MCHbest. NPM 15: Continuous and Adequate Insurance
Strategy. Insurance Enrollment Helpline (Benefits Counseling)
Approach. Maintain a state-run helpline to assist with insurance enrollment navigation.
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:
- The full range of health insurance benefits.
- In- and out-of-network providers.
- Additional insurance options available in their state, such as Medicaid buy-in programs or Medicaid waivers.
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.
- The Connecticut Title V/CSHCN program contracts with an organization that does outreach, enrollment, and benefits counseling with families regardless of the type of insurance for which they may be eligible.
- The Kentucky Family-to-Family (F2F) Health Information Center Co-Directors are employed by and housed within the Kentucky Commission for Children with Special Health Care Needs, which is the Title V/CSHCN program. The Co-Directors are Certified Application Counselors (CACs).
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:
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):
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.