Medicaid and the health care of children in poverty and near poverty: some successes and failures.

Recent trends in access to and utilization of health services by children living in poverty, near poverty, and higher income households in the Flint, Michigan, metropolitan area are examined. During the period under study (1973-1977), there were substantial increases in the percentage of poor children enrolled in Medicaid. By 1977, however, 15 per cent of children in poverty in the city of Flint were still not enrolled; in suburban areas, this estimate was 30 per cent. Some correlates of non-enrollment are identified. These changes in Medicaid enrollment were accompanied by an attenuation of differences in the utilization of ambulatory medical services among income groups, although children on Medicaid in 1977 were still less likely to have a regular source of care, and less likely to have a pediatrician as a regular physician. Although dental visits were covered by Medicaid beginning in 1975, economic differentials in dental utilization appear to have widened over the period under study. A variety of barriers to the delivery of services under Medicaid in this community are noted, and the generalizability of these findings discussed.