View Research by Author - Brigette Courtot

Publications

With less than two years to go before the Affordable Care Act is fully implemented, the State of Colorado is reasonably well positioned. A bipartisan foundation was built before the ACA became law, and stakeholders have largely worked collaboratively to begin putting various required policies and structures in place. Adopting a "Colorado-specific" version of health reform has been critical for state policymakers in responding to the ACA, and was a key factor in the successful passage of exchange legislation. Strong leadership, bipartisan political support, and continued aggressive action will be needed for Colorado to succeed in implementing reform on time.

In this third of a series of ten briefs on states' implementation of the Affordable Care Act, Urban Institute researchers summarize their findings from a site visit and extensive interviews with Maryland state officials and health care stakeholders. The analysis of the state's progress to date highlights successes and challenges related to insurance exchange planning and information technology development, private insurance market reforms, Medicaid, and provider and insurance markets. Gubernatorial leadership, stakeholder involvement, legislative progress, the state's prior experience in health system reform, and the importance of the state’s all-payer hospital rate-setting system are all discussed.

The Covering Kids and Families program was a national initiative of the Robert Wood Johnson Foundation to reduce the number of eligible but uninsured children and adults through enrollment in Medicaid and SCHIP. This report presents trends in media use and in-person outreach conducted by state grantees and local projects funded through the initiative. While grantees faced funding and staffing limitations, demand for their services remained high due to decreases in state-funded outreach. Grantees stretched their resources by partnering with other organizations, relying heavily on media outreach to reach large numbers of families, and performing outreach at already-established events.

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.

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