Abstract Introduction: Nationally, 24% of low-income children remain uninsured after the implementation of the State Children's Health Insurance Program (SCHIP). Method: The purpose of this study was to understand why children remain uninsured by comparing children with insurance to those without it. Using a cross-sectional survey design, 392 low-income parents were interviewed. Results: There were distinct profiles for the privately insured, Medicaid-insured and uninsured groups. Statistically significant differences were found across the three groups in income, working status of the adults, education, health status of the adult and child, and in the utilization of health care. Parents of the uninsured children were less knowledgeable about the application process. Discussion: Parents of uninsured children face multiple life challenges that may interfere with the enrollment process. Health problems, work schedules, and lack of knowledge may all need to be addressed before we can decrease the number of uninsured children in our nation. J Pediatr Health Care. (2003). 17, 32-38.