Publications by Jennifer Pelletier for Health Policy Center

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This paper examines measures of Medicaid and Children’s Health Insurance Program (CHIP) coverage duration available for potential inclusion in a core set of children's health care quality measures as called for by the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009. The authors review possible measures and argue that prospective measures of duration and churning based on cohorts of new enrollees hold the most promise for producing valid estimates and that additional technical and financial resources and enhancements to administrative data systems will be needed to support state efforts in this area of quality assessment.

Many young children have developmental or behavioral problems that could be addressed with appropriate services but are not identified or treated before entering kindergarten, compromising a child's ability to perform up to full potential in school and leading to costly special education and health care interventions later. The patchwork of public programs that finances services creates barriers in access to follow-up services for children identified by diagnostic assessments as having developmental delays or behavioral problems that would benefit from intervention. This brief discusses referrals to services to address developmental delays and behavioral and physical health problems.

Many young children have health, developmental or behavioral problems that are not identified before entering kindergarten, preventing them from receiving early intervention services. Large gaps in early identification exist in Medicaid, the nation's largest health insurance program for children, in which eligible children are entitled to regular screenings. This brief breaks down the shortfalls in receipt of developmental screenings into: not all eligible children are enrolled in Medicaid/CHIP; not all enrollees see a health care provider; and not all providers have the appropriate skills. To address these problems, states can take a number of steps within the Medicaid/CHIP policy environment.

According to the Congressional Budget Office, the Affordable Care Act will result in 16 million new Medicaid enrollees. A key question is whether the new population covered under Medicaid will be less healthy and thus be relatively expensive, or whether they will be healthier and therefore less expensive than the current Medicaid population. The answer to this question depends largely on the level of Medicaid participation rates under reform. Using the Medical Expenditure Panel Survey (MEPS) to provide a detailed look at the demographic and health characteristics of the population who will be newly eligible for Medicaid, we conclude that on average, this population is likely to be healthier and less costly than those currently enrolled in Medicaid.

Kentucky implemented numerous Medicaid policy changes under authority granted by the Deficit Reduction Act of 2005, which allowed greater flexibility in benefit design and cost-sharing. This case study describes these changes and explores their impacts, along with the political, regulatory, and institutional environments that shaped these impacts. While Kentucky succeeded in meeting some of the original goals of the policy changes, further Medicaid changes would be needed to have major impacts on costs and beneficiary behaviors; however, such changes will likely be heavily dependent on how Kentucky weathers the current economic downturn and on the policy changes the state makes associated with federal health reform efforts.

Idaho implemented numerous Medicaid policy changes under authority granted by the Deficit Reduction Act of 2005, which allowed greater flexibility in benefit design and cost-sharing. This case study describes these changes and explores their impacts, along with the political, regulatory, and institutional environments that shaped these impacts. While Idaho succeeded in meeting some of the original goals of the policy changes, further Medicaid changes would be needed to have major impacts on costs and beneficiary behaviors; however, such changes will likely be heavily dependent on how Idaho weathers the current economic downturn and on the policy changes the state makes associated with federal health reform efforts.

Health reform is expected to have a number of positive effects on the lives of children age 18 and under. Millions of uninsured kids are likely to gain coverage through either Medicaid or the new health insurance exchanges. Expanded coverage for parents will also increase children's coverage and access to care. New requirements on private plans, increased Medicaid reimbursement for primary care, and investments in public health and prevention will also likely have positive effects on children. Updated 7/28/10

This report concludes a comprehensive evaluation of The Data & Democracy II project, a program funded by The California Endowment and implemented by UCLA. These organizations sought to increase the capacity of local community-based organizations (CBOs) to collect, analyze, and interpret data to identify and prioritize areas for action. The program was structured after the Train-the-Trainer model, in which a group from local CBOs is trained in these skills and required to disseminate the information by conducting workshops in their own communities. We examine the program's effectiveness, long-term impacts, and challenges through observations, surveys and case studies.

Young adults should benefit from several policy changes that were introduced as part of health reform, particularly the Medicaid expansion, the subsidies offered for coverage through the new health insurance exchanges, the expansion in dependent coverage, and the health insurance market reforms. While many young adults are expected to benefit from health reform, some above 133 percent of the FPL will face penalties for opting out of coverage or will spend more on coverage than they would have otherwise chosen. However, young adults will also benefit from other health care investments in public health, prevention, and chronic disease management.

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.

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