The availability of health care, and health insurance undeniably improves the physical health of children and their families.  For many low-income children, public health insurance has been demonstrated to improve access to health care and improve the quality of care children receive.Medicaid, SCHIP, and MO HealthNet programs in Missouri provide thousands of low income persons, including children, with more affordable health care.  The AllKids program in Illinois is designed to provide access to healthcare insurance, regardless of family income, immigration status or health condition.

In Missouri

Statewide, MO HealthNet eligibility levels for adults are among the lowest in the U.S. leaving many poor and working poor without health insurance or access to care.  In St. Louis City and County there are 155,000 uninsured people.  Between 2002 and 2008, the number of uninsured increased significantly, while the overall population decreased, and the number of Medicaid recipients significantly declined.  A recent Regional Health Commission study shows encouraging increases in local access to care, as measured by encounters with “safety net” providers (local St. Louis providers who attend to the health needs of the underprivileged).  The study also notes that $23 million annually, or 20% of funding supporting the community health centers is uncertain in the long-term.2 This is an even greater concern in light of Missouri’s budget and revenue shortfalls.

Eligibility levels for children in MO are higher; MO HealthNet covers children up to 300% of the federal poverty level, though some of these families pay premiums for their coverage.  Locally, the Maternal, Child and Family Health Coalition works to address health care access and utilization for low-income women and children, and to establish a sustainable infrastructure capable of systemically examining and addressing issues related to health care for women and children, in the context of family.  According to their 2009 document “Mapping a Course to a Healthier Community for Women, Children and Families,” the growing rate of uninsured and under-insured was ranked as the second priority for the metro area, (the first was poverty).  Cuts in the Medicaid program, decreases in employer-sponsored coverage, affordability of coverage, and lack of coverage for specialty and mental health services were listed among the major concerns of parents, community members and professionals in St. Louis.

Cultural Competency

One barrier to health care access is inadequate cultural competency.  Certain populations in the St. Louis metro area, including African Americans, Hispanic, and the foreign-born, are at greater risk of poor health outcomes.  Another at-risk population – children who have experienced child abuse and neglect – may have special physical, behavioral and mental health barriers to treatment that can be eased by provider training.  Initiatives to increase provider knowledge of special populations, and patient knowledge of available programs and services are needed.

Local access to quality medical services hinges significantly on proposed national health care reform legislation.  Please see the list of National Resources and the topic Health Care Coverage & Insurance.

1Mitchell, J. (2006). RTI International. What happens to children who lose public health coverage?

2St. Louis Regional Health Commission. (2009).  Progress Toward Building a Healthier St. Louis: 2009 Access to Care Report.