Evidence Tools
Adequate Insurance
Introduction
This toolkit summarizes content from the Adequate Insurance Evidence Accelerator and the MCHbest database. The peer-reviewed literature supporting this work can be found in the Established Evidence database. Use the resources below as you develop effective evidence-based/informed programs and measures.
From the MCH Block Grant Guidance. Inadequately insured children are more likely to have delayed or forgone care and are less likely to have a medical home and receive needed referrals, care coordination, and family-centered care.1 The American Academy of Pediatrics (AAP) highlighted the importance of this issue with a policy statement. The major problems cited were cost-sharing requirements that are too high, benefit limitations, and inadequate coverage of needed services.2
Goal. To increase the percent of children who are continuously and adequately insured.
Note. Access other related measures in this Population Domain through the Toolkits page.
Detail Sheet: Start with the MCH Block Grant Guidance
GOAL: To increase the percent of children who are continuously and adequately insured.
DEFINITION:
Numerator: Number of children, ages 0 through 17, who are reported by a parent to be continuously insured in the past year with adequate coverage, based on 3 criteria: covers needed services, covers needed providers, and reasonably covers costs.
Denominator: Number of children, ages 0 through 17
Units: 100
Text: Percent
HEALTHY PEOPLE 2030 OBJECTIVE: Related to Access to Health Services (AHS) Objective 01: Increase the proportion of persons with medical insurance. (Baseline: 89.0% in 2018, Target: 92.1%)
DATA SOURCES: National Survey of Children's Health (NSCH)
MCH POPULATION DOMAIN: Child Health, Adolescent Health, and/or Children with Special Health Care Needs
MEASURE DOMAIN: Clinical Health Systems
1. Accelerate with Evidence—Start with the Science
The first step to accelerate effective, evidence-based/informed programs is ensuring that the strategies we implement are meaningful and have high potential to affect desired change. Read more about using evidence-based/informed programs and then use this section to find strategies that you can adopt or adapt for your needs.
Evidence-based/Informed Strategies: MCHbest Database
The following strategies have emerged from studies in the scientific literature as being effective in advancing the measure. Use the links below to read more about each strategy or access the MCHbest database to find additional strategies.
Field-Based Strategies: Find promising programs from AMCHP’s Innovation Hub
Emerging:
- Child Development Clinic Services (VA; 2021)
- Child Service Assessments (RI; 2023)
- Expanded Eligibility (WV; 2021)
- Publicly Financed Pediatric Palliative Care Model (FL; 2011)
Promising:
- Flexible Case Management Model to Serve Young Parents (MA; 2020)
- Health Education, Case Management, and Patient Navigation (NY; 2019)
- Home Visiting and Parent Education (VA; 2020)
Best:
- Systems Building Grants (NC; 2018)
2. Think Upstream with Planning Tools—Lead with the Need
The second step in developing effective, evidence-based/informed programs challenges us to plan upstream to ensure that our work addresses issues early and is measurable in “turning the curve” on big issues that face MCH populations. Read more about moving from root causes to responsive programs and then use this section to align your work with the data and needs of your populations.
Move from Need to Strategy
Use Root-Cause Analysis (RCA) and Results-Based Accountability (RBA) tools to build upon the science to determine how to address needs.
Planning Tools: Use these tools to move from data to action
3. Work Together with Implementation Tools—Move from Planning to Practice
The third step in developing effective, evidence-based/informed programs calls us to work together to ensure that programs are implementable and moveable within the realities of Title V programs and lead to improved health outcomes for all people. Read more about implementation tools designed for MCH population change and then use this section to develop responsive strategies to bring about change that is responsive to the needs of your populations.
Additional MCH Evidence Center Resources: Access supplemental materials from the literature
- Find field-based resources focused on continuous and adequate insurance relevant to Title V programs in the MCH Digital Library.
- Search the Established Evidence database for peer-reviewed research articles related to strategies for increasing continuous and adequate insurance.
- Request Technical Assistance from the MCH Evidence Center
- MCH Evidence Center Frameworks and Toolkits:
Implementation Resources: Use these field-generated resources to affect change
Practice. The following tools can be used to translate evidence to action to advance this SM:
- Leverage Opportunities + Speak the Medicaid Language: A Workbook for Title V (Boston University, Center for Innovation in Social Work & Health). This workbook describes elements of the Medicaid program and guides users to map their Medicaid system.
- Electronic health record tools to assist with children's insurance coverage (OCHIN, Inc.). This article highlights tools to help clinics provide insurance enrollment support in pediatrics.
Partnership. The following organizations focus efforts on supporting adequate insurance coverage:
- The Catalyst Center. Aims to promote universal, continuous, and affordable coverage for all CYSHCN, close benefit and financing gaps, and build capacity to promote financing in care.
- Leveraging Title V Partnerships to Advance the NPM.
- Strategies states are using to improve and finance care for CYSHCN.
- National Academy for State Health Policy. Works with state officials on efforts to improve affordable coverage options, promote enrollment, and ensure access to quality care.
- The Urban Institute. Analyzes the role of Medicaid and CHIP in providing affordable coverage and accessible care for children.
Additional Resources:
- Data Resource Center for Child and Adolescent Health (DRC): A project of the Child and Adolescent Health Measurement Initiative, the DRC is a national data resource providing easy access to children’s health data on a variety of important topics, including the health and well-being of children and access to quality care
- Rural Care Coordination Toolkit: The evidence-based toolkit is designed to help rural communities identify and implement a care coordination program. It also provides links to resources and best practices (Rural Health Information Hub).
References
Introductory References: From the MCH Block Grant Guidance
1 Yu J, Perrin JM, Hagerman T, Houtrow AJ. Underinsurance Among Children in the United States. Pediatrics.2022;149(1):e2021050353. doi:10.1542/peds.2021-050353.
2 Hudak ML, Helm ME, White PH; Committee on Child Health Financing. Principles of Child Health Care Financing. Pediatrics. 2017;140(3):e20172098. doi:10.1542/peds.2017-2098