This issue paper discusses the findings of four focus groups conducted with outreach and enrollment workers who provide services to legally residing immigrant families, a group with high rates of uninsurance. They identified the importance of Medicaid and the Children's Health Insurance Program (CHIP) to immigrant families; in particular, these programs provide prenatal care and help families afford primary and preventive care as well as nutrition services for their children. They also discussed the barriers eligible families face, including fear of deportation if the parents are not citizens but the children are, confusing application processes, and notices that are difficult to understand and not provided in a family's primary language. In addition to problems enrolling in coverage, the paper reports that barriers persist even after families are enrolled, as many don't understand how to access care through managed care organizations. Two Affordable Care Act (ACA) provisions that will go into effect in 2014 have the potential to help more families, including legally residing immigrant families, gain access to affordable insurance: the Medicaid expansion and tax credits to help low- and moderate-income families purchase insurance through the health exchanges. In order to realize this promise of health reform, it will be important to adopt strategies to help legally residing immigrant families overcome barriers to enrollment, such as the ones identified in this study. Strategies include creating checklists so families will know the documents they need to provide and to help them track income and expenses, cards that families can show to request translation services, and most important, the use of cultural brokers so families can receive assistance from trusted members of their communities.

Learn more about cultural broker programs  at the National Center for Cultural Competence.

According to this report, primary care providers who think their 1:1 relationship with their patients is enough may want to hold that thought until they switch to electronic medical records (EMRs). Doctors at a health center in Portland, Oregon thought they knew their patients well until they started using EMRs and realized they had patients with chronic conditions whom they had not seen in years. Now they can reach out to patients with chronic conditions to make sure they are receiving needed preventive care, like flu shots, and other follow-up care. EMRs can also be used to "grade" doctors to see how they are doing and help identify areas in which they can improve. It can be expensive for providers to adopt EMRs, but insurers like them because they provide data. The Obama administration, in recognition of the potential of EMRs, included funding under the Affordable Care Act (ACA) to help hospitals and clinics adopt the use of EMRs.

The six Democratic and six Republican members of the Super Committee, charged with finding at least $1.2 trillion in spending cuts to reduce the federal deficit over the next ten years, had been in a tug of war over the issue of raising taxes to increase revenue and cutting social programs like Medicaid. In a realization that the federal deficit cannot be reduced only by cutting expenses, 40 House Republicans and 60 House Democrats agreed that both tactics were needed. The Super Committee has until November 23, 2011, to make their recommendations, and time is running out. While they can create a deficit reduction plan that cannot be amended by the House or Senate, they cannot give themselves more time.

How do providers bridge the treatment gap between individuals who need intervention for substance abuse disorders and limitations due to staff issues of high turnover, inadequate training, and not enough time? Technology and social media can provide a cost-effective way to address these issues. Computer programs, videos, text messages, cell phone apps, and other social media were effective treatments, either as stand-alone interventions, or as companion supports to other traditional therapies, according to Lisa A. Marsch, PhD, Director of the Center for Technology and Behavioral Health at the Dartmouth Psychiatric Research Center. Multimedia prevention programs also helped children and youth learn to "just say no" to risky behaviors. 

Participants who self report health information on surveys from the U.S. Department of Health and Human Services (HHS) will soon be answering new questions about race, ethnicity, sex, primary language, or disability. These standardized questions, a requirement under the Affordable Care Act (ACA), will not only help researchers collect information about, analyze, and identify health disparities specific to ethnic groups, but also design interventions to reduce health disparities in other underserved populations, including individuals with disabilities. Read the final data collection standards  for race, ethnicity, sex, primary language, and disability status. 

The Maternal and Child Health Bureau (MCHB) funded this report through Project Thrive at the National Center for Children in Poverty.  Project Thrive  helps states improve early childhood services and reduce disparities in access and quality of care. In this report, the authors provide an overview of the development of the medical home concept, with an emphasis on the American Academy of Pediatrics (AAP) 2005 definition of medical home for children with special health care needs. They examined data from the 2007 National Survey of Children's Health  and found that children living in poverty, ages birth to 5 years old, were less likely to have a medical home, get referrals, and receive coordinated, family-centered care than children in higher income families. Additionally, Hispanic and Black children living in poverty had the highest unmet needs in these areas. With these data in mind, the authors note the suggestion by the Child Health Fund  to expand the AAP's medical home definition to include "development of enhanced medical homes for medically underserved children." They discuss State Medicaid and the Children's Health Insurance Program (CHIP) projects, state partnerships with private health insurers, and private payer initiatives, all designed to expand access to medical homes, along with payment strategies, including Accountable Care Organizations (ACOs), a provision of the Affordable Care Act (ACA), which will be implemented in 2012. They suggest ACOs can provide targeted outreach to underserved and at risk children to provide high quality care.