Publications by Brigette Courtot for Health Policy Center

Back to Browse by Author

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

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.

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.

Return to list of authors.