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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. Educate professionals on issues related to policies that extend greater coverage for children and families experiencing health disparities and limited access to healthcare, enabling them to access needed health care services

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Overview. Medicaid and health insurance enhancements can extend coverage for more children for needed health care 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 accessible 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 health care services.

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):

  • 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. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

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 policy proposals developed and introduced to expand Medicaid and insurance coverage for children and families. (Measures policy formulation efforts.)
  • Number of legislators and decision-makers reached through education and advocacy efforts related to child health coverage policies. (Captures advocacy and education reach.)
  • Number of coalition partners mobilized to support advocacy campaigns for child health coverage policies. (Assesses stakeholder engagement.)

OUTCOME MEASURES:

  • Number of children and families who gain health insurance coverage through successful policy changes. (Captures impact on coverage rates.)
  • Number of newly covered children who access essential health services, including preventive care and treatment for chronic conditions. (Measures impact on service utilization.)
  • Number of children who experience improved health outcomes and reduced disparities as a result of expanded coverage policies. (Indicates health impact.)

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

PROCESS MEASURES:

  • Percent of policy proposals that are informed by analysis of child health needs, coverage gaps, and disparities data. (Assesses data-driven advocacy.)
  • Percent of coverage policy advocacy efforts that center the voices and priorities of affected children and families. (Measures family and community engagement.)
  • Percent of policymakers who express increased understanding and support for child health coverage policies as a result of advocacy. (Captures effectiveness of education efforts.)

OUTCOME MEASURES:

  • Percent of newly eligible children and families who enroll in and utilize coverage, among those who gain access through policy changes. (Measures uptake and participation.)
  • Percent of children who receive recommended preventive care and screenings under expanded coverage policies. (Assesses quality of care received.)
  • Percent of families who report improved financial protection and access to care for their children as a result of coverage policy changes. (Captures family impact.)

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

PROCESS MEASURES:

  • Number of states and localities that adopt and implement coverage expansion policies aligned with advocacy goals. (Measures policy adoption and spread.)
  • Number of partnerships formed with healthcare providers, insurers, and community organizations to support implementation of coverage policies. (Captures implementation partnerships.)
  • Number of child health quality measures and pay-for-performance initiatives incorporated into coverage policies to drive accountability. (Assesses quality and value focus.)

OUTCOME MEASURES:

  • Number of communities that achieve sustained reductions in child uninsured rates and health disparities through coverage policy changes. (Measures population health impact.)
  • Number of state Medicaid and CHIP programs that demonstrate improved quality, efficiency, and equity as a result of policy enhancements. (Captures health system impact.)
  • Number of best practices and lessons learned from successful child health coverage policies disseminated and adapted in other states. (Assesses knowledge dissemination impact.)

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

PROCESS MEASURES:

  • Percent of coverage policy proposals that include provisions to address social determinants of health and advance health equity. (Measures equity focus in policy design.)
  • Percent of community-based organizations and advocates from underserved communities engaged in shaping coverage policy priorities. (Assesses diverse and inclusive advocacy.)
  • Percent of resources and technical assistance dedicated to supporting community-led advocacy for equitable child health coverage policies. (Captures investment in community capacity.)

OUTCOME MEASURES:

  • Percent reduction in child uninsured rates, with accelerated progress among racial/ethnic groups and geographic areas with the greatest disparities. (Measures equity impact.)
  • Percent decrease in the gap between children from advantaged and disadvantaged backgrounds in accessing comprehensive health services under coverage expansions. (Captures equity in access.)
  • Percent of families from historically marginalized communities who report improved trust and satisfaction with the health system as a result of equitable coverage policies. (Assesses perceptions of equity and inclusion.)

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.