Assessing Community-Based Outreach and Enrollment Activities and Outcomes Relative to Need in Los Angeles County

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Abstract

Health planners must invest in programs to maximize effectiveness and reach communities with the highest need. They often lack data to rationally allocate resources based on need. Using data from multiple sources, this study asks whether the resources devoted to outreach activities and the subsequent enrollment services are aligned with estimates of uninsured children among service planning areas and health districts in Los Angeles. Funds for outreach have been relatively well allocated in proportion to the distribution of uninsured children. Differences within SPAs, particularly with respect to outreach contacts and applications completed, were more noticeable. This suggests that some reallocation of outreach investment could lead to expanded coverage in some communities.

Introduction

The Los Angeles Healthy Kids program was implemented in July 2003 extending health coverage to uninsured children in families with incomes below 300 percent of the federal poverty level (FPL) who are ineligible for Medi-Cal or Healthy Families. The program was funded with an initial allocation of $100 million from First 5 LA for children ages 0–5 years old. Subsequent fundraising efforts by the Children's Health Initiative (CHI) Coalition of Greater Los Angeles expanded the program to children through age 18 beginning in May 2004.

The implementation of the Healthy Kids program in Los Angeles County was accompanied by additional funding from First 5 LA and The California Endowment dedicated to support outreach and enrollment activities for children and families in the county. The outreach program was intended to close gaps in children's health insurance coverage by identifying and linking uninsured, eligible children and their families with an appropriate health insurance program for which they are eligible. First 5 LA partnered with Los Angeles County's Department of Health Services (DHS) to coordinate and carry out these outreach and enrollment efforts. DHS then subcontracted with 15 community-based organizations (the contractors). During the same period, The California Endowment (TCE) funded 16 community-based organizations to conduct outreach and enrollment assistance county-wide, with half of these agencies also receiving grants from DHS.

The Healthy Kids program has shown remarkable success in Los Angeles. By 2005, more than 42,000 children were enrolled, 35,000 of whom are ages 6–18. While funds remain available for the continued enrollment of children ages 0–5, funds to cover premiums for older children ages 6–18 were quickly exhausted causing the CHI to put a temporary enrollment hold in place and create a waiting list for children ages 6–18 beginning in June 2005. Recent new funding has allowed the program to slowly enroll children off the waiting list. A four-year evaluation of the Los Angeles Healthy Kids Program is currently being conducted by The Urban Institute and its partners—the University of Southern California, the University of California at Los Angeles, Mathematica Policy Research, Inc., and Castillo & Associates. A broad range of activities are being conducted over the span of the evaluation, including case studies of implementation, focus groups with parents, a longitudinal household survey, and ongoing process monitoring of the outreach, enrollment, and service delivery systems.

The purpose of this paper. Funders and health planners are often faced with the problem of where to invest in programs to maximize effectiveness and reach communities with the highest need. The success of the Children's Health Initiative of Greater Los Angeles similarly is linked partially to the efficient and effective allocation of limited outreach and enrollment resources to maximize the number of uninsured children enrolled in health programs. From the beginning the Los Angeles County Department of Health Services attempted to systematically deploy its limited outreach and enrollment resources based on the number of uninsured. But they also considered agency experience, promise of innovation, and performance (Balaoing et al. 1995). Yet DHS recognized the challenge in quantifying the number of uninsured because data are often unavailable at the sub-county level. It also challenges evaluators seeking to quantify the effects of community based programs in achieving outcomes (Nutt 1984; Patton 1987; Aday et al. 2004).

This study asks whether the resources devoted to outreach activities and the subsequent enrollment services are aligned with need. Specifically, we examine whether current investments in outreach and enrollment (contract amounts and distribution) and activities (outreach contacts, applications) and outcomes (Healthy Kids enrollments) are proportionately distributed relative to the number of uninsured children. Also unknown are differences in productivity and efficiency among the agencies providing these services. Information from these analyses will enable funders to better determine how to more efficiently allocate limited resources and maximize the number of uninsured children and families reached and enrolled in health coverage. This study is a continuation of a similar analysis developed as part of the Step by Step project funded by the California Healthcare Foundation.

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Disclaimer: The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.