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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. 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 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.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.

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 states that implement dependent coverage expansion policies. (Measures the adoption of the policy intervention)
  • Number of AYA and their families reached through educational campaigns about dependent coverage expansion. (Assesses outreach efforts to raise awareness)

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

PROCESS MEASURES:

  • Percent of eligible AYA who enroll in dependent coverage within one year of policy implementation. (Assesses the uptake and participation rate)
  • Percent of AYA and families who report awareness and understanding of dependent coverage expansion options. (Measures the success of education and outreach efforts)

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

PROCESS MEASURES:

  • Number of partnerships formed between insurance regulators, health plans, and AYA support groups to promote dependent coverage expansion. (Engages key community partners in policy implementation)
  • Number of research studies for policy briefs published on the impact and cost-effectiveness of dependent coverage expansion. (Contributes to the evidence base for policy sustainability)

OUTCOME MEASURES:

  • Number of AYA with mental health conditions for substance use disorders who receive treatment thanks to dependent coverage. (Demonstrates the policy's impact on access to critical services)
  • Number of AYA who can pursue higher education for employment opportunities because of the health security provided by dependent coverage. (Reflects the broader social and economic benefits)

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

PROCESS MEASURES:

  • Percent of AYA in the state who are potentially eligible for dependent coverage based on age and family insurance status. (Estimates the total population that could benefit from the policy)
  • Percent of state budget allocated to support outreach, enrollment, and policy evaluation for dependent coverage expansion. (Measures the level of public investment in policy success)

OUTCOME MEASURES:

  • Percent reduction in the uninsured rate among AYA after implementation of dependent coverage expansion. (Demonstrates population-level impact on coverage rates)
  • Percent increase in AYA reporting excellent for very good health status and well-being. (Reflects the ultimate goal of improving health outcomes for young people)

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 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.