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

This Urban Institute study, with partner the National Academy for State Health Policy, presents findings from a 50-state analysis of Medicaid outreach and enrollment strategies targeting pregnant women. The study finds significant variation across states, but observes that the majority have policies to facilitate pregnant women's access to coverage through simplified enrollment; however, there is considerable room for improvement in outreach efforts and enhanced prenatal care. The paper presents policy recommendations for state officials to facilitate enrollment of pregnant women, raise public awareness of available coverage, and broaden the scope of prenatal care. The March of Dimes funded this study.

This comparative case study describes the organization, delivery, and content of care of three maternity care models serving low-income women at risk of poor birth outcomes in Wards 5, 6, and 7 in Washington D.C. The first model, a birth center, provides prenatal care, birth services, postpartum follow-up, and infant and child health care. The second is a safety net clinic, which provides a variety of primary health care services, as well as prenatal care services. A not-for-profit teaching and research hospital represents a third option in which prenatal and postnatal care is provided through an on-site obstetric clinic.

The authors use variation across states and over time in managed care (MC) programs for publicly insured children to examine whether effects differ for children with chronic health conditions (CWCHC) and those without. The authors pool data from the 1997 to 2002 National Health Interview Survey and link county, year, and health status information on type of MC programs implemented. Findings show that the effects of MC are concentrated on CWCHC and that CWCHC experience reductions in use of specialist, mental health, and prescription drugs. Capitated programs with mental health or specialty carve-outs are associated with a greater number and larger decreases in service use compared to integrated capitated programs. While it is not possible to determine whether MC programs resulted in more appropriate use of services, corresponding reductions in perceived access were not observed, suggesting that net effects of MC on service use represent improvements in care coordination.

Seven states with separate (as opposed to Medicaid expansion) State Children's Health Insurance Programs (SCHIP) implemented enrollment caps during the 2001–2003 recession. Interviews with SCHIP officials and Covering Kids and Families grantees in these states examined implementation policies and their effects on enrollment, outreach, and public support. Enrollment caps were generally maintained for less than a year and resulted in large spending reductions, but enrollment declined steeply. Most key informants indicated that caps were preferable to reversals of simplified enrollment, comprehensive benefits, and low cost sharing and thus offered policymakers an important tool for controlling costs. [Health Affairs 26, no. 1 (2007): 258–268; 10.1377/hlthaff.26.1.258]

The Covering Kids & Families (CKF) initiative of the Robert Wood Johnson Foundation had two goals: to increase the amount of uninsured children and adults enrolled in Medicaid or the State Children's Health Insurance Program (SCHIP) and to discover ways to sustain the increase after the program's end. This report examines trends in Medicaid and SCHIP enrollment in Oregon between 1999 and 2004, during which time CFK was in operation. In 1999, Oregon entered a budget crisis situation and by the end of 2001 the state had the highest unemployment rate in the nation at 7.5 percent.

The Los Angeles Healthy Kids program, during its first four years, extended comprehensive, affordable coverage to over 40,000 poor and vulnerable children, and improved their access to and use of care. Yet, the program also faced serious challenges, primarily related to financing. Funding for children ages 6 through 18 ran short in spring 2005 and Healthy Kids capped their enrollment. State health reform efforts that could have stabilized funding for the program have failed. Based on interviews with over 40 stakeholders, this case study analyzes the complex challenges that the Los Angeles Healthy Kids program faces at this critical juncture.

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.

The Los Angeles Healthy Kids program, during its first four years, extended comprehensive, affordable coverage to over 40,000 poor and vulnerable children, and improved their access to and use of care. Yet, the program also faced serious challenges, primarily related to financing. Funding for children ages 6 through 18 ran short in spring 2005 and Healthy Kids capped their enrollment. State health reform efforts that could have stabilized funding for the program have failed. Based on interviews with over 40 stakeholders, this case study analyzes the complex challenges that the Los Angeles Healthy Kids program faces at this critical juncture.

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.

The Los Angeles Healthy Kids program extends health coverage to uninsured children from birth through age 18 in families with income below 300 percent of the federal poverty level who are ineligible for Medicaid or SCHIP. Results from the first case study report on Healthy Kids implementation indicate that the program is off to a very positive start. Researchers found that the program's effective community-based outreach and simplified enrollment have fueled strong enrollment, its benefits package and managed care provider network were carefully designed to meet the needs of vulnerable children, and that Healthy Kids has been implemented smoothly.

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