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Managed care is the dominant form of health insurance in the United States, covering millions of children. Little is known about whether inner-city parents adequately understand managed care's complex definitions and rules.The objective of this study was to examine managed care knowledge and practices among inner-city parents.We conducted a cross-sectional survey of parents at inner-city community sites in Boston, including supermarkets, hair salons, and laundromats. Participants were asked 74 questions on access, insurance, and managed care.The 1100 participants were mostly poor, minority (82% Latino, 10% black) and covered by public health insurance. Although 55% of insured children were covered by managed care, 45% of the managed care-covered children's parents were unaware of their children's managed care coverage. When asked “What is managed care?,” 88% of parents did not know it was a type of insurance, and 94% did not identify a specific feature; Latino parents were significantly more likely to provide a wrong/do not know answer to this question, and there was no significant association with whether the child was covered by managed care. Latino parents and parents with children not covered by managed care were significantly more likely to provide a wrong/do not know answer for all 11 questions about specific features of managed care, but the proportion of parents with managed care-covered children who gave wrong/do not know answers for these 11 questions ranged from 41% to 84%. More than half of parents gave wrong/do not know answers to 10 of the 11 questions about specific managed care features, regardless of whether their child was covered by managed care. Most parents reported that if their child were covered by managed care, they would bring the child to the emergency department without prior approval for 4 minor childhood illnesses. For each of these illnesses, at least two thirds of parents said that they would bring their child in without prior approval, ranging from 72% of parents for a child with diarrhea to 90% for a child with a sprained ankle. Latino ethnicity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2–3.1), having a nonmanaged care-covered child (OR, 2.3; 95% CI, 1.5–3.7), and having a managed care-covered child but being unaware of the managed care coverage (OR, 2.9; 95% CI, 1.6–5.2) were associated with greater adjusted odds of incorrect/do not know parental definitions of managed care. Low family income and limited English proficiency were consistently associated with a significantly higher adjusted odds of wrong/do not know answers about specific managed care features. In multivariable analyses, Latino parents were significantly more likely to bring a managed care-covered child with a minor illness to the emergency department without prior approval.Regardless of whether their children have managed care coverage, most inner-city parents interviewed in this study do not know what managed care is, have insufficient knowledge of managed care rules and practices, and believe that prior approval for emergency department visits for mild childhood illnesses is unnecessary. These findings indicate that many urban parents may need better, more comprehensible information about managed care, particularly those who are poor, Latino, and have limited English proficiency.