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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Usual Source of Sick Care.

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Strategy. Expanded Health Insurance Coverage

Approach. Expand health insurance coverage

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Overview. Gaps in insurance coverage are associated with limited access to quality healthcare, including among children with special healthcare needs that may require more frequent or tailored care.[1] Comprehensive, consistent insurance coverage reduces financial challenges, allowing families to seek care for their child without facing surprise medical bills. Studies show that children's health is adversely affected when parents are uninsured, highlighting the importance of coverage for all family members.[2] Prioritizing efforts to expand health insurance coverage can significantly improve healthcare access and outcomes for all children, irrespective of their health status or socioeconomic background. Evidence shows that expanded health insurance coverage facilitates access to care and is associated with better health outcomes.[3]

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.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Medicaid and CHIP enrollment data
  • Provider claims data
  • Healthcare Effectiveness Data and Information Set (HEDIS) Measures

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

  • Health Care Access for All MCH Populations.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.

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 individuals enrolled in health insurance plans. (Measures insurance uptake)
  • Number of outreach efforts conducted to connect individuals to insurance options. (Assesses engagement strategies)

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

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

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

  • Percent of coverage expansion programs developed with input from communities. (Measures community engagement in coverage design)
  • Percent of enrollment resources allocated to community-based organizations. (Assesses impact of investment)
  • Percent decrease in coverage differences across all populations. (Measures impact on reducing coverage gaps)
  • Percent of individuals from reporting coverage initiatives as responsive to their needs. (Assesses alignment with community priorities)

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] Tumin D, Miller R, Raman VT, Uffman JC, Tobias JD. Patterns of Health Insurance Discontinuity and Children's Access to Health Care. Matern Child Health J. 2019 May;23(5):667-677. doi: 10.1007/s10995-018-2681-0. PMID: 30600518.

[2] DeVoe JE, Tillotson CJ, Angier H, Wallace LS. Recent health insurance trends for US families: children gain while parents lose. Matern Child Health J. 2014 May;18(4):1007-16. doi: 10.1007/s10995-013-1329-3. PMID: 23817728; PMCID: PMC4918757.

[3] National Research Council (US) and Institute of Medicine (US) Committee on Children, Health Insurance, and Access to Care; Edmunds M, Coye MJ, editors. America's Children: Health Insurance and Access to Care. Washington (DC): National Academies Press (US); 1998. 3, Health Insurance and Access to Care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK230385/

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.