Increasing health insurance coverage in the first year of life

Objectives: To determine the proportion of infants who are uninsured and the sociodemographic characteristics of their mothers, including prenatal and post-partum insurance coverage, in order to identify strategies to increase infant health coverage. Methods: Data from the 2001 California Maternal and Infant Health Assessment (MIHA) were analyzed. MIHA is a cross-sectional survey of a statewide representative sample of 3,475 postpartum women. We calculated the proportion of uninsured infants overall and by several maternal characteristics. Adjusted and unadjusted odds ratios for infant uninsurance are reported. Results: In the overall study sample, 8.7% of infants were uninsured. Low-income infants were significantly more likely to be uninsured than infants in households with incomes above 200% of the federal poverty level (13.7% vs. 2.5%). The mother's prenatal and post-partum health coverage, her age, and family income were associated with an increased risk of infant uninsurance after adjustment for other maternal characteristics. A large majority of the uninsured infants (88.1%) were living in low-income families. The mothers of 60% of the uninsured infants were enrolled in Medicaid during the pregnancy. Conclusions: Approximately 14% of California's low-income infants were uninsured at the time of the survey despite being income-eligible for Medicaid. The proportion of uninsured infants could potentially be reduced by more than one-half through strategies to provide 12 month continuous enrollment of infants with federally mandated Medicaid eligibility for the first year of life.