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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. Health Reform Legislation

Approach. Support legislative changes to reduce uninsurance and improve access to care for children.

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Overview. In 2006, Massachusetts passed major health reform legislation, including an individual mandate for adults (who were required to purchase insurance or face a penalty); Medicaid expansion (i.e., children’s eligibility for the state’s Medicaid-CHIP increased from 200 to 300% of the FPL and adult eligibility for Medicaid increased to 100% FPL), and minimum essential benefits for private insurance (e.g., coverage of basic specialty services, no co-pay or deductible for preventive care visits). Massachusetts health reform, the model for the ACA, reduced uninsurance and improved access to some types of care for children in the state.

Evidence. Emerging. There is some evidence that health insurance legislation reduces uninsurance and improves access to care, 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).

Target Audience. State/Systems/Community/National.

Outcome. Decrease uninsurance rates; improve access to care for children. 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 “Support legislative changes to reduce uninsurance and improve access to care for children,” 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 insurers covering minimum essential benefits for children and families.

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

  • Percent of insurers covering minimum essential benefits for children and families.

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

  • Number of parents reporting coverage for their children after/as a result of legislative changes.
  • Number of parents reporting increased access to services for their children after/as a result of legislative changes.

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

  • Percent of parents reporting coverage for their children after/as a result of legislative changes.
  • Percent of parents reporting increased access to services for their children after/as a result of legislative changes.

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.

 

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.