View Research by Author - Jennifer M. Haley

Publications

The number of children eligible for and enrolled in Medicaid and CHIP increased in recent years. As a consequence, the number of eligible but uninsured kids fell by about 340,000 between 2008 and 2009. Rates of participation in Medicaid/CHIP increased, from 82.1 to 84.8 percent nationally, with sixteen states achieving participation rates of 90 percent or higher in 2009. This report suggests that the high participation rates among children over the past few years are likely due in part to ongoing federal and state policy efforts aimed at improving enrollment and retention among children.

This report uses the 2005 Kaiser Low-Income Coverage and Access Survey to examine low-income parents' perceptions of access and quality of care for the uninsured. The findings indicate that most low-income parents perceive that the uninsured do not have access to affordable medical and dental care and that the quality of care they receive is lower than for the insured. Low-income parents also have generally positive perceptions of Medicaid, indicating that efforts to increase eligibility and enrollment in Medicaid such as those included in current health care reform proposals would reduce uninsurance among this population.

This brief examines the dental access problems experienced by adults ages 19 to 64 in families with incomes at or below 200 percent of the Federal Poverty Level (FPL) using the 2005 Kaiser Low-Income Coverage and Access Survey. This report finds that both dental coverage and access to care are limited for low-income adults and that even low-income adults with dental coverage are not getting sufficient levels of needed dental care.

Using the 2001 National Survey of Children With Special Health Care Needs, the authors find that many low-income parents with uninsured children with special health care needs do not have full information about Medicaid and State Children's Health Insurance programs (SCHIP) or have concerns about the application processes. Although 93.5% of these children's parents had heard of at least 1 of the 2 programs, only 54.6% believed that their child was eligible for public coverage, and just 48.1% believed that the application processes were easy. Initiatives to increase enrollment should yield real dividends given that the vast majority of low-income uninsured children with special health care needs have parents who say they would enroll their children in public coverage.

This paper uses data from the 1999 and 2002 rounds of National Survey of Americas' Families to examine variation and trends in the duration of uninsurance. The results show that 49 million people were uninsured at some time during the 2001-2002 period, with over half (26 million) being uninsured for 12 months or longer. Rates of short-term uninsurance for various subgroups were often similar, while rates of long-term uninsurance varied widely and accounted for large differences in overall uninsurance rates. Although a slightly smaller share of the population was uninsured for 12 months or more in 2002 than in 1999, the overall change in the rate of uninsurance was small.

This paper uses data from the 1997 and 1999 National Survey of America's Families to compare access and utilization between American Indians/Alaska Natives (AI/ANs) and non-Hispanic whites. We used multivariate regressions to adjust odds ratios for access and utilization and to estimate the effects of the Indian Health Service (IHS). AI/ANs had less insurance coverage and worse access and utilization than whites. However, among the low-income population, AI/ANs with only IHS access fared better than uninsured AI/ANs and as well as insured whites for key measures but received less preventive care. Over half of low-income uninsured AI/ANs do not have access to the IHS. The IHS partially offsets lack of insurance for some uninsured AI/ANs, but important needs were potentially unmet. (American Journal of Public Health 94(1): 53–59, January 2004.)

Data from the third round of the National Survey of America's Families show that between 1999 and 2002, the number of uninsured children under age 19 fell from 9.6 to 7.8 million. The uninsurance rate among low-income children declined by nearly six percentage points. Regardless of family income, uninsurance rates among black and Hispanic children declined by more than four percentage points each. Receipt of well-child care, office visits, and dental care by low-income children increased by 3.5 percentage points, 4.5 percentage points, and 2.1 percentage points respectively. More than 4 million uninsured children appear eligible for Medicaid or SCHIP.

Data from the third round of the National Survey of America's Families show that between 1999 and 2002, the share of low-income uninsured children whose parents had heard of their state's separate SCHIP program increased from 47.2 to 70.6 percent. Among families familiar with Medicaid or SCHIP, 81.7 percent of low-income uninsured children had parents who said they would enroll their child if told the child was eligible.

Using data from the National Survey of America's Families, this paper examines insurance coverage changes for Medicaid-eligible citizen children between 1997 and 1999, early in the implementation of federal welfare reform. More than 20 million children qualified for Medicaid, but many were uninsured. Insurance coverage deteriorated for eligible children between 1997 and 1999, largely due to dramatic declines in cash assistance participation. This paper shows that following federal welfare reform, states have faced new challenges reaching and enrolling the growing numbers of eligible children who are not connected with the welfare system. (Haley, Jennifer, and Genevieve Kenney. Summer 2003. "Coverage Gaps for Medicaid-Eligible Children in the Wake of Federal Welfare Reform." Inquiry 40(2): 158-168.)

This report, the first from a congressionally mandated evaluation, draws on case studies in six of the ten states included in the national evaluation, focus groups, preliminary data from a survey of low-income uninsured families nationwide, and enrollment records from three states. The authors found that states acted quickly and made great use of the flexibility afforded by the SCHIP statute to design their programs, although they did face many implementation challenges. Despite the challenges that remain, evidence to date suggests that SCHIP is a successful program popular among legislators, families, advocates, and providers alike. [Read the corresponding press release.]

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