Publications by Sarah Benatar for Health Policy Center

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

In 2008 San Mateo County, California launched its Adult Coverage Expansion and Systems Redesign Initiative. The initiative expanded coverage for all uninsured adults below 200 percent of the poverty level and redesigned care in county safety net clinics. The program substantially improved access to care for uninsured adults, as well as improved continuity and quality of care for those served by county safety net clinics. However, access remains a problem for new enrollees, due to restrained provider supply and the economic recession. The report provides lessons for other counties as they expand coverage under national health reform.

This second case study of the implementation of Best Start LA finds that the place-based investment—designed to improve the well-being, development and care experienced by children ages five and under—has made good progress during its second year, gaining momentum as it has become more firmly established in the downtown Metro LA pilot community. Welcome Baby! home visiting appears to be a high-quality service that could serve as a model throughout Los Angeles County. Community strategies have been funded through a series of "first step" contracts with various local agencies. And systems-level efforts appear to be laying the groundwork for important changes that could make Los Angeles communities more family-friendly for parents with young children.

A case study of the initial implementation of Best Start LA-a place-based community investment in Los Angeles County designed to improve the well-being, development, and care experienced by children ages five and under-finds mostly positive results, thus far. At the family level, home visiting for pregnant and parenting mothers is off to a strong start, rendering services to nearly 750 families by the end of 2010. Community-level efforts to mobilize community members and develop family-support strategies have been slower to develop. Systems-level investments to develop family-friendly policies and services across the county are proceeding on schedule.

An evaluation of San Mateo County's comprehensive health system redesign initiative finds notable improvements in access to high quality patient care for formerly uninsured adults. For example, the percent of such individuals having a usual source of care rose from 42.5 to 91.2 percent with the initiative. The initiative met with success despite mounting fiscal challenges associated with the economic recession and state budget crisis – threatening the county's ability to support these innovations. The county's efforts offer lessons for local and national policymakers, program administrators, and providers about how progress is possible despite severe financial obstacles.

This report assesses the administrative, fiscal, and political feasibility of implementing a universal childhood vaccine purchasing program in New York State. Program benefits, stakeholder impacts, and implementation challenges were considered through interviews with key stakeholders, program managers in states with universal vaccine purchasing programs, and independent experts. Costs were estimated from population data, immunization schedules, and a range of possible purchase prices. Findings illustrate that a universal vaccine purchasing program is feasible in New York and could result in benefits for children and primary care providers, but ought to build upon existing infrastructure and incorporate lessons from other states' experiences.

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 report examines the state of the L.A. Healthy Kids program in light of recent economic and political challenges. In particular, this paper explores what may be lost if Healthy Kids' must close due to insufficient funds for children 6-18 premiums. Implications of closing the program identified include the loss of health insurance coverage for roughly 80,000 children across California, a weakened health care safety net, decreased health care access for adults and parents, loss of an outreach funding source in Los Angeles county, far-reaching effects on children's attendance and school performance, and loss of momentum towards universal children's coverage.

This report presents findings from the first 18 months of an evaluation of San Mateo County's Health System Redesign and Adult Coverage Initiative (ACE), an effort to improve access to high quality care for uninsured and underinsured adults and improve the financial sustainability of the San Mateo Medical Center (SMMC) and related delivery systems. The County has begun implementation of team-based care, disease management, Advanced Access scheduling, and electronic medical records. Enrollment in the ACE program continues to exceed expectations, and data collected for the evaluation show increased access to care and receipt of doctor visits.

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.

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