A Model for Improving Uninsured Childrenʼs Access to Health Insurance via the Emergency Department

A shift in commercially insured patients to publicly insured or uninsured status has caused an increase in emergency department (ED) visits for routine and nonemergent care. Meanwhile, hospitals struggle to compensate for decreasing reimbursements across all payer groups and increasing underwritten costs of care for the uninsured. Children represent a particularly vulnerable population and a substantial proportion of uninsured patients. In this study we assessed the efficacy and financial benefit of an insurance-referral program that is integrated into the routine pediatric ED admitting protocol of an academic hospital for the period 2004 to 2007. In this model, the ED of Stanford Hospital and Clinics acted as a referral agency to the San Mateo County Children's Health Initiative, a county coalition that carries out screening and enrollment assistance for public insurance. Referral from the ED was available 24 hours a day, and partnership with the county coalition negated the use of a hospital insurance-enrollment worker. Over the four-year study period, the referral program attained a successful linkage rate of 54.5 percent, which represents nearly 800 newly insured children. The vast majority (88.6 percent) of these pediatric patients were linked to Medicaid, which can reimburse retroactively for services rendered. For the academic hospital, this linkage rate resulted in $105,829.25 in insurance reimbursements and $658,559.97 deflected from bad-debt conversion. This pilot program is a sustainable, medically responsible model for linking uninsured children who need medical services with healthcare insurance. In addition, the program has the potential to yield financial return for the hospital. Similar models may be implemented in EDs across the United States. Healthcare managers who are seeking to alleviate the financial impact of care for the uninsured may find this model to be useful.