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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 15: Continuous and Adequate Insurance

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Strategy. Expansion of Coverage Eligibility

Approach. Promote expansion of Medicaid benefit eligibility through support of Medicaid buy-in policy.

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Overview. Children who reside in states that expanded public health insurance programs to parents participate in Medicaid at a rate that is 20 percentage points higher than of those who live in states with no expansions.1,2

Evidence. Moderate Evidence. Medicaid buy-in programs have shown to be effective. 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/National.

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.

Examples from the Field. There are currently 2 ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Promote expansion of Medicaid benefit eligibility through support of Medicaid buy-in policy,” 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 children within the state who are eligible for Medicaid benefits through Medicaid buy-in program.

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

  • Percent of children within the state who are eligible for Medicaid benefits through Medicaid buy-in program.

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

  • Number of children within the state who are eligible for Medicaid buy-in and utilize benefits.

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

  • Percent of children within the state who are eligible for Medicaid buy-in and utilize benefits.

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.


Reference:

1Hudson, J. L., & Moriya, A. S. (2017). Medicaid expansion for adults had measurable ‘welcome mat’ effects on their children. Health Affairs36(9), 1643-1651.

2 Dubay & Kenney. (2003). Expanding Public Health Insurance to Parents: Effects on Children’s Coverage Under Medicaid. Heath Services Research.

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.