View Research by Author - Brigette Courtot

Brigette Courtot is a Research Associate in the Urban Institute's Health Policy Center. Her current work focuses on Medicaid and Children's Health Insurance Program (CHIP) policies relating to eligibility and enrollment, managed care delivery systems, and health care quality measurement. Prior to joining the Urban Institute, she was Senior Policy Analyst for Health and Reproductive Rights at the National Women's Law Center, where she examined women's access to health coverage, implementation of the federal health reform law, and how various public policies affect women's health outcomes. In her previous tenure at the Urban Institute (2003-2007) she conducted maternal and child health services research with an emphasis on access to care for underserved populations, including work on both the San Mateo County and Los Angeles County Healthy Kids program evaluations and the national Covering Kids and Families program evaluation. She holds a bachelor's degree from Northwestern University and a Master in Public Health degree from the Johns Hopkins University Bloomberg School of Public Health.

Publications

Work Support Strategies (WSS) is a multiyear, multi-state initiative to implement reforms that help eligible low-income families get and keep a full package of work support benefits, including Medicaid, nutrition assistance (SNAP), and child care assistance. This report describes South Carolina's accomplishments and lessons learned during the initiative's first year. During this year, the two primary agencies involved in delivering work support program benefits in the state began breaking down the barriers between them to create a more efficient, coordinated approach. The state undertook activities to improve the business and technological processes used within each agency while also identifying areas for cross-program alignment.

Even in the wake of the Supreme Court ruling that made the Affordable Care Act's (ACA) Medicaid expansion voluntary for states, Medicaid remains a centerpiece in the law’s effort to expand coverage and reform the nation’s health care system. In addition to the now-optional eligibility expansion, the ACA includes many other Medicaid-related provisions, such as the option to expand Medicaid early (before 2014), the requirement to modernize eligibility and enrollment systems, and testing of new delivery systems. A related provision gives states the option to create a Basic Health Program that could resemble Medicaid. This brief describes ten states’ experiences with and decisions about implementing these selected major Medicaid provisions. At this juncture in ACA implementation, the states are assiduously working on many different fronts to prepare for the 2014 coverage expansions while also taking advantage of various ACA-related opportunities to save costs and improve their programs.

A longstanding leader in private- and public-sector health reform, Minnesota is making remarkable progress implementing the Patient Protection and Affordable Care Act (ACA), despite a challenging political environment. The state’s ability to accomplish as much as it has including the creation of two task forces, securing multiple grants to support different pieces of ACA implementation, adopting the early Medicaid expansion, implementing early insurance reforms, and taking vigorous steps toward building an effective Exchange in time to meet challenging federal deadlines testifies to remarkable collaboration between multiple state agencies and stakeholders in transforming the state’s health system.

This brief draws on the experiences of five states-Colorado, Kansas, Minnesota, New York and Oregon—that received federal State Health Access Program (SHAP) grant funding to expand health coverage using approaches that included community-based outreach and improvements to Medicaid/CHIP eligibility and enrollment processes. We describe the best practices that these states shared with regards to activities related to outreach, streamlining application and enrollment processes, and modernizing eligibility determination systems, and consider the implications of these practices for implementing the Affordable Care Act (ACA).

The Affordable Care Act (ACA) requires that most Americans have health insurance by January 1, 2014. To help achieve this coverage goal, the ACA includes several provisions calling for major changes in state eligibility and enrollment processes currently used in public health insurance programs. To a large extent much of the responsibility for creating these eligibility and enrollment systems resides with the states. In this brief we draw on the experiences of five states—Colorado, Kansas, Minnesota, New York and Oregon—that had begun modernizing their eligibility and enrollment systems and processes prior to the ACA. We describe the best practices that these states have employed with regard to these activities, and consider the implications of these practices for implementing the ACA.

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.

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