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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Adequate Insurance.

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Strategy. Expansion of Coverage Eligibility (Partnerships with Medicaid)

Approach. Promote expansion of Medicaid benefits; reduce barriers to Medicaid enrollments; leverage partnerships with Medicaid

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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] Numerous, overarching approaches for this strategy include: Improving parents' health coverage, thus increasing coverage and access to care for entire family; Removing red tape barriers that can keep eligible children from maintaining consistent Medicaid or CHIP coverage, boost outreach and enrollment efforts, 12-month continuous coverage, presumptive eligibility, consumer assistance/navigators; Measuring and reporting data on child health quality (e.g., all Medicaid and CHIP Core Set measures, managed care plan performance); and, Establishing, nurturing, and leveraging partnerships with Medicaid to maximize the proportion of children who are covered by Medicaid as well as maximizing the benefits that are covered, especially in alternative payment models like managed care.

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
  • Health Outcomes. This strategy helps contribute to reducing avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

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. Here are sample ESMs to use as models 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?")

PROCESS MEASURES:

  • Number of outreach activities conducted to promote Medicaid enrollment for eligible children (measures education and awareness efforts)
  • Number of partnerships established with community organizations to facilitate Medicaid enrollment (assesses collaboration networks)

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

PROCESS MEASURES:

  • Percent of eligible families who receive assistance with Medicaid enrollment processes (measures the effectiveness of outreach efforts)
  • Percent of Medicaid applications completed accurately on first submission (assesses the quality of enrollment assistance)

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

PROCESS MEASURES:

  • Number of training sessions provided to enrollment assisters on streamlined Medicaid application procedures (builds capacity for effective enrollment)
  • Number of simplified enrollment pathways developed to reduce administrative barriers (facilitates easier access to coverage)

OUTCOME MEASURES:

  • Number of previously uninsured children who gain Medicaid coverage through expansion efforts (demonstrates direct impact on coverage)
  • Number of children who maintain continuous Medicaid coverage for 12 months (captures impact on coverage stability)

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

PROCESS MEASURES:

  • Percent of Medicaid-eligible children enrolled in coverage in the state (measures the reach and potential for population-level impact)
  • Percent of enrollment partners who report satisfaction with Medicaid enrollment processes (evaluates stakeholder perceptions of system effectiveness)

OUTCOME MEASURES:

  • Percent reduction in uninsured rates among children in the state (captures the program's impact on reducing unmet insurance needs)
  • Percent increase in children receiving recommended preventive services through Medicaid (reflects the impact on healthcare utilization)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Hudson, J. L., & Moriya, A. S. (2017). Medicaid expansion for adults had measurable ‘welcome mat’ effects on their children. Health Affairs, 36(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.