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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. CHIP

Approach. Support the enrollment of children in the Children’s Health Insurance Program. (CHIP) across the state

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Overview. The Children’s Health Insurance Program. (CHIP) is a public benefits program exclusively for uninsured children whose family income is too high for Medicaid. CHIP, financed jointly by the federal government and individual states and administered by the states, insures over 8 million children.[1] The Patient Protection and Affordable Care Act of 2010. (ACA) contains provisions to strengthen coverage for children under CHIP, including requirements to conduct outreach and enrollment of populations with additional health needs including children and youth with special health care needs. (View policy paper: Affordable Care Act and Children with Special Health Care Needs). http://hdwg.org/sites/default/files/ACAandCSHCNpaper.pdf

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts, guidelines, or committee statements; these strategies are consistent with accepted theoretical frameworks and have good potential to work. Often there is literature-based evidence supporting these strategies in related topic areas that indicate this approach would prove effective for this issue. Further research is needed to confirm effects in this topic area.

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

Source. Boston University's Catalyst Center Financing Strategies Database

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.
  • 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.

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. Outreach (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 events for campaigns conducted to educate families about CHIP eligibility and benefits. (Measures efforts to raise awareness and promote enrollment)
  • Number of partnerships established with schools, community organizations, and healthcare providers to identify and refer eligible children to CHIP. (Shows the breadth of community partner engagement in outreach)

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

PROCESS MEASURES:

  • Percent of potentially eligible children who are enrolled in CHIP. (Shows the program's penetration and success in reaching the focus population)
  • Percent of CHIP applications that are accurately processed within the state's standard timeframe. (Assesses the efficiency and responsiveness of the enrollment system)

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

PROCESS MEASURES:

  • Number of trainings provided to CHIP outreach workers and application assisters on best practices for engaging and enrolling various populations. (Builds workforce capacity for effective outreach)
  • Number of quality improvement initiatives implemented by CHIP health plans to enhance access and quality of care for enrolled children. (Drives system-level enhancements)

OUTCOME MEASURES:

  • Number of emergency department visits and hospitalizations prevented among CHIP enrollees due to better access to preventive and primary care. (Demonstrates the potential for cost savings)
  • Number of school days attended by children enrolled in CHIP who previously missed school due to untreated health conditions. (Reflects the program's impact on child well-being and academic success)

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

PROCESS MEASURES:

  • Percent of eligible but unenrolled children who are successfully contacted and assisted with CHIP enrollment. (Measures the effectiveness of tailored outreach to those most in need)
  • Percent of CHIP enrollees that are retained in coverage for at least 12 continuous months. (Shows the stability of coverage and protection against gaps in care)

OUTCOME MEASURES:

  • Percent reduction in the uninsured rate among eligible children after CHIP outreach and enrollment efforts. (Demonstrates population-level impact on coverage)
  • Percent decrease in child conditions commonly identified and treated through CHIP (e.g., asthma, ADHD, dental caries). (Reflects the program's impact on health)

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 Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs. CHIP Financing Strategy.
https://ciswh.org/project/the-catalyst-center/financing-strategy/chip/

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.