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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. Dependent Coverage Expansion

Approach. Use dependent coverage expansion policies to prevent loss of insurance coverage among adolescents and young adults (AYA).

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Overview. Research indicates that offering dependent coverage expansion policies at the state and federal level can significantly reduce loss of insurance coverage among AYA. Other health reforms implemented by the Affordable Care Act, such as Medicaid expansion, the creation of health insurance exchanges with subsidies, and the prohibition of pre-existing condition exclusions, can facilitate new sources of insurance for AYA who previously relied on dependent coverage.1

Evidence. Moderate. There is strong evidence that dependent coverage expansion policies can provide continuous and adequate insurance coverage for adolescents and young adults. 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/Community; adolescents and young adults between 16 and 18 years who were enrolled in a health plan as a dependent.

Outcomes. Reduction in exit from dependent coverage; maintenance of health care coverage. 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 “Use dependent coverage expansion policies to prevent loss of insurance coverage among adolescents and young adults (AYA),” 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 adolescents and young adults covered by dependent care expansion policies.

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

  • Percent of adolescents and young adults covered by dependent care expansion policies.

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

  • Number of adolescents and young adults who did not exit from dependent coverage and who maintained health care coverage.

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

  • Percent of adolescents and young adults who did not exit from dependent coverage and who maintained health care coverage.

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 Wisk LE, Finkelstein JA, Toomey SL, Sawicki GS, Schuster MA, Galbraith AA. Impact of an individual mandate and other health reforms on dependent coverage for adolescents and young adults. Health services research. 2018 Jun;53(3):1581-99.

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.