Research by Author & Topic

Publications by Embry M. Howell on Medicaid

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.

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.

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.

This brief presents highlights from rigorous, independent evaluations of the Healthy Kids programs in three California counties, Los Angeles, San Mateo, and Santa Clara. The three Healthy Kids programs provide children with comprehensive health insurance coverage. Children are eligible for Healthy Kids if they are ineligible for California's two major state insurance programs, Medi-Cal and Healthy Families, and live in families with incomes up to 300 percent of the federal poverty level (FPL) in Los Angeles and Santa Clara counties, and 400 percent of the FPL in San Mateo County. This brief describes some of the many positive impacts that Healthy Kids programs have had on children, including improvements in their access to and use of medical services and reductions in their unmet need for care.

As part of a multi-year evaluation of the Healthy Kids program in Los Angeles, we analyzed service utilization of Healthy Kids enrollees ages 0 to 18 using health plan encounter and claims data and assessed these data for completeness. Results suggest that actual service rates are higher than administrative data indicate. Other evidence from the evaluation suggests that some services are likely reimbursed by Restricted/Emergency Medi-Cal, and other services are provided just prior to enrolling in Healthy Kids. As a result, some encounters are not captured in health plan data for Healthy Kids, and will present challenges for ongoing program monitoring.

This study examines the costs and service use for children enrolled in public health insurance in San Mateo County, California using encounter data from the Health Plan of San Mateo. In that county, the financing burden for children’s public health insurance programs is concentrated in the top tenth of health care users, while the other 90% of children are very inexpensive. This finding suggests that early identification and greater efficiency in care management for high-cost children could free up funding to expand public insurance services to more low-cost children. As states evaluate the feasibility of public health care for all children, it is important to examine the distribution of costs and services within existing programs, in order to better plan services for the highest cost children.

Even though most low income children in the U.S. are entitled to public health insurance, many children are still uninsured. One reason for this problem is that when insurance expires (after, for example, one year of enrollment) parents may fail to re-enroll their child. This report examines rates of renewal in three public health insurance programs in San Mateo County, California: Healthy Families, Healthy Kids, and Medi-Cal. Renewal rates were low in all three programs; only about 50 percent of children renewed coverage after a year. The report provides recommendations regarding improving monitoring systems for tracking retention over time.

During difficult economic times, many California counties have expanded health insurance coverage for low-income children. These Children's Health Initiatives (CHIs) enroll children in public programs and provide new health insurance, Healthy Kids, for those ineligible for existing programs. This article describes the policy issues in implementing the Santa Clara and San Mateo County CHIs, as well as the children's enrollment levels and utilization of services. These CHIs are among the first of the thirty California counties planning or implementing such initiatives. Their success depends on leadership from county agencies that have not traditionally worked closely together, as well as the development of a diverse public and private funding base. This effort to provide universal coverage for all children is important to national policymakers desiring similar goals.

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. This third annual CHI evaluation report describes the demographic and health status characteristics of children enrolled in three public health insurance programs served by the CHI; how service use has changed over time; characteristics of high cost users of services and how they differ from other children; access to dental services and mental health services; the role of schools in outreach and enrollment; and the factors influencing employer decisions to offer insurance for dependents.

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.