Evidence Tools
Uninsured
Introduction
This toolkit summarizes content from the Uninsured 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. There is a well-documented benefit for children in having health insurance. Research has shown that children who acquire health insurance are more likely to have access to a usual source of care, receive well child care and immunizations, to have developmental milestones monitored, and receive prescriptions drugs, appropriate care for asthma and basic dental services.1 Serious childhood problems are more likely to be identified early in children with insurance, and insured children with special health care needs are more likely to have access to specialists.1 Insured children not only receive more timely diagnosis of serious health care conditions but experience fewer avoidable hospitalizations, improved asthma outcomes and fewer missed school days.1 The number of uninsured children in the United States decreased for many years, reaching the lowest percent in 2016 at 4.7%.2 However, between 2016 and 2018 the number of uninsured children increased by 12.5%,largely due to a decline in public coverage.2 From 2018 to 2020, the number of uninsured children increased by 1.6 percentage points for children living in poverty.3 As part of the public health emergency response to the COVID-19 pandemic, temporary changes to Medicaid and CHIP drove a decrease in the level of uninsured children, back down to 5.0%.4
Goal. To ensure access to needed health care services for children.
Note. Access other related measures in this Population Domain through the Toolkits page.
Detail Sheet: Start with the MCH Block Grant Guidance
DEFINITION
Numerators:
Number of children, ages 0 through 17, who are reported by a parent to not be currently covered by any private or public health insurance
Denominators:
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% of persons under 65 years had medical insurance in 2018, Target: 92.1%)
DATA SOURCES
Child Health and/or Adolescent Health
MCH POPULATION DOMAIN
Child Health and/or Adolescent Health
MEASURE DOMAIN
Social Determinants of Health
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.
| Evidence-Informed |
Evidence-Based |
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Mixed Evidence |
Emerging Evidence |
Expert Opinion |
Moderate Evidence |
Scientifically Rigorous |
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Field-Based Strategies: Find promising programs from AMCHP’s Innovation Hub
Emerging:
- Child Development Clinic Services (VA; 2021)
- 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)
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 increasing health insurance coverage for children 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 health insurance coverage for children.
- 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 NPM:
- Medicaid and CHIP Renewals: Patient-Centered Messaging for Clinical Offices and Health Care Settings (CMS). A toolkit to support health care facilities in sharing information on Medicaid and CHIP enrollment and renewals with families.
- Happy, Healthy, and Ready to Learn: Insure All Children Toolkit (School Superintendents Association). Toolkit to support school-based health center outreach and enrollment.
Partnership. The following organizations focus efforts on advancing health insurance coverage:
- National Alliance to Advance Adolescent Health. Provides education, policy analysis, and TA, including expanding access to health coverage.
- First Focus Campaign for Children. Advocates for child and family-centered legislative change in Congress, including ensuring that all children have access to health coverage and care.
- National Center for a System of Services for CYSHCN (AAP). Supports the Blueprint for Change for CYSHCN; see toolkit below.
References
Introductory References: From the MCH Block Grant Guidance
1 Institute of Medicine (US) Committee on Health Insurance Status and Its Consequences. America’s Uninsured Crisis: Consequences for Health and Health Care. Washington (DC): National Academies Press (US); 2009. https://nap.nationalacademies.org/catalog/12511/americas-uninsured-crisis-consequences-for-health-and- health-care
2 Alker J, Roygardner L. The Number of Uninsured Children is On the Rise. Georgetown University Health Policy Institute, Center for Children and Families. 2019 October. https://ccf.georgetown.edu/wp- content/uploads/2019/10/Uninsured-Kids-Report.pdf
3 U.S. Census Bureau. Changes in Children’s Health Coverage Varied by Poverty Status From 2018 to 2020. 14 September 2021. https://www.census.gov/library/stories/2021/09/uninsured-rates-for-children- in-poverty-increased-2018-2020.html
4 U.S. Census Bureau. More Children Were Covered by Medicaid and CHIP in 2021. 13 September 2022.
https://www.census.gov/library/stories/2022/09/uninsured-rate-of-children-declines.html