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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. Premium Assistance

Approach. Support the development of a premium assistance program for low-income working families.

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Overview. Premium assistance programs are an example of a strategy states can use to ensure children and youth with special health care needs (CYSHCN) have adequate insurance coverage. In premium assistance programs, an agency pays all or part of a family or child’s health insurance premium. These programs are often implemented for low-income working families who cannot afford the expense of family coverage under an employer-sponsored plan. Premium assistance programs have grown in popularity with the advent of the Children’s Health Insurance Program (CHIP), in part as a strategy to ensure that low-income families do not drop their employer-sponsored coverage in order to obtain less costly CHIP coverage for their children, and also to help support families to keep working.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 theirĀ practice report.

Target Audience. State/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 “Support the development of a premium assistance program for low-income working families,” 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):

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

  • Number of uninsured low-income working families who are working with Title V to secure coverage.

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

  • Percent of uninsured low-income working families who are working with Title V to secure coverage.

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

  • Number of low-income working families who receive assistance from the state with insurance premium as a result of Title V activities.

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

  • Percent of low-income working families who receive assistance from the state with insurance premium as a result of Title V activities.

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):

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. Premium Assistance Financing Strategy.

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.