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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Forgone Health Care.

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Strategy. Medicaid and Insurance Program Enhancements

Approach. Support policies that extend greater coverage for children and their families in focused population groups, enabling them to access needed healthcare services

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Overview. Medicaid and health insurance enhancements can extend coverage for more children for needed healthcare services. Enhancements such as continuous eligibility policies,[1] Medicaid managed care,[2] and Medicaid Buy-In programs[3] are associated with improved utilization of primary and preventive care for children, including children with disabilities and children in foster care, by making services more usable and affordable. Evidence suggests that health insurance enhancements are an effective way to ensure that more children and youth are covered and able to access needed healthcare services.

Evidence. Moderate Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

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

  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.
  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

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. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of policy proposals promoted by Title V to expand Medicaid and insurance coverage for children and families. (Measures policy formulation efforts) Number of coalition partners led by Title V mobilized to support support campaigns for child health coverage policies. (Assesses partner engagement)

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

  • Percent of policy proposals promoted by Title V to expand Medicaid and insurance coverage for children and families. (Measures policy formulation efforts) Percent of coalition partners led by Title V mobilized to support support campaigns for child health coverage policies. (Assesses partner engagement)

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

  • Number of localities that adopt and implement coverage expansion policies aligned with state Title V goals. (Measures policy adoption and spread) Number of partnerships led by Title V formed with healthcare providers, insurers, and community organizations to support implementation of coverage policies that results in high levels of engagement. (Shows implementation partnerships) Number of communities that achieve sustained reductions in child uninsured rates through coverage policy changes. (Measures population health impact) Number of state Medicaid and CHIP programs that demonstrate improved quality, and efficiency as a result of policy enhancements. (Shows health system impact)

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

  • Percent of localities that adopt and implement coverage expansion policies aligned with state Title V goals. (Measures policy adoption and spread) Percent of partnerships led by Title V formed with healthcare providers, insurers, and community organizations to support implementation of coverage policies that results in high levels of engagement. (Shows implementation partnerships) Percent of communities that achieve sustained reductions in child uninsured rates through coverage policy changes. (Measures population health impact) Percent of state Medicaid and CHIP programs that demonstrate improved quality, and efficiency as a result of policy enhancements. (Shows health system impact)

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] Brantley, E., & Ku, L. (2022). Continuous Eligibility for Medicaid Associated With Improved Child Health Outcomes. Medical care research and review : MCRR, 79(3), 404–413.

[2] Bright, M. A., Kleinman, L., Vogel, B., & Shenkman, E. (2018). Visits to Primary Care and Emergency Department Reliance for Foster Youth: Impact of Medicaid Managed Care. Academic pediatrics, 18(4), 397–404.

[3] Hirschi, M., Walter, A. W., Wilson, K., Jankovsky, K., Dworetzky, B., Comeau, M., & Bachman, S. S. (2019). Access to care among children with disabilities enrolled in the MassHealth CommonHealth Buy-In program. Journal of child health care : for professionals working with children in the hospital and community, 23(1), 6–19.

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.