Publications by Ian Hill for Health Policy Center

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More about Ian Hill's areas of expertise can be found on this Urban Institute expert's page.

This report synthesizes findings from case studies conducted in 2001 and 2002 in ten states selected for the Congressionally Mandated Evaluation of SCHIP: California, Colorado, Florida, Illinois, Louisiana, Missouri, New Jersey, New York, North Carolina, and Texas (Hill et al. 2002). Discussion addresses such issues as program design, outreach and enrollment strategies, benefits, service delivery systems, cost sharing, crowd out prevention, parental coverage, financing, and coordination of SCHIP and Medicaid. Overarching conclusions identify lessons learned from effective implementation.

For the Robert Wood Johnson Foundation's Covering Kids and Families evaluation (CKF), researchers conducted focus groups to explore parents' experiences accessing health care for their children, and to assess whether these experiences affected decisions to enroll their children in Medicaid or the State Children's Health Insurance Program (SCHIP). In each community, groups were conducted with parents of children insured by Medicaid or SCHIP and parents of uninsured children. Researchers concluded that even when parents encountered problems accessing care, very few indicated that this discouraged them from enrolling their children into Medicaid or SCHIP, or from renewing their children's public coverage.

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.

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.

In 2005 The Children's Trust of Miami-Dade County initiated HealthConnect in Our Community, designed to improve the health of children and adolescents in the county. The program uses community workers to reach out to underserved children and their families. The Urban Institute and three local consultants conducted a formative assessment the program's first year of operation. In a six-day site visit we interviewed 26 individuals, observed program operations in 19 separate locations, and conducted five focus groups, three with clients and two with program staff. This report summarizes the findings from the evaluation, and provides recommendations for improving the program.

HealthConnect in Our Community is one component of a three-part initiative to address the health and related needs of children in Miami-Dade County. This report provides findings from five focus groups, two with community workers and three with parents. Both staff and parents are pleased with the program. They believe that the greatest strength of the program is its responsiveness to the cultural diversity represented in Miami-Dade County. The focus group participants also provided some areas for improvement, such as the need to raise the program's visibility in the community; improve targeting of services; and standardize data collection protocols.

A second series of focus groups with parents of children enrolled in the Los Angeles Healthy Kids program found that opinions of the program remain favorable despite its recent fiscal challenges. Healthy Kids had provided comprehensive, affordable coverage to nearly 45,000 poor children from birth through age 18 until mid-2005, but funding shortfalls led the program to cap enrollment for older children and enrollment levels for all children subsequently slipped. Still, the program remains highly valued by parents for providing high quality, comprehensive coverage and parents report good access to linguistically appropriate care and affordable out-of-pocket costs.

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.

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.

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