss, and logistic regression analysis to determine factors associated with insurance reacquisition, among these youth. Results: A total of 206 adolescents (51%) left foster care during follow up, of whom 138 (67%) lost health insurance coverage within a mean of 3 months of leaving foster care. Those who regained coverage (34; 17% of those leaving foster care) did so after a mean period of 8 months spent without insurance. Hazard of insurance loss was lower for employed adolescents (HR = .5; 95% CI = .4-.7; p < .0001), but only half of all adolescents leaving foster care reported being able to secure employment. Student health insurance did not reduce hazard of insurance loss. Boys had significantly lower odds of regaining insurance compared with girls (OR = .2, SE = .5, p = .003). Conclusions: Most youth leaving the child welfare system seem unable to transition to other forms of health insurance coverage. Even those that do acquire coverage, do so after an inordinate period of time. Enacting existing extensions of Medicaid coverage until age 21 for foster care youth is necessary to provide the resources to address the considerable health and mental health needs among these youth.

    AB - Purpose: To determine whether adolescents who lose Medicaid entitlements when they leave foster care are subsequently able to secure employer-sponsored or student health insurance coverage. Methods: This was a 2-year follow-up study of a cohort of 404 adolescents leaving foster care in eight counties in a midwestern state. We conducted survival analysis to study predictors of time to first insurance loss, and logistic regression analysis to determine factors associated with insurance reacquisition, among these youth. Results: A total of 206 adolescents (51%) left foster care during follow up, of whom 138 (67%) lost health insurance coverage within a mean of 3 months of leaving foster care. Those who regained coverage (34; 17% of those leaving foster care) did so after a mean period of 8 months spent without insurance. Hazard of insurance loss was lower for employed adolescents (HR = .5; 95% CI = .4-.7; p < .0001), but only half of all adolescents leaving foster care reported being able to secure employment. Student health insurance did not reduce hazard of insurance loss. Boys had significantly lower odds of regaining insurance compared with girls (OR = .2, SE = .5, p = .003). Conclusions: Most youth leaving the child welfare system seem unable to transition to other forms of health insurance coverage. Even those that do acquire coverage, do so after an inordinate period of time. Enacting existing extensions of Medicaid coverage until age 21 for foster care youth is necessary to provide the resources to address the considerable health and mental health needs among these youth.

    KW - Child welfare

    KW - Foster care

    KW - Health insurance

    KW - Medicaid

    UR - http://www.scopus.com/inward/record.url?scp=57649178848&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=57649178848&partnerID=8YFLogxK

    U2 - 10.1016/j.jadohealth.2008.08.008

    DO - 10.1016/j.jadohealth.2008.08.008

    M3 - Article

    C2 - 19101457

    AN - SCOPUS:57649178848

    VL - 44

    SP - 41

    EP - 47

    JO - Journal of Adolescent Health

    JF - Journal of Adolescent Health

    SN - 1054-139X

    IS - 1

    ER -