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Strengthen the Evidence for Maternal and Child Health Programs

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Strategy. Health Insurance Coverage

Approach. Expand health insurance coverage and reduce financial barriers for children and families to increase access to affordable and high quality care

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Overview. The expansion of health insurance coverage and reduction of financial barriers to healthcare can have a positive impact for children and their families. Strategies may involve supporting policies that increase access to affordable health insurance options, such as Medicaid or the Children's Health Insurance Program. (CHIP) and reducing gaps in coverage. In particular, continuous eligibility may be an effective strategy to reduce gaps in coverage for children and reduce paperwork burden on Medicaid agencies.[1] Policies that ensure continuity of coverage may result in fewer barriers to needed care, which may lead to fewer health problems in the future for the most children and adolescents who have additional health needs.[2]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed 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):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for 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 outreach, enrollment, and navigation assistance programs implemented to help eligible children and families access and maintain health insurance coverage. (Assesses enrollment support and facilitation efforts)
  • Number of healthcare providers and practices partnered with Title V that accept and serve patients with various types of health insurance coverage, including public and subsidized plans. (Shows network adequacy and provider participation)

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

PROCESS MEASURES:

  • Percent of outreach, enrollment, and navigation assistance programs implemented to help eligible children and families access and maintain health insurance coverage. (Assesses enrollment support and facilitation efforts)
  • Percent of healthcare providers and practices partnered with Title V that accept and serve patients with various types of health insurance coverage, including public and subsidized plans. (Shows network adequacy and provider participation)

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

PROCESS MEASURES:

  • Number of multi-sector partnerships and initiatives led by Title V established to address non-medical influences on health and other barriers to health insurance enrollment and utilization. (Measures collaborative efforts to improve insurance coverage and access)
  • Number of research studies, evaluations, and data analytics conducted to assess the impact and sustainability of health insurance expansion efforts for children and families. (Shows evidence-building and continuous improvement efforts)

OUTCOME MEASURES:

  • Number of communities that achieve significant reductions in child and family uninsured rates and barriers to care through comprehensive health insurance expansion and support strategies. (Measures population health impact)
  • Number of cross-sector policy and systems changes catalyzed by the evidence and momentum generated through successful child and family health insurance initiatives. (Shows broader influence and systems change impact)

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

PROCESS MEASURES:

  • Percent of multi-sector partnerships and initiatives led by Title V established to address non-medical influences on health and other barriers to health insurance enrollment and utilization. (Measures collaborative efforts to improve insurance coverage and access)
  • Percent of research studies, evaluations, and data analytics conducted to assess the impact and sustainability of health insurance expansion efforts for children and families. (Shows evidence-building and continuous improvement efforts)

OUTCOME MEASURES:

  • Percent of communities that achieve significant reductions in child and family uninsured rates and barriers to care through comprehensive health insurance expansion and support strategies. (Measures population health impact)
  • Percent of cross-sector policy and systems changes catalyzed by the evidence and momentum generated through successful child and family health insurance initiatives. (Shows broader influence and systems change 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] Cousineau, M. R., Kim, S. E., Hamilton, A. S., Miller, K. A., & Milam, J. (2019). Insurance Coverage, and Having a Regular Provider, and Utilization of Cancer Follow-up and Noncancer Health Care Among Childhood Cancer Survivors. Inquiry : a journal of medical care organization, provision and financing, 56, 46958018817996.

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.