P2C117: Delayed Enrollment in Medicaid Among Eligible Families with Children Admitted to the Neonatal Intensive Care Unit

Background: Health insurance is vital to the well-being of all children, including premature infants admitted to the Neonatal Intensive Care Unit (NICU). Medicaid is an important insurance provider but there are several barriers to the Medicaid enrollment process, some of which may be specific to the NICU population. The patient population in our NICU mostly includes families with Medicaid insurance. As a result, we set out to study the prevalence and reasons for delayed enrollment in Medicaid among eligible families with children admitted to the NICU.

Methods: We obtained approval from our institution’s Institutional Review Board for this study. This is an ongoing single-center, prospective survey study conducted in a 71-bed level IV NICU. We aim to enroll a convenience sample of 150 patients and their mothers into this study. Eligible neonates include those determined to be eligible for Medicaid enrollment on comprehensive social work evaluation. We included neonates born in our hospital or transferred in from outlying facilities, who are hospitalized in the NICU for at least 21 days. We decided on 21 days to allow a reasonable length of time for Medicaid enrollment. Our social work team reminds parents to enroll their neonates in insurance during the intake evaluation which takes place within the first 48 hours of admission. Exclusion criteria include neonates with length of stay less than 21 days, life-limiting conditions or transfer from an outlying facility after the first week of life.

The primary outcome variable was enrollment in public insurance by the time of survey completion. We approach mothers in-person between the 21st and 28th day of the neonate’s life to describe the study and obtain informed consent. We then administer an anonymous survey. The survey includes questions regarding the neonate’s current Medicaid enrollment status and barriers encountered during the enrollment process if any. We also collect data on demographics and socioeconomic status from the medical records.

Results: To date, we have collected data on fifty-six of one hundred thirty-three eligible infants. We did not approach sixty-nine parents due to infrequent family visitation, and eight parents did not consent to the study. Among the fifty-six study neonates, 86% were enrolled in Medicaid at the time of the survey, 7% had a Medicaid application submitted but not yet approved, and 7% did not have a Medicaid application submitted. Eighty percent of parents stated they had no barriers during their Medicaid enrollment process, while barriers identified included difficulty understanding the application forms as well as the enrollment process.

Conclusion: Overall, most Medicaid-eligible babies in our institution had obtained coverage through Medicaid prior to the fourth week of life. Of the families who encountered barriers, the most common included difficulty understanding the application process and the Medicaid application forms.