Youth with sickle cell disease (SCD) are at risk for functional limitations and poor health-related quality of life (QoL). This study examined sociodemographic factors that may interact with medical complications to reduce functional ability and QoL among youth with SCD. Fifty-three patient/caregiver pairs (children 8 to 18 years; M=12.3 y) with SCD completed the Functional Disability Inventory and Pediatric Quality of Life Inventory questionnaires. Medical database reviews were conducted to collect health care utilization, disease complications, and sociodemographic information; insurance type (public vs. private insurance) and family zip code to access Census tract data reflecting neighborhood distress. Insurance type, but not neighborhood sociodemographic risk indicators, was significantly associated with disease-related complications and QoL. There were significant differences in both health care utilization and QoL by insurance type. Complications were higher in the group with public insurance. Insurance type seems to be more strongly related to disease outcomes and QoL than neighborhood sociodemographic distress. Closer attention to the contribution of insurance type to health outcomes may provide important insight to potential barriers for disease management. These issues are critically important for health care efficiency and equity for poor and underserved children with chronic health conditions.