Evaluation of an Emergency Department–Based Enrollment Program for Uninsured Children

Study objective We evaluate the effectiveness of an emergency department (ED)–based outreach program in increasing the enrollment of uninsured children. Methods The study involved placing a full-time worker trained to enroll uninsured children into Medicaid or the State Childrenʹs Health Insurance Program in an inner-city academic childrenʹs hospital ED. Analysis was carried out for outpatient ED visits by insurance status, average revenue per patient from uninsured and insured children, proportion of patients enrolled in Medicaid and State Childrenʹs Health Insurance Program through this program, estimated incremental revenue from new enrollees, and program-specific incremental costs. A cost-benefit analysis and breakeven analysis was conducted to determine the impact of this intervention on ED revenues. Results Five thousand ninety-four uninsured children were treated during the 10 consecutive months assessed, and 4,667 were treated during program hours. One thousand eight hundred and three applications were filed, giving a program penetration rate of 39%. Eighty-four percent of applications filed were resolved (67% of these were Medicaid). Average revenue from each outpatient ED visit for Medicaid was US$135.68, other insurance was US$210.43, and uninsured was US$15.03. Estimated incremental revenue for each uninsured patient converted to Medicaid was US$120.65. Total annualized incremental revenue was US$224,474, and the net incremental revenue, after accounting for program costs, was US$157,414 per year. Conclusion A program enrolling uninsured children at an inner-city pediatric ED into government insurance was effective and generated revenue that paid for program costs.