Publications by Brigette Courtot for Health Policy Center

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

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.

This brief presents data on mental health coverage benefits and enrollees' access to and use of mental health services through the Healthy Kids program in San Mateo County, California. The prevalence of mental health conditions among enrollees is similar to national levels, but despite the generous mental health benefits offered under the program, only a small fraction of enrollees with mental health conditions receive care. Reasons why more children do not use mental health services are explored. The brief also shows that enrollees with mental health needs have higher use of other health services compared to all Healthy Kids members.

A series of focus groups with parents of children enrolled in the Los Angeles County Healthy Kids program found that the program is providing families with a highly valued service in the form of comprehensive health insurance coverage, permitting their children easier access to care, making health services more affordable, and increasing options for where and when to obtain care. The groups explored parents' feelings about and experiences with Healthy Kids, which extends coverage to uninsured children from birth through age 18 in families with income below 300 percent of the federal poverty level who are ineligible for Medicaid or SCHIP.

The Los Angeles Healthy Kids program extends health coverage to uninsured children from birth through age 18 in families with income below 300 percent of the federal poverty level who are ineligible for Medicaid or SCHIP. Results from the first case study report on Healthy Kids implementation indicate that the program is off to a very positive start. Researchers found that the program's effective community-based outreach and simplified enrollment have fueled strong enrollment, its benefits package and managed care provider network were carefully designed to meet the needs of vulnerable children, and that Healthy Kids has been implemented smoothly.

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.

A series of focus groups with parents of children enrolled in the Los Angeles County Healthy Kids program found that the program is providing families with a highly valued service in the form of comprehensive health insurance coverage, permitting their children easier access to care, making health services more affordable, and increasing options for where and when to obtain care. The groups explored parents' feelings about and experiences with Healthy Kids, which extends coverage to uninsured children from birth through age 18 in families with income below 300 percent of the federal poverty level who are ineligible for Medicaid or SCHIP.

The Los Angeles Healthy Kids program extends health coverage to uninsured children from birth through age 18 in families with income below 300 percent of the federal poverty level who are ineligible for Medicaid or SCHIP. Results from this first case study report on Healthy Kids implementation indicate that the program is off to a very positive start. Researchers found that the program's effective community-based outreach and simplified enrollment have fueled strong enrollment, its benefits package and managed care provider network were carefully designed to meet the needs of vulnerable children, and that Healthy Kids has been implemented smoothly.

State policymakers are using the flexibility built into Title XXI to manage their SCHIP programs, cutting or expanding as fiscal conditions permit. This conclusion is based on our third annual survey of SCHIP directors in the 13 ANF states, which explored the impacts of budget pressures on child health insurance policies in 2004. On the plus side, several states reversed previous cuts; for example, every ANF state that capped enrollment in 2003 lifted the cap in 2004. However, states kept many of their prior years' cuts in place during '04, and some imposed new restrictions.

Interviews with SCHIP administrators in 13 states indicate that cuts to SCHIP in FY 2003 were more widespread than in 2002. Virtually all states reduced or eliminated outreach activities. Four states either froze enrollment or reduced eligibility thresholds. Half the states raised premiums and copayments for program participants. Five states either froze or cut provider reimbursement. Compared with other areas in state budgets, state officials universally described SCHIP cuts as among the smallest, and last, to be adopted, reflecting policymakers' strong support of the program. In addition, most states continued to simplify enrollment, and generous benefits were maintained in all but two states. Despite the deeper cuts, states' capacity to insure children remains much stronger than before the creation of SCHIP in 1997.

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