View Research by Author - Lisa Dubay

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

This brief examines the characteristics of the children who were eligible for Medicaid/CHIP in 2007. The results show that while participation rates were high in both Medicaid and CHIP, some 5 million remained uninsured despite being eligible for coverage. Participation rates, which were found to vary across areas, have likely increased given recent declines in the number of uninsured children. The brief also shows that while interest in public coverage is high among low-income parents, many do not know not know that their child is eligible for Medicaid/CHIP, do not know how to apply, and/or find the application process difficult.

In this analysis, a health reform scenario is modeled that would expand Medicaid to an estimated 17.0 million uninsured individuals with incomes up to 133 percent of the federal poverty level (FPL), would provide subsidies to 16.3 million uninsured individuals with incomes between 133 and 399 percent of the FPL, and would require an additional 4.3 million uninsured individuals to obtain coverage through an individual mandate, though they would not be eligible for Medicaid or subsidies. The first brief contains an overview of the entire nonelderly uninsured population, and the three remaining briefs address children, parents and childless adults, respectively.

The Los Angeles Healthy Kids program provides health insurance to low income children in the county who have no other source of coverage (including undocumented children and children above the income limits for Medi-Cal and Healthy Families). These findings from a longitudinal survey of parents of young children in the program indicate that access to medical and dental care for enrolled children increased dramatically over time, use of the emergency room went down, and parents perceived improvements in the health status of their children. This analysis is one piece of a broader Urban Institute evaluation of the program.

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.

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.

Two-thirds of children in the United States were income-eligible for Medicaid or the State Children's Health Insurance Program (SCHIP) at some point from 1996 to 2000. One in five children were income-eligible for both programs, and 73 percent of children ever eligible for SCHIP were eligible at other times for Medicaid. As SCHIP is reauthorized, Congress will need to give states the tools and financial commitment to assure that uninsured children are enrolled in and retain the coverage for which they are eligible.

A longitudinal survey of parents of enrollees in the Los Angeles Healthy Kids Program has found that the program had significant positive impacts on children’s health and access to care. Children experienced improvements in access to and use of ambulatory, specialty and dental care; reduced unmet need; increased parent confidence in getting care and satisfaction with quality; and reduced financial worries. Most important, children’s health status improved, as perceived by parents and according to several measures. Healthy Kids covers uninsured children below 300 percent of poverty who are ineligible for Medicaid or SCHIP, and primarily serves poor, undocumented Latino children.

Congress mandated in the Balanced Budget Refinement Act of 1999 (BBRA) that the Secretary of the U.S. Department of Health and Human Services conduct an independent comprehensive study of the State Children's Health Insurance Program (SCHIP). This report presents the findings from the mandated surveys of SCHIP enrollees and disenrollees in 10 states (conducted during 2002). SCHIP programs were found to provide health coverage to the population SCHIP was intended to serve, primarily children who would otherwise have been uninsured. The programs availed enrollees of needed primary and other health care services, and were found to have a positive impact on enrollees' access to health care services, leaving enrollees with fewer unmet needs than they would have had in the absence of SCHIP. Families were satisfied with the ease of enrolling children, many of whom remained enrolled for 12 months, depending on the state.

This paper examines the extent to which the State Children’s Health Insurance Program (SCHIP) might be substituting for private health insurance coverage at the time of enrollment. Among children who were newly enrolled in SCHIP in 2002 in ten states, about 14 percent had private coverage that they could have retained as an alternative to SCHIP. Of this 14 percent, about half of parents reported that the private coverage was unaffordable compared with SCHIP. This suggests that relatively few SCHIP enrollees could have retained private coverage and that even fewer had parents who felt that the option was affordable.

This report summarizes the findings from a survey of parents of Healthy Kids enrollees aged 1 to 5 in Los Angeles County. The Los Angeles Healthy Kids program was implemented in July 2003 and provides insurance coverage to low income, uninsured children, who are ineligible for Medi-Cal or Healthy Families. This report is one of a series evaluating the Healthy Kids program in L.A. and analyses the demographic characteristics of enrolled children, their health status, health care access and use experiences, parental impressions of the enrollment and renewal processes, among other topics. One year from now, a second survey report will provide results from the longitudinal follow-up with the same parents and will assess the impact of the Healthy Kids program in L.A.

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