Strategy. Eligibility Expanded Insurance Coverage/Medicaid Eligibility
Approach. Adopt a protocol to ensure that all persons in maternal, child, and adolescent health programs are referred for enrollment in health insurance
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Overview. Evidence suggests that the effect of expansion to near-universal health insurance coverage for preventive screenings may lead to a large uptake in preventive screening, such as cancer screening, mammograms, and cervical cancer screening, for patients.[1]
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:
- Program protocols and referral tracking systems
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Client intake and assessment data
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Client surveys and feedback
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.
- Health Care Access for All MCH Populations.
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.
Community-Focused
Examples from the Field.
Access descriptions of ESMs
that use this strategy or aligned components.
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).
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Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)
- Number of program staff trained on the health insurance referral protocol, including eligibility criteria, enrollment process, and available coverage options. (Measures the capacity building efforts to ensure effective implementation of the referral protocol)
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Number of program participants identified as potentially eligible for health insurance coverage and referred for enrollment assistance. (Measures the reach and scale of the referral protocol in connecting individuals to coverage opportunities)
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Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)
- Percent of program staff demonstrating proficiency in explaining health insurance options, eligibility requirements, and enrollment process to participants. (Measures the effectiveness of staff training and capacity building efforts)
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Percent of program participants screened for health insurance eligibility and provided with appropriate referrals and enrollment support. (Measures the comprehensiveness and fidelity of the referral protocol implementation)
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Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)
- Number of data-sharing agreements and systems implemented to track referrals, enrollments, and utilization of preventive services across programs and insurance providers. (Measures the use of data and technology to monitor and evaluate the protocol's impact)
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Number of policy and systems changes supported and implemented to expand insurance eligibility, simplify enrollment process, and improve coverage affordability for program participants. (Measures the protocol's influence on creating an enabling environment for insurance access)
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Number of program participants who gain health insurance coverage for the first time as a result of the referral protocol. (Measures the protocol's success in reducing coverage gaps)
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Number of maternal, child, and adolescent health programs that demonstrate sustained improvements in insurance coverage rates and preventive care utilization among their participants over time. (Measures the long-term effectiveness and sustainability of the referral protocol)
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Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)
- Percent of program participants from communities with the lowest insurance coverage rates who receive tailored outreach and referral services. (Measures the focused implementation of the referral protocol)
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Percent of enrollment materials, resources, and support services provided in languages and formats usable to program participants with health literacy needs. (Measures the accessibility and appropriateness of enrollment support)
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Percent reduction in gaps in health insurance coverage, preventive care utilization, and health outcomes between program participants referred for enrollment and comparable populations not reached by the protocol. (Measures the protocol's impact on reaching those in greatest need)
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Percent of program participants who report sustained health insurance coverage, engagement in preventive care, and improved health and well-being for themselves and their families over an extended period following initial enrollment through referral. (Measures the protocol's enduring impact on participants' health trajectories and intergenerational well-being)
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Note. When looking at your ESMs, SPMs, or other strategies:
- Move from measuring quantity to quality.
- Move from measuring effort to effect.
- Quadrant 1 strategies should be used sparingly, when no other data exists.
- 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 Sabik, L. M., & Bradley, C. J. (2016). The impact of near‐universal insurance coverage on breast and cervical cancer screening: evidence from Massachusetts. Health economics, 25(4), 391-407.
