View Research by Author - Dana Hughes

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

This report presents early findings of an evaluation of San Mateo County's Health System Redesign and Adult Coverage Initiative (ACE), an effort to improve effectiveness, efficiency, and care coordination among uninsured and underserved adults in the county. Enrollment in the ACE program has exceeded expectations, yet sustained financing for the program has yet to be identified. We have observed reforms in scheduling, team-based care, and the implementation of electronic medical records. However, we found significant barriers to access for primary care and specialty appointments. This analysis is the first of several ongoing evaluation reports by the Urban Institute and UCSF.

This brief presents highlights from rigorous, independent evaluations of the Healthy Kids programs in three California counties: Los Angeles, San Mateo, and Santa Clara. Launched by Children’s Health Initiatives (CHIs) in these counties between 2001 and 2003, the three Healthy Kids programs provide children with comprehensive health insurance coverage, including a broad range of medical, dental, and vision care; prescription drugs; and mental health services. 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. Most of the children enrolled in Healthy Kids have family incomes at or below the poverty level. This brief describes some of the many positive impacts that Healthy Kids programs have had on children’s access and use of dental services. For more information on these and other findings on the three programs, see http://www.urban.org and http://www.mathematica-mpr.com/health/chi.asp.

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.

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.

This brief presents data on dental coverage benefits and enrollee's access and use of dental services through the Healthy Kids program in San Mateo County, California, which offers subsidized health and dental insurance for children living below 400 percent of federal poverty who are ineligible for Medi-Cal and Healthy Families (California's SCHIP program). Healthy Kids dental coverage has led to use of dental services among a sizable portion of enrollees. Children seeking dental services were more costly for the program than other enrollees, and dental care costs accounted for a large proportion of the overall cost of their healthcare. While there is adequate service capacity to meet children’s dental needs in the county, renewed efforts to link enrollees with dental care are needed.

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.

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), a program to ensure that all children have access to comprehensive health insurance coverage. The report describes the governance structure for the CHI; its financing; enrollment growth (for all three public programs); access to services; use and cost of services for all three public programs; satisfaction on the part of both parents and providers; prior insurance and crowd-out; and the effect the initiative has had on hospital finances. Areas identified as needing attention include improving access to after-hours and dental care; increasing the use of preventive service; and developing new sources of financing for the CHI.

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), a program to ensure that 100 percent of children have access to comprehensive health insurance coverage. This first annual CHI evaluation report shows that, in its early months, the CHI achieved rapid enrollment growth in its new insurance product, "Healthy Kids." Utilization of services was low in the initial months. This successful outreach and enrollment is a product of intensive and sustained collaboration among the CHI partners. Future evaluation reports will document the impact of the program on access to care and cost.

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