April 2012

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


BACKGROUND: Despite recent expansions in public insurance programs, it must be recognized that the effectiveness of public insurance programs has historically been compromised by high rates of disenrollment. One key barrier to the Oregon Health Plan’s (OHP) effective expansion has been the lack of a thorough understanding of why people leave the program, and what happens to them when they do. In early 2007, the Division of Medical Assistance Programs (DMAP) commissioned a study on OHP disenrollment to address these questions. This secondary data analysis of data from this study focuses on children who were disenrolled from OHP. RESEARCH QUESTIONS: 1) What factors are associated with a child’s disenrollment from the Oregon Health Plan? 2) What are the impacts on children whose parents do not reapply to renew their OHP coverage with regard to healthcare utilization and health outcomes? (3) What factors predict the eventual attainment of health insurance? METHODS: We used data from the 2007 OHP Disenrollment Study, a prospective cohort study, which identified a random cohort of children from a group of OHP applicants and re-applicants during a three-month sampling window. Parents or guardians of selected children were surveyed six months later using a validated survey tool about their child’s insurance status and healthcare utilization. To address our research questions, we performed complete descriptive analyses as well as multivariate logistic regression modeling. RESULTS: 585 children participated in this survey and 392 were included in this secondary analysis. This number was weighted to reflect the total eligible OHP population during the sampling window and to account for survey non-response. Compared with those who were accepted into the program and those that were denied coverage, children whose parents did not reapply to renew their coverage were more likely to come from families with employed parents (73.3%, p<0.001) and annual household incomes of more than $15,000 (40.9%, p<0.001). Children whose parents did not reapply to renew their coverage had higher odds of unmet healthcare needs compared with those who were accepted into the program (OR: 2.8, 95% CI: 1.3-6.1) and those who were denied coverage (OR: 1.8, 95% CI: 0.7-4.4). This association was explained by the fact that they were more likely to have a gap in insurance coverage than those in the other application groups. A gap in insurance coverage was strongly associated with having an unmet healthcare need (OR: 8.5, 95% CI: 2.9-24.8). Approximately one-third of parents cited burdensome process requirements as the primary deterrents to their child’s OHP reenrollment. These children were far less likely than those who disenrolled due to improved circumstances to be insured at the end of the study period (65.8%, p<0.01). CONCLUSIONS: This study confirms previous findings regarding the importance of continuous insurance coverage. Furthermore, many children are being disenrolled from OHP due to burdensome process requirements. Future efforts should focus on minimizing barriers to enrollment and reenrollment in public insurance programs in order to ensure continuous insurance coverage for all children.




School of Medicine



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