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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 15: Continuous and Adequate Insurance

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Strategy. Insurance Enrollment Helpline (Benefits Counseling)

Approach. Maintain a state-run helpline to assist with insurance enrollment navigation.

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Overview. Some Title V programs and family leader organizations provide benefits counseling to help families understand the full range of health insurance benefits and any additional coverage options available in their state. Often families struggle to understand how their health insurance works and the services it covers. Benefits counseling can help families understand:

These options can reduce underinsurance by ensuring that children are able to utilize their benefits to the maximum as well as minimizing out-of-pocket costs.1 Community‐based case managers who provide health insurance information, support filling out applications, and negotiate with the insurer appear to increase enrollment of children in health insurance programs.2

Evidence. Moderate Evidence. Insurance enrollment helplines have shown to be effective. This strategy has been tested more than once and results trend positive overall. (Read more about understanding evidence ratings). The Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs (CYSHCN) has identified this strategy as an innovative strategy. Read more in their practice report.

Target Audience. Patients.

Outcome. Percent of children ages 0-17 who are adequately insured. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

The Role of Title V. Title V programs can hire benefits counselors to work with families directly or it can fund and/or partner with family leader organizations (e.g., Family Voices, F2F) to provide benefits counseling that helps families understand the full range of health insurance benefits, in- and out-of-network providers, and any additional insurance options available in their state.

Sample ESMs. Using the approach “Maintain a state-run helpline to assist with insurance enrollment navigation,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework:

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of calls to the helpline per month.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of monthly calls to the hotline for child insurance coverage.
  • Percent of uninsured individuals who utilize state-run helpline per month.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of calls to helpline per month that result in successful insurance coverage enrollment as reported by caller in 3 month follow-up survey.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of calls to helpline per month that result in successful insurance coverage enrollment as reported by caller in 3 month follow-up survey.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


Reference:

1 Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs. Benefits Counseling Financing Strategy.

2 Jia et al. (2014). Strategies for Expanding Health Insurance Coverage in Vulnerable Populations. Cochrane Database Systemic Review.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.