Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), CLASSROOM_SCHOOL, PROFESSIONAL_CAREGIVER, Outreach (caregiver), Communication Tools, Distribution of Promotional Items (Classroom/School)

Intervention Description: In Michigan, a school-based outreach effort was piloted using existing school communication tools to identify children who are currently uninsured and may be eligible for state-subsidized health insurance. School districts were provided with two health insurance status collection forms to be included with the free and reduced school lunch application, and as part of the student registration packet and welcome materials for school. Completed forms were sent to a state registered application-assisting agency to ensure families can access the coverage and services they need. A final step in the process is outreach to eligible respondents by the Michigan Primary Care Association to help ensure that they receive information and access to the healthcare coverage and services they need.

Intervention Results: As a result of the survey, 156 children were identified as not having health insurance. This represents more than 44% of the 358 children who are eligible for State subsidized health insurance, in the participating school districts, but are uninsured. Integrating the collection of health insurance status into routine school communication channels is an effective way to identify children who do not have health insurance and may be eligible for state subsidized benefits.

Conclusion: 1. The Michigan Department of Community Health should lead the effort to work with the Michigan Department of Education to modify the Free and Reduced Lunch Application to capture whether or not the applicant has health insurance. 2. The Michigan Department of Community Health should lead the effort to incorporate into the direct certified free and reduced lunch eligibility process a systematic check as to whether or not the applicant has State subsidized health insurance. 3. The Michigan Department of Community Health should provide resources from the expected performance bonus to work with schools across the State to implement these changes.

Study Design: Cross-sectional pilot study

Setting: Schools (School districts in Van Buren County, Michigan)

Population of Focus: Uninsured children

Data Source: Survey data

Sample Size: 8,999 children

Age Range: School-aged children

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: We used electronic health record (EHR) data to assess temporal patterns of healthcare utilization after Oregon's 2009-2010 CHIP expansion. We hypothesized increased post-expansion utilization among children who gained public insurance.

Intervention Results: Among the newly insured group, utilization rates of preventive dental visits increased significantly from 0.24 to 0.63 encounters per patient per year between pretest and posttest (adjusted rate ratio=2.56, 95% CI: 2.38-2.75). Between-group pretest-posttest differences in rate ratios revealed that changes in utilization of preventive dental visits were significantly different from those of the continuously insured and continuously uninsured groups (p<0.001).

Conclusion: This study used EHR data to confirm that CHIP expansions are associated with increased utilization of essential pediatric primary and preventive care. These findings are timely to pending policy decisions that could impact children's access to public health insurance in the United States.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: Community health centers (CHC) in Oregon

Population of Focus: Patients aged 2-18 years who were not pregnant and did not have insurance other than Medicaid/CHIP with ≥ 1 visit before and after their ‘start date’

Data Source: CHC EHR data; state administrative data

Sample Size: Newly insured (n=3,054) Continuously insured (n=10,946) Continuously uninsured (n=10,307)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Public Insurance (State), Outreach (School Staff),

Intervention Description: The intervention is state Medicaid policies allowing 12 months of continuous eligibility for children, regardless of changes in family income that would otherwise end eligibility.

Intervention Results: Results show that continuous eligibility is associated with reduced rates of uninsurance, gaps in coverage, gaps due to application problems, and fair or poor health status. For children with special health care needs, it is also associated with increased preventive care, specialty care, and any medical care.

Conclusion: Continuous eligibility may be an effective strategy to reduce gaps in coverage for children and reduce paperwork burden on Medicaid agencies.

Study Design: Cross-sectional study analyzing data from a national survey.

Setting: The study analyzed data from children in all 50 states, focusing on those with incomes below 138% of the federal poverty level.

Population of Focus: The target audience is policymakers and Medicaid administrators.

Sample Size: The full sample size is 22,622 children. The sample of children with special health care needs is 6,081.

Age Range: The age range is 0-17 years.

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid, Health Insurance Coverage, Public Insurance (State),

Intervention Description: Fluctuating insurance coverage, or churning, is a recognized barrier to health care access. We assessed whether state policies that allow children to remain covered in Medicaid for a 12-month period, regardless of fluctuations in income, are associated with health and health care outcomes, after controlling for individual factors and other Medicaid policies. This cross-sectional study uses a large, nationally representative database of children ages 0 to 17.

Intervention Results: Continuous eligibility was associated with improved rates of insurance, reductions in gaps in insurance and gaps due to application problems, and lower probability of being in fair or poor health. For children with special health care needs, it was associated with increases in use of medical care and preventive and specialty care access. However, continuous eligibility was not associated with health care utilization outcomes for the full sample.

Conclusion: Continuous eligibility may be an effective strategy to reduce gaps in coverage for children and reduce paperwork burden on Medicaid agencies.

Study Design: Cross-sectional study

Setting: State Medicaid policies

Population of Focus: Children aged 0 to 17 years old with annual family incomes at or below 138% of the federal poverty line (FPL) and a subpopulation of children in low-income families with special health care needs, based on specific criteria related to health problems that require special assistance or limit the child's abilities

Sample Size: 22,622 respondents aged 0 to 17 years old with annual family incomes at or below 138% of the federal poverty line (FPL); subpopulation of 6,081 children with special health care needs in low-income families

Age Range: Children and adolescents 0-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Public Insurance (State), Medicaid Reform, STATE

Intervention Description: The goal of this study was to use claims data linked with community-level measures to evaluate the impact of preventive services on the time to subsequent restorative, advanced restorative, and complex dental treatment among children enrolled in the Virginia Medicaid program.

Intervention Results: The analysis included 430,594 children (10,204,182 claims). A log-rank test showed significant differences (P < 0.001) between the times to treatment of those who had a preventive service and those who did not have a preventive service prior to a treatment service. Both Kaplan-Meier curves and the adjusted HR (1.88; 95% confidence interval [CI], 1.46-2.15) indicated that children without preventive services were more likely to have basic restorative treatment at an earlier age along with advanced restorative treatment (HR, 1.52; 95% CI, 1.28-1.80) and complex treatment (HR, 2.13; 95% CI, 1.68-2.61).

Conclusion: In a population of Medicaid-enrolled children, children who did not receive preventive services were significantly more likely to have treatment at an earlier age than those who did receive preventive services.

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Nurse/Nurse Practitioner, PROFESSIONAL_CAREGIVER, Patient Navigation (Assistance), Care Coordination, STATE, Multicomponent Approach

Intervention Description: The Healthy Beginnings system of care in Atlanta, GA connects children and their families to health insurance and a medical home model of care to support children’s health and development. The main components are care management + education and parent engagement + collaborative partnerships. A registered nurse, known as the health navigator, supports parents and helps them learn how to work with health care professionals on behalf of their children; they also connect parents to the Center for Working Families to ensure that they receive public benefits for which they are eligible.

Intervention Results: Healthy Beginnings coordinated care approach has ensured that participating children and families have health insurance (97%) and receive regular immunizations (92%), ongoing health care from a primary care physician and dental health provider, and regular developmental screenings (98%) and follow-up care. Healthy Beginnings has dramatically increased children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Conclusion: By building upon the partnerships formed through the foundation’s community change effort, Healthy Beginnings has dramatically increased neighborhood children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Study Design: Program evaluation

Setting: Community (Community-based organizations in Atlanta, Georgia)

Population of Focus: Low-income young children and families

Data Source: Questionnaire data

Sample Size: 279 children

Age Range: 0-10 years

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: We examine how access to and use of oral and dental care under the Children's Health Insurance Program (CHIP) compared to private coverage and being uninsured in 10 states.

Intervention Results: The percentage of established CHIP enrollees (continuously enrolled for at least 12 months) having had a dental visit for checkup or cleaning in the past year was 38% higher (p≤0.01) than recent enrollees who were uninsured for 5 to 12 months before enrollment and 5.3% higher (p≤0.05) than recent enrollees who were privately insured for 12 months before enrollment.

Conclusion: Enrolling eligible uninsured children in CHIP led to improvements in their access to preventive dental care, as well as reductions in their unmet dental care needs, yet the CHIP program has more work to do to address the oral health problems of children.

Study Design: QE: nonequivalent control group

Setting: AL, CA, FL, LA, MI, NY, OH, TX, UT, VA

Population of Focus: Children aged 18 years or younger enrolled in CHIP

Data Source: Parent telephone survey

Sample Size: Established enrollees (n=5,518) Recent enrollees (n=4,142)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Public Insurance (State), STATE

Intervention Description: To evaluate the impact of an oral health integration training program on children's receipt of oral health and dental services in Southern Oregon.

Intervention Results: The percentage of children receiving oral health assessments increased over time. Visiting a trained provider was consistently associated, each year, with a greater likelihood of receipt of fluoride varnish and preventive and diagnostic dental services but was not associated with treatment dental services or dental sealants.

Conclusion: This study reports evidence for the overall impact of an oral health integration training on children's receipt of oral and dental services. Health systems implementing these types of training strategies should consider how to reach specific underserved subgroups, increase paediatric dentists, and expand efforts to include older children.

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Collaboration with Local Agencies (State), Educational Material (caregiver), STATE, Multicomponent Approach

Intervention Description: In New York, to maximize comprehensive insurance coverage for CYSHCN, a Service Integration Model was formed between the Office of Health Insurance Services and the Early Intervention Program. The 3 key components include educational messaging (jointly prepared messages about health insurance benefits and enrollment assistance offered by the Office of Health Insurance Services through the Early Intervention Program) + data from program databases (data matching with the Early Intervention Program) + individual counseling using program staff (incorporation of the Office of Health Insurance Services program staff—child benefit advisors—to work directly with parents of children in the Early Intervention Program to facilitate enrollment and renewal. The model overcomes enrollment barriers by using consumer friendly enrollment materials and one-on-one assistance, and shows the benefits of a comprehensive and collaborative approach to assisting families with enrollment into public health insurance.

Intervention Results: Since 2008, more than 5,000 children in the Early Intervention Program have been successfully enrolled and coverage renewed in Medicaid through the Service Integration Model. In 2008, the study team found that children in the Early Intervention Program had a 34% churning rate for Medicaid because of enrollment barriers and misconception of the Early Intervention Program as a replacement for Medicaid. By 2010, the churning rate for clients assisted through Office of Health Insurance Services was reduced from 34% to 8%. The Office of Health Insurance Services will modify the Service Integration Model to respond to New York State’s implementation of the Health Insurance Exchange required by the 2010 ACA. Partnerships across government programs and agencies offer opportunities to enroll hard-to-reach populations into public health insurance. The model reflects how government programs can work together to improve rates of enrollment and retention in public health insurance. The key elements of integration of program messages, data matching, and staff involvement allow for the model to be tailored to the specific needs of other government programs.

Conclusion: The model overcomes enrollment barriers by using consumer-friendly enrollment materials and one-on-one assistance, and shows the benefits of a comprehensive and collaborative approach to assisting families with enrollment into public health insurance.

Study Design: Program evaluation

Setting: Community (New York City Department of Health and Mental Hygiene's Office of Health Insurance Services and the Early Intervention Program)

Population of Focus: Uninsured and underinsured young children with special health care needs in New York City participating in the Early Intervention Program

Data Source: Evaluation data

Sample Size: 6,500 children in early intervention with a Medicaid number

Age Range: 0-3 years

Intervention Components (click on component to see a list of all articles that use that intervention): Public Insurance (State), Policy/Guideline (State), Medicaid,

Intervention Description: To assess the impact of parental health insurance expansions from 1999 to 2012 on the likelihood that parents are insured; their children are insured; both the parent and child within a family unit are insured; and the type of insurance. Cross-state and within-state multivariable regression models estimated the effects of health insurance expansions targeting parents using 2-way fixed effect modeling and difference-in-difference modeling. All analyses controlled for household, parent, child, and local area characteristics that could affect insurance status

Intervention Results: Expansions increased parental coverage by 2.5 percentage points and increased the likelihood of both parent and child being insured by 2.1 percentage points. Substantial variation was observed by type of expansion. Public expansions without premiums and special subsidized plan expansions had the largest effects on parental coverage and increased the likelihood of jointly insuring both the parent and child. Higher premiums were a substantial deterrent to parents’ insurance. Our findings suggest that premiums and the type of insurance expansion can have a substantial impact on the insurance status of the family. The most effective expansions for parental insurance coverage were those for traditional Medicaid coverage without premiums and for special subsidized plans that subsidized costs for individuals to purchase state-sponsored plans. These findings can help inform states as they continue to make decisions about expanding Medicaid under the Affordable Care Act to cover all family members.

Conclusion: Our findings suggest that premiums and the type of insurance expansion can have a substantial impact on the insurance status of the family. These findings can help inform states as they continue to make decisions about expanding Medicaid under the Affordable Care Act to cover all family members.

Study Design: Cross-sectional analysis of data

Setting: Policy (States)

Population of Focus: Parents and Children

Sample Size: 19 expansion states (representing 28 expansions) and 22 control states without a parental expansion during the study period

Age Range: Parents and children; specific ages not stated

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid, Public Insurance (State), Care Coordination,

Intervention Description: Children with disabilities utilize more health-care services and incur higher costs than other children do. Medicaid Buy-In programs for children with disabilities have the potential to increase access to benefits while reducing out-of-pocket costs for families whose income exceeds Medicaid eligibility. This study sought to understand how parents and caregivers of Massachusetts children with disabilities perceive access to care under CommonHealth, Massachusetts’s Medicaid Buy-In program. Parents and caregivers (n = 615) whose children were enrolled in CommonHealth participated in a survey assessing the impact of the program. Qualitative data were coded across five access domains—availability, accessibility, accommodation, affordability, and acceptability.

Intervention Results: Data suggest that CommonHealth improves access to care for children with disabilities by providing the benefits that were limited in scope or unavailable through other insurance before enrollment and by making available services more affordable. Policy and administrative changes could improve the program and further increase access to care for children with complex, costly conditions.

Conclusion: Adopting a Medicaid Buy-In program may be an effective way for states to create a pathway to Medicaid for children with disabilities whose family income is too high for Medicaid and who have unmet needs and/or whose families incur high out-of-pocket costs for their care.

Study Design: Qualitative study

Setting: MassHealth CommonHealth Buy-In program, a Medicaid Buy-In program in Massachusetts

Population of Focus: Parents and caregivers of children with disabilities who are enrolled in the MassHealth CommonHealth Buy-In program in Massachusetts

Sample Size: 615 parents and caregivers whose children were enrolled in CommonHealth

Age Range: Children and youth ages 0-18 years and their adult parents and caregivers

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Outreach (caregiver), POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: Three California counties (Los Angeles, San Mateo, and Santa Clara) expanded health insurance coverage for undocumented children and some higher income children not covered by Medi-Cal (Medicaid) or Healthy Families (SCHIP). This paper presents findings from evaluations of all three programs.

Intervention Results: Results consistently showed that health insurance enrollment increased access to and use of medical and dental care, and reduced unmet need for those services.

Conclusion: After one year of enrollment the programs also improved the health status of children, including reducing the percentage of children who missed school due to health.

Study Design: QE: nonequivalent control group

Setting: Los Angeles, San Mateo, and Santa Clara, CA

Population of Focus: Children aged 1-5 years in Los Angeles and those aged 1-18 years in San Mateo and Santa Clara enrolled in the Healthy Kids program

Data Source: Parent telephone survey

Sample Size: Established enrollees (n=1,842) New enrollees (n=1,879)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: This article examines experiences under Medicaid and the State Children's Health Insurance Program (SCHIP), drawing on surveys of over 3,000 enrollees in California and North Carolina in 2002.

Intervention Results: Established Medicaid enrollees were 12 and 16 percentage points more likely to receive a dental visit for checkup/cleaning than all recent enrollees and recent enrollees who were previously uninsured for 6 months prior to enrollment (p<0.05). Established enrollees were not more likely to receive preventive dental visits than recent enrollees who were insured for some or all of the 6 months prior to enrollment.

Conclusion: Relative to being uninsured, Medicaid enrollment was found to improve access to care along a number of different dimensions, controlling for other factors. Furthermore, this study emphasizes the need for continued evaluation of access to care for both programs.

Study Design: QE: nonequivalent control group Kulkarni (2013) Canada City-operated child care centers or Ontario Early Years Centers in Toronto Young children (no exclusion criteria) Study group (n=161) Control group (n=181) Prospective coh

Setting: CA and NC

Population of Focus: Children older than 3 years enrolled in Medicaid or SCHIP in 2002

Data Source: Parent telephone survey

Sample Size: Established enrollees (n=830) Recent enrollees (n=332)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: Examine the extent to which enrollment in the State Children's Health Insurance Program (SCHIP) affects access to care and service use in 10 states that account for over 60 percent of all SCHIP enrollees.

Intervention Results: SCHIP enrollment was found to improve access to care along a number of different dimensions, other things equal, particularly relative to being uninsured. Established SCHIP enrollees were more likely to receive office visits, preventive health and dental care, and specialty care, more likely to have a usual source for medical and dental care and to report better provider communication and accessibility, and less likely to have unmet needs, financial burdens, and parental worry associated with meeting their child's health care needs. The findings are robust with respect to alternative specifications and hold up for individual states and subgroups.

Conclusion: Enrollment in SCHIP appears to be improving children's access to primary health care services, which in turn is causing parents to have greater peace of mind about meeting their children's needs.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: CA, CO, FL, IL, LA, MO, NJ, NY, NC, TX

Population of Focus: Children older than 3 years enrolled in SCHIP in 2002

Data Source: Parent telephone survey

Sample Size: Intervention (n=4,953) Control (n=840)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: To determine the impact of children's health insurance programs on access to health care and on other aspects of the lives of the children and their families.

Intervention Results: Among the continuously enrolled children, preventive dental visits increased from 34.2% to 55.6% between enrollment and 6 months post-enrollment (p<0.005). Between 6 months post-enrollment and 12-months post-enrollment, it increased from 55.6% to 61.5% (p<0.005). The increase from enrollment to 12-months post enrollment was significant (p<0.005). Comparison children at enrollment (28.5%) had a lower percentage of preventive dental visits than continuously enrolled children at enrollment (34.2%); therefore, the changes observed in the study group were attributable to the insurance programs rather than to other environmental trends.

Conclusion: Extending health insurance to uninsured children had a major positive impact on children and their families. In western Pennsylvania, health insurance did not lead to excessive utilization but to more appropriate utilization.

Study Design: Time trend analysis

Setting: Western PA

Population of Focus: Children up to 19 years in families with incomes less than 235% FPL enrolled in the Children’s Health Insurance Program of Pennsylvania (BlueCHIP) and the Highmark Blue Cross Blue Shield Caring Program (Caring)

Data Source: Parent telephone survey

Sample Size: Study group (n=1,031) Comparison group (n=460)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Public Insurance (State), Enrollment Assistance

Intervention Description: There has been increasing interest among policy makers, navigators, and consumer organizations in developing novel outreach methods to address diverse barriers to enrollment. This study evaluates the impacts of personalized, live outbound telephone calls from service center representatives on enrollment in California's ACA Marketplace, Covered California, which accounts for 13.5% of national ACA Marketplace enrollment. The intervention targets consumers who had initiated the enrollment process by submitting an application but had yet to select a plan. Households in the study population were randomly assigned to one of two groups at the outset of the intervention period: a treatment group that was assigned to receive a phone call (hereafter referred to as an “outbound call”) from a service center representative and a control group that was assigned to not receive an outbound call. This intervention could address enrollment barriers such as lack of awareness of health insurance options, low health insurance literacy or computer literacy, preference for in-language assistance, and the time and cognitive costs of shifting through options. Those in the control group, similar to any other consumers, could contact the Covered California service center by calling the publicly available number that had been provided to them.

Intervention Results: Personalized telephone calls from service center representatives increased take-up of Covered California health insurance. Outbound calls were placed to 27,123 households in the treatment group (49%). Receiving an outbound call increased Marketplace health insurance take-up by 2.7 percentage points (p<0.001) for consumers who received a call because of random assignment—a 22.5 percent increase over the control-group rate. Enrollment impacts were statistically significant for lower-income households (below 200% of the FPL) but not for higher-income households as well as those who were referred from Medicaid, those ages 30-50 or older then age 50, those who were Hispanic, and those whose preferred spoken language was Spanish or English. The total intervention cost to Covered California was approximately $243,000, or approximately $224 per new member acquired. Our calculations suggested that the return on investment was 102%. Similiar to prior studies, we found that information interventions do not fully overcome barriers to enrollment for many consumers. Nonetheless, informational interventions may induce modest gains ine enrollment among certain segments of the population while yielding a positive return on investment.

Conclusion: The intervention provided a two-to-one return on investment. Yet absolute enrollment in the target population remained low; persistent enrollment barriers may have limited the intervention’s impact. These findings inform implementation of the American Rescue Plan Act of 2021, which expands eligibility for subsidized coverage.

Study Design: RCT

Setting: Service Center for Marketplace Insurance Enrollment in California

Population of Focus: Consumers who had applied but not selected a plan

Sample Size: 79,522 consumers (treatment group=55,519; control group=24,003)

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Collaboration with Local Agencies (State), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Referrals, STATE, Mini Grants, Public Insurance (State)

Intervention Description: Small grants to community-based organizations have been shown to be effective in garnering the involvement of the local community in health promotion efforts. The Georgia Utilization Mini-grant Program leveraged modest funding and resources to promote community involvement to improve enrollment and utilization of Medicaid and CHIP services for children. It demonstrates how a state Medicaid agency can step outside its usual administrative role to play an important part in supporting local outreach and marketing efforts to promote Medicaid/CHIP enrollment and utilization.

Intervention Results: Funded community-based organizations improved utilization of children’s health services by developing innovative staffing patterns, creating new data systems for scheduling appointments and maintaining records, and forging new collaborative relationships to leverage financial support. Responses suggest that the program improved levels of enrollment, appointment-setting and referrals for social and other services. Common facilitators and barriers to success and ways to address them were also identified.

Conclusion: Elaboration on each of the facilitators of success led to the development of several recommendations as guidance for future outreach funding programs such as: staffing, data systems, collaboration and how to address incentives and barriers.

Study Design: Participatory approach

Setting: Community (Community-based organizations)

Population of Focus: Children enrolled in Medicaid and PeachCare

Data Source: Questionnaires, telephone interviews, one-on-one counseling, application assistance, home visits

Sample Size: 6 organizations

Age Range: Children; specific ages not stated

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Collaboration with Local Agencies (State), Public Insurance (Health Care Provider/Practice), PROFESSIONAL_CAREGIVER, Outreach (caregiver), STATE, Data Collection System

Intervention Description: Florida Covering Kids & Families (FL-CKF) is dedicated to developing outreach methods for enrolling and retaining eligible children in the state’s CHIP. FL-CKP developed a strong data system that allows it to evaluate the effectiveness and success of statewide enrollment and retention efforts. Community and school outreach partners enter data each month on all completed CHIP applications via a secure interface, and data are then transmitted to the state. The data system is an outreach method for enrolling and retaining coverage; it can also monitor outcomes and provide feedback to community outreach partners. Organizations helping uninsured children apply for health insurance may benefit from creating data collection systems to monitor project efficacy and modify outreach and enrollment strategies for greater effectiveness.

Intervention Results: The highest number of application submissions were through outreach at a child’s school or childcare facility, through a community-based organization, or through targeted outreach events. However, even though those strategies resulted in the largest number of application, approval and denial rates show which of these strategies (through a CHIPRA grant partner site or government agency) yielded the highest enrollments. This information can be further stratified by individual project partner to show which strategies are working best in that region. The improved data collection system of Cycle II enables FL-CKF to better monitor the efforts of project partners by tracking monthly progress toward grant deliverable goals.

Conclusion: Organizations helping uninsured children apply for health insurance may benefit from creating data collection systems to monitor project efficacy and modify outreach and enrollment strategies for greater effectiveness.

Study Design: Evaluation assessment

Setting: Community (Community-based organizations and schools in Florida)

Population of Focus: Eligible children in Florida's CHIP

Data Source: Checkbox Survey Solutions data system

Sample Size: 502,866 children in Florida who are uninsured

Age Range: 0-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Public Insurance (State), Policy/Guideline (State), Medicaid Reform,

Intervention Description: The study aimed to examine whether this health reform was associated with reduced uninsurance and greater access to care for children at one and five years post-reform. The health reform implemented in Massachusetts, also known as Chapter 58, aimed to provide near-universal health insurance coverage to the state's residents. The reform was signed into law in 2006 and required all residents to have health insurance or face penalties. The reform also expanded Medicaid and created a state-run health insurance exchange, the Health Connector, to provide affordable health insurance options to individuals and small businesses. The reform also included subsidies to help low-income individuals and families afford health insurance.

Intervention Results: Compared to other New England states, Massachusetts's enactment of the individual mandate, Medicaid expansion, and essential benefits was associated with trends at 5 years post-reform toward lower uninsurance for children overall (DD = - 1.1, p-for-DD = 0.05), increased access to specialty care (DD = 7.7, p-for-DD = 0.06), but also with a decrease in access to preventive care (DD=-3.4, p-for-DD = 0.004). At 1 year post-reform, access to specialty care improved for children newly-Medicaid-eligible (DD = 18.3, p-for-DD = 0.03).

Conclusion: Adult-oriented health reforms may have reduced uninsurance and improved access to some types of care for children in Massachusetts. Repealing the ACA may produce modest detriments for children.

Study Design: Difference in difference analysis

Setting: State (Massachusetts)

Population of Focus: CSHCN in Massachusetts

Sample Size: 34,943 children (5,760 children in Massachusetts, 28,183 children in comparison New England states)

Age Range: 0-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Public Insurance (State), HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice)

Intervention Description: Researchers used data on individuals 12 years of age and older from the Canadian Health Survey to esitmate the marginal effects (ME) of having dental insurance including increased dental attendance.

Intervention Results: Having dental insurance increased the proportion of participants who visited the dentist in the past year (56.6 to 79.4%, ME: 22.8, 95% confidence interval (CI): 20.9–24.7) and who reported very good or excellent oral health (48.3 to 57.9%, ME: 9.6, 95%CI: 7.6–11.5).

Conclusion: Findings suggest that dental insurance is associated with improved dental visiting behaviours and oral health status outcomes. Policymakers could consider universal dental coverage as a means to support financially vulnerable populations and to reduce oral health disparities between the rich and the poor.

Setting: Community

Population of Focus: Children 12 years of age and older