Research by Author & Topic

Publications by Embry M. Howell on Uninsured/Uncompensated Care

This report synthesizes findings from case studies conducted in 2001 and 2002 in ten states selected for the Congressionally Mandated Evaluation of SCHIP: California, Colorado, Florida, Illinois, Louisiana, Missouri, New Jersey, New York, North Carolina, and Texas (Hill et al. 2002). Discussion addresses such issues as program design, outreach and enrollment strategies, benefits, service delivery systems, cost sharing, crowd out prevention, parental coverage, financing, and coordination of SCHIP and Medicaid. Overarching conclusions identify lessons learned from effective implementation.

This report presents early findings of an evaluation of San Mateo County's Health System Redesign and Adult Coverage Initiative (ACE), an effort to improve effectiveness, efficiency, and care coordination among uninsured and underserved adults in the county. Enrollment in the ACE program has exceeded expectations, yet sustained financing for the program has yet to be identified. We have observed reforms in scheduling, team-based care, and the implementation of electronic medical records. However, we found significant barriers to access for primary care and specialty appointments. This analysis is the first of several ongoing evaluation reports by the Urban Institute and UCSF.

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), to ensure that all children have access to comprehensive health insurance coverage. Healthy Kids covers uninsured children below 400 percent of poverty and primarily serves poor, undocumented Latino children. A survey of parents of Healthy Kids enrollees found that in the first year of enrollment, children experienced improvements in access to and use of medical and dental care; a reduction in missed school days due to health problems; reduced unmet need; increased parent confidence in getting care and satisfaction with quality; and reduced financial worries. Moreover, use of preventive and dental services continued to improve during the children's second and third years of continuous enrollment.

This brief presents data on mental health coverage benefits and enrollees' access to and use of mental health services through the Healthy Kids program in San Mateo County, California. The prevalence of mental health conditions among enrollees is similar to national levels, but despite the generous mental health benefits offered under the program, only a small fraction of enrollees with mental health conditions receive care. Reasons why more children do not use mental health services are explored. The brief also shows that enrollees with mental health needs have higher use of other health services compared to all Healthy Kids members.

At least 10 percent of low-income American children have emotional and behavioral problems. States have adopted widely different ways of financing and delivering children's mental health services. This brief provides new information on SCHIP coverage of mental health services, and on the prevalence of mental health problems among children by income and health insurance coverage. Since Medicaid and SCHIP cover most low-income children and provide relatively generous coverage of mental health compared with private insurance, they provide important access to child mental health services. Medicaid and SCHIP agencies could better assess and coordinate mental health services for low-income children.

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), a program to ensure that 100 percent of children have access to comprehensive health insurance coverage. This first annual CHI evaluation report shows that, in its early months, the CHI achieved rapid enrollment growth in its new insurance product, "Healthy Kids." Utilization of services was low in the initial months. This successful outreach and enrollment is a product of intensive and sustained collaboration among the CHI partners. Future evaluation reports will document the impact of the program on access to care and cost.

This article provides a review the literature on the cost-effectiveness of health services for returning prisoners. The review focuses on studies related to screening and treatment for five conditions disproportionately prevalent among returning prisoners: HIV/AIDS, sexually transmitted diseases, tuberculosis, mental illness, and substance abuse. Research suggests that programs addressing these conditions are cost-effective. However, there are not enough well designed studies that include returning prisoners—or very similar populations—to draw definitive conclusions. More research is needed to assess the impacts of such programs on returning prisoners. (Journal of Correctional Health Care 10(3), 2004.)

This brief examines the experience of four states -- Minnesota, New Jersey, Rhode Island, and Wisconsin -- which have used waivers to cover parents under their State Children's Health Insurance Program (SCHIP). The brief explores the reasons that these states chose to cover parents, and their early experiences with parental coverage. The experience of these initial four states shows that, once offered, the demand for such coverage is high and SCHIP waivers can be a relatively straightforward way to implement family coverage.