What Should Be the Nature and Scope of Pediatricians’ Duties to Keep Their Patients Insured?
Year: 2025
Type: article
Abstract: Access to health care is a key structural determinant of health, with lack of health insurance as a main barrier.In the United States, nearly half of children rely on Medicaid or the Children's Health Insurance Program for health insurance.Children's eligibility for coverage under these programs is income dependent and can vary over time, so changes in insurance status signal a need to screen for unmet structural needs.Clinicians, who are obligated to respond to what screening reveals, should be prepared to help deploy practice-based, health system, and community resources to help meet the needs of children and families.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM .Physicians should claim only the credit commensurate with the extent of their participation in the activity.Case DD lives in a rural state, works 2 jobs, and is a grandparent and legal guardian of 3 children under the age of 12. DD's English language proficiency is limited, so DD brings a letter she received in the mail for review by Dr P, the children's pediatrician.The letter states that, unless several forms are completed, DD's grandchildren will be ineligible for the state's Medicaid insurance coverage.Dr P walks DD and her grandchild to the front desk and says, "Our staff will help you with this paperwork," and then moves on to their next patient.A member of Dr P's office staff looks briefly at the letter and informs DD, "You need to find these forms on the internet, print them, fill them out, and then send them to the address on the bottom of the letter."Office staff members are overwhelmed with helping patients complete enrollment paperwork and structural determinants of health (SDoH) screening documentation.Three months later, when DD brings one of the grandchildren to Dr P, Dr P's office staff inform DD that the child is no longer enrolled in Medicaid.DD's grandchild is part of the 72% of individuals disenrolled from Medicaid for procedural reasons. 1
Source: The AMA Journal of Ethic
Authors: Sarah D. Ronis, Genevieve M. Birkby
Language: English
Topic: Child and Adolescent Health
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4413879800