Citation URL: http://www.urban.org/LisaDubay

A large number of California counties have taken bold steps to extend health insurance to all poor and near-poor children through county-based Children's Health Initiatives. The Los Angeles Healthy Kids program extends coverage to uninsured children in families with incomes below 300 percent of the federal poverty level who are ineligible for Medi-Cal (California Medicaid) and Healthy Families (its SCHIP). A four-year evaluation of Healthy Kids finds the program has improved access for more than 40,000 children, most of whom are immigrant Latinos, who have almost no access to employer coverage. However, sustaining this program has proved to be challenging.

Two-thirds of children in the United States were income-eligible for Medicaid or the State Children's Health Insurance Program (SCHIP) at some point from 1996 to 2000. One in five children were income-eligible for both programs, and 73 percent of children ever eligible for SCHIP were eligible at other times for Medicaid. As SCHIP is reauthorized, Congress will need to give states the tools and financial commitment to assure that uninsured children are enrolled in and retain the coverage for which they are eligible.

A longitudinal survey of parents of enrollees in the Los Angeles Healthy Kids Program has found that the program had significant positive impacts on children’s health and access to care. Children experienced improvements in access to and use of ambulatory, specialty and dental care; reduced unmet need; increased parent confidence in getting care and satisfaction with quality; and reduced financial worries. Most important, children’s health status improved, as perceived by parents and according to several measures. Healthy Kids covers uninsured children below 300 percent of poverty who are ineligible for Medicaid or SCHIP, and primarily serves poor, undocumented Latino children.

Congress mandated in the Balanced Budget Refinement Act of 1999 (BBRA) that the Secretary of the U.S. Department of Health and Human Services conduct an independent comprehensive study of the State Children's Health Insurance Program (SCHIP). This report presents the findings from the mandated surveys of SCHIP enrollees and disenrollees in 10 states (conducted during 2002). SCHIP programs were found to provide health coverage to the population SCHIP was intended to serve, primarily children who would otherwise have been uninsured. The programs availed enrollees of needed primary and other health care services, and were found to have a positive impact on enrollees' access to health care services, leaving enrollees with fewer unmet needs than they would have had in the absence of SCHIP. Families were satisfied with the ease of enrolling children, many of whom remained enrolled for 12 months, depending on the state.

This paper examines the extent to which the State Children’s Health Insurance Program (SCHIP) might be substituting for private health insurance coverage at the time of enrollment. Among children who were newly enrolled in SCHIP in 2002 in ten states, about 14 percent had private coverage that they could have retained as an alternative to SCHIP. Of this 14 percent, about half of parents reported that the private coverage was unaffordable compared with SCHIP. This suggests that relatively few SCHIP enrollees could have retained private coverage and that even fewer had parents who felt that the option was affordable.

This report summarizes the findings from a survey of parents of Healthy Kids enrollees aged 1 to 5 in Los Angeles County. The Los Angeles Healthy Kids program was implemented in July 2003 and provides insurance coverage to low income, uninsured children, who are ineligible for Medi-Cal or Healthy Families. This report is one of a series evaluating the Healthy Kids program in L.A. and analyses the demographic characteristics of enrolled children, their health status, health care access and use experiences, parental impressions of the enrollment and renewal processes, among other topics. One year from now, a second survey report will provide results from the longitudinal follow-up with the same parents and will assess the impact of the Healthy Kids program in L.A.

The Healthy Kids program in Los Angeles, California provides health insurance coverage to uninsured low-income children. This brief shows strong evidence that Healthy Kids program has improved access to medical and dental care for its enrollees. According to a survey of parents, young children enrolled in Healthy Kids for a year were much more likely to have a usual source of medical and dental care. Use of medical care increased with enrollment in the program. Enrollment also increased parents' confidence that they could obtain needed medical care for their children and reduced their financial burdens.

This paper considers four programs--Medicaid and the State Children's Health Insurance Program (SCHIP), food stamps, child care subsidies, and the earned income tax credit (EITC)--that form the core work support system in the United States. It highlights differences in program funding, eligibility, and delivery systems. It describes trends in participation and synthesizes research knowledge about the observed differences in program participation. The paper concludes that these programs do not form an effective system. Each program operates under different rules that many low-income working families find daunting. A few recent state innovations offer potential for improving the system.

This Congressionally mandated evaluation found the SCHIP program to be successful in nearly all of the areas examined. The findings reveal an effective program. For example, the findings demonstrate that states were prompt to develop generous programs and design effective outreach strategies to attract and enroll children, and that states adopted simplified application and enrollment processes to aid families and retain enrollees. SCHIP programs were found to provide health coverage to the population SCHIP was intended to serve, particularly to children who would otherwise have been uninsured. The programs availed enrollees of needed primary and other health care services, leaving enrollees with fewer unmet needs than they would have had in the absence of SCHIP. Families were satisfied with the ease of enrolling children, many of whom remained enrolled for 12 months, depending on the state.

This study assesses the impact of mandatory Medicaid managed care in Missouri, relative to fee-for-service on prenatal care, maternal behavior, and low birth weight among pregnant women. Using birth certificate data linked to Medicaid enrollment data in 1995 and 2000, the authors found that managed care appears to have a positive effect on smoking cessation among pregnant women, but a negative effect on prenatal care and no effect on birth weight. The authors concluded that managed care appears to have a positive impact on smoking cessation but other policy changes may be needed to improve birth outcomes. (Sommers, Anna S., Kenney, Genevieve, and Dubay, Lisa. July 2005. "Implementation of Mandatory Medicaid Managed Care in Missouri: Impacts for Pregnant Women." American Journal of Managed Care 11(7): 433-442.)

Return to list of authors