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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. Medicaid Buy-In Program

Approach. Adopt a Medicaid Buy-In program for children with disabilities to ensure adequate insurance coverage.

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Overview. Adopting a Medicaid Buy-In program may be an effective way for states to create a pathway to Medicaid for children with disabilities whose family income is too high for Medicaid and who have unmet needs and/or whose families incur high out-of-pocket costs for their care.1 The Massachusetts Medicaid Buy-In program, called MassHealth CommonHealth, allows families of children with disabilities to buy into the state’s Medicaid program to cover more services and to defray costs that private insurance does not cover.2

Evidence. Emerging. There is some evidence that community-wide physical activity campaigns increase physical activity among children, increase walking in intervention communities, and may reduce sedentary time among adults, but further research is needed to confirm effects. This strategy has been tested more than once and results trend positive overall. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (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. Systems.

Outcome. Cover more services and defray costs. 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 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 “Adopt a Medicaid Buy-In program for children with disabilities to ensure adequate insurance coverage,” 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 private health agencies complying with mandated benefits.

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

  • Percent of private health agencies complying with mandated benefits.

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

  • Number of families utilizing a Medicaid Buy-In program to cover more services.
  • Number of families reporting reasonable out-of-pocket costs as a result of the Medicaid Buy-In program.

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

  • Percent of families utilizing a Medicaid Buy-In program to cover more services.
  • Percent of families reporting reasonable out-of-pocket costs as a result of the Medicaid Buy-In program.

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.


References:

1 https://ciswh.org/project/the-catalyst-center/financing-strategy/medicaid-buy-ins/.

2 Hirschi M, Walter AW, Wilson K, Jankovsky K, Dworetzky B, Comeau M, Bachman SS. Access to care among children with disabilities enrolled in the MassHealth CommonHealth Buy-In program. Journal of Child Health Care. 2019 Mar;23(1):6-19.

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.