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

In 2005 The Children's Trust of Miami-Dade County initiated HealthConnect in Our Community, designed to improve the health of children and adolescents in the county. The program uses community workers to reach out to underserved children and their families. The Urban Institute and three local consultants conducted a formative assessment the program's first year of operation. In a six-day site visit we interviewed 26 individuals, observed program operations in 19 separate locations, and conducted five focus groups, three with clients and two with program staff. This report summarizes the findings from the evaluation, and provides recommendations for improving the program.

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.

This article examines experiences under Medicaid and the State Children's Health Insurance Program (SCHIP), drawing on surveys of over 3,000 enrollees in California and North Carolina in 2002. In both States, Medicaid enrollees were less likely than SCHIP enrollees to have parents who were covered by employer-sponsored insurance (ESI). With the exception of dental care and provider perceptions, access experiences were fairly comparable across the two programs, despite differences in the characteristics of the children served by the two programs. Relative to being uninsured, Medicaid enrollment was found to improve access to care along a number of different dimensions, controlling for other factors. Furthermore, this study emphasizes the need for continued evaluation of access to care for both programs.

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.

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.

Health planners must invest in programs to maximize effectiveness and reach communities with the highest need. They often lack data to rationally allocate resources based on need. Using data from multiple sources, this study asks whether the resources devoted to outreach activities and the subsequent enrollment services are aligned with estimates of uninsured children among service planning areas and health districts in Los Angeles. Funds for outreach have been relatively well allocated in proportion to the distribution of uninsured children. Differences within SPAs, particularly with respect to outreach contacts and applications completed, were more noticeable. This suggests that some reallocation of outreach investment could lead to expanded coverage in some communities.

This brief examines Medicaid beneficiaries who receive long-term care services using data from the Medicaid Statistical Information Summary files. Medicaid long-term care users accounted for 7 percent of the Medicaid population in 2002 but over half of total program spending. Three-quarters of these dollars were spent on long-term care and 25 percent were spent on acute care and supportive services. About 55 percent of long-term care spenders were elderly and 34 percent were nonelderly disabled individuals. Children and adults not deemed disabled but using long-term services are a unique population whose medical needs should be assessed in light of recent DRA-related Medicaid changes. (Available from the Kaiser Commission on Medicaid and the Uninsured.)

Spending in Medicaid is concentrated among a small percentage of enrollees with very high costs, suggesting opportunities to develop cost-containment strategies that focus on this group while maintaining access to appropriate care. This brief uses data from the Medicaid Statistical Information System Summary File to examine the distribution of Medicaid spending for all enrollees with a focus on "high-cost" individuals. In 2001, 8 percent of Medicaid enrollees exceeded $10,000 in annual spending and accounted for roughly two-thirds of Medicaid dollars. Most other enrollees spent less than $5,000. (Available from the Kaiser Commission on Medicaid and the Uninsured)

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.

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