MCHbest. NPM 15: Continuous and Adequate Insurance
Strategy. Mandated Benefits
Approach. Implement mandated (state-required) benefits to include specific services for children covered by private health insurers.
Overview. Mandated benefits, also called state-required benefits, address underinsurance by requiring private health insurers to cover specific benefits, such as early intervention, autism services, or medical foods or for services such as newborn and infant hearing screenings, lead poisoning screenings, and childhood immunizations. These types of mandated benefits have the potential to save costs to the health care system as a whole by catching conditions before they become severe and expensive to treat.1
Evidence. Expert Opinion/Field Generated. 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. Systems.
Outcome. Percent of children, ages 0 through 17, who are continuously and 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.
Examples from the Field. Access descriptions of ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.
Sample ESMs. Using the approach “Implement mandated (state-required) benefits to include specific services for children covered by private health insurers,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):
Notes. 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. Mandated Benefits Financing Strategy.