The Personal Responsibility and Work Opportunity Reconciliation Act of 1996: access and utilization of health care services among children of Black foreign-born mothers
Creators: name: Browne, Michelle Nichole Charlene
Publisher: name: Maryland Shared Open Access Repository
Year: 2012
Subjects: Black immigrants
dental services
medical services
welfare reform

description: Objectives: This comparative retrospective study examined the health care access, health care status, and health service utilization of children from birth to seventeen years whose mothers self identified as native-born and foreign-born blacks from the National Survey of Children's Health (NSCH).  In addition, it investigated whether the Medicaid provision for immigrants in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) (Public Law No. 104-193) was associated with differential utilization of dental, medical, and mental health services among children born to mothers who identified as blacks.  Embedded within PRWORA is a stipulation asserting that to receive Medicaid, one must reside in the United States (US) continuously for a period of five years beginning in August 1996. Design: This study utilized data from the NSCH, a nationally representative survey instrument having a sample size of 102, 353 children from zero to seventeen years. Children's caretakers were interviewed from January 2003 to July 2004.  Of those, 11,535 children had mothers who self-identified as foreign-born.  The sample population for this comparative research consisted of the 651 children whose mothers self identified as being Black foreign-born and 7,815 children whose mothers self identified as Black native-born.  This investigation stratified the children from the NSCH into four categories: 0-3; 4-7; 8-11; and 12-17. Main outcome measures:  The theoretical framework that guided this investigation was the original Behavioral Model of Health Service Use developed by Robert Andersen in 1968.  The main clinical outcome measures were the provision of dental, mental health and medical services to children from birth to seventeen years of age. Results: Bivariate analyses disclosed that there were significant differences among the children born to mothers who identified as black foreign-born and mothers who self-identified as black native-born in various predisposing, enabling, and need variables. Statistical differences were reported in insurance type for all age cohorts except 4-7.  Logistic regression models were developed to perform multivariate analyses on the odds ratio for the receipt of dental services, medical services, mental health services, and any one of these services (any service) and having Medicaid as a type of insurance.  The analysis revealed that there were no statistically significant differences between the receipt of any service Odds Ratio (OR) =1.34; 95% confidence intervals (CI) =0.45-4.00); and dental service (OR =1.36; CI= 0.76-2.46) among the US population of black children.   The OR for mental health service was 0.36; CI =0.15-0.89 revealing that children of black foreign-born were less likely to receive mental health services compared to children of black natives. There were no statistically significant differences in having Medicaid (OR =0.60; CI =0.35-1.05) as an insurance type among the US black population of children.  Children with Medicaid were more likely to have medical services (OR=1.51; CI=1.07-2.15); and mental services (OR=2.27; CI=1.25-4.11) compared to uninsured children. Public Administrative Significance:  The purpose of the Medicaid Program is to address the health care needs of the poor. Since 1965, various federal and state administrations have utilized this significant public policy legislation to increase access to health care for their constituents. This study highlighted the pivotal role that Medicaid continues to play in both accessing and the utilization of health services for the US population of black children.  Public administrators implementing various programs should continue to advocate for the Medicaid program and increase societal education on the need to address mental health services among young children. Conclusion:  This analysis discovered that unlike research on the children born to Asian and Hispanic parents where low access and utilization of health care services were found; children born to black foreign-born mothers are assessing an array of services in the US health care system.  Findings indicate the need for interventions to address disparities among the black sub-population of children in the receipt of mental health services. There remains a need to collect data specific to black sub-population groups at the federal, state, and local levels on health access and service utilization. Disparities among sub-populations identify a critical need to explore factors beyond commonly researched variables to ascertain the root causes of health outcomes.