Can private companies contribute to public programs' outreach efforts? Evidence from California

Health Affairs

Volumn 26, Issue 2, 2007, Pages 538-548

  Jacobson, Mireille ^a   Buchmueller, Thomas C ^b  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b UNIVERSITY OF MICHIGAN   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADOLESCENT; ARTICLE; CHILD; CHILD HEALTH CARE; COMMUNITY CARE; ECONOMICS; EPIDEMIOLOGY; HEALTH CARE QUALITY; HUMAN; MEDICAID; MEDICAL RECORD; NEEDS ASSESSMENT; ORGANIZATION AND MANAGEMENT; PRESCHOOL CHILD; PUBLIC RELATIONS; SOCIAL SECURITY; SOCIAL WELFARE; SOCIOECONOMICS; STATISTICS; UNITED STATES;

ADOLESCENT; AID TO FAMILIES WITH DEPENDENT CHILDREN; CALIFORNIA; CHILD; CHILD HEALTH SERVICES; CHILD, PRESCHOOL; COMMUNITY HEALTH SERVICES; COMMUNITY-INSTITUTIONAL RELATIONS; ELIGIBILITY DETERMINATION; FORMS AND RECORDS CONTROL; HEALTH CARE SURVEYS; HUMANS; MEDICAID; NEEDS ASSESSMENT; PRIVATE SECTOR; PROGRAM EVALUATION; SOCIAL WELFARE; SOCIOECONOMIC FACTORS; UNITED STATES;

EID: 33947303032     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.2.538     Document Type: Article

References (40)

1. C. DeNavas-Walt et al., Income, Poverty, and Health Insurance Coverage in the United States: 2005 (Washington: U.S. Government Printing Office, 2006).
2. T.M. Selden, J.L. Hudson, and J.S. Banthin, "Tracking Changes in Eligibility and Coverage among Children, 1996-2002," Health Affairs 23, no. 5 (2004): 39-50.
3. Estimates from the March 1999 Current Population Survey indicate that more than 70 percent of uninsured children in California were eligible for Medicaid or SCHIP (California Department of Health Services, 2000).
4. M. Perry et al., Medicaid and Children: Overcoming Barriers to Medicaid Enrollment: Findings from a National Survey (Washington: Kaiser Commission on Medicaid and the Uninsured, 2000);
5. D. Card and L. Shore-Sheppard, "Using Discontinuous Eligibility Rules to Identify the Effects of the Federal Medicaid Expansions on Low Income Children," Review of Economics and Statistics 86, no. 3 (2004): 752-766;
6. G. Kenney and J. Haley, Why Aren't More Uninsured Children Enrolled in Medicaid or SCHIP?, Series B, no. B-35 (Washington: Urban Institute, 2001);
7. G. Kenney, J. Haley, and L. Dubay, How Familiar Are Low-Income Parents with Medicaid and SCHIP?, Series B, no. B-34 (Washington: Urban Institute, 2001);
8. and J.S. McAlearney, "Opportunities for Outreach: Medicaid Participation among Children in Ohio," Journal of Health Care for the Poor and Underserved 15, no. 3 (2004): 357-374.
9. M. Mickey, CHIP Outreach and Enrollment: A View from the States (Washington: American Public Health Services Association, 1999);
10. Perry et al., Medicaid and Children;
11. M. Rosenbach et al., Implementation of the State Children's Health Insurance Program: Synthesis of State Evaluations (Baltimore: Centers for Medicare and Medicaid Services, 2003);
12. and D. Ringold, T. Olson, and L. Leete, CHIP and Medicaid Outreach: Strategies, Efforts, and Evaluation (Washington: Federalism Research Group, 2003).
13. See C. Bansak and S. Raphael, "The Effects of State Policy Design Features on Take Up and Crowd Out Rates for the State Children's Health Insurance Program," Journal of Policy Analysis and Management 26, no. 1 (2007): 149-175;
14. B. Wolfe and S. Scrivner, "The Devil May Be in the Details: How the Characteristics of SCHIP Programs Affect Take-Up," Journal of Policy Analysis and Management 24, no. 3 (2005): 499-522;
15. and K. Kronebush and B. Elbel, "Enrolling Children in Public Insurance: SCHIP, Medicaid, and State Implementation," Journal of Health Politics, Policy and Law 29, no. 3 (2004): 451-489.
16. See, for example, U.S. Government Accountability Office, Medicaid: Demographics of Non-Enrolled Children Suggest State Outreach Strategies, Pub no. GAO/HEHS-98-93 (Washington: U.S. Government Printing Office, 1998);
17. Perry et al., Medicaid and Children;
18. and J. Stuber and E. Bradley, "Barriers to Medicaid Enrollment: Who Is at Risk?" American Journal of Public Health 95, no. 2 (2005): 292-298.
19. I. Hill, M.E. Harrington, and C. Hawkes, "Congressionally Mandated Evaluation of the State Children's Health Insurance Program, Final Cross-Cutting Report on the Findings from Ten State Site Visits,"Report submitted to the U.S. Department of Health and Human Services (Washington: Mathematica Policy Research and Urban Institute, 2003);
20. and Rosenbach et al., Implementation.
21. Wolfe and Scrivner, "The Devil May Be in the Details," also find that dedicated phone help lines and Web sites improve take-up.
22. Reimbursements are based on successful applications by program. If a family application has multiple children, some eligible for Medi-Cal and some for SCHIP, the maximum reimbursement for that application would be $100 ($50 for Healthy Families and $50 for Medi-Cal).
23. Perry et al., Medicaid and Children;
24. and J. Stuber et al., Beyond Stigma: What Barriers Actually Affect the Decisions of Low-Income Families to Enroll in Medicaid, Issue Brief (Washington: Center for Health Services Research and Policy, George Washington University, 2000).
25. A. Aizer, "Public Health Insurance, Program Take-up, and Child Health," Review of Economics and Statistics (forthcoming).
26. See Healthy Families, Application Assistance Fact Book, March 2002, http://www.mrmib.ca.gov/MRMIB/HFP/CAAFactBk.pdf (accessed 2 January 2007).
27. Prior to July 2003, fees were paid for assisting women applying for the state's subsidized insurance for pregnant women and infants and adults applying for the state's high-risk insurance pool. Fees for these programs have not been reinstated.
28. California Department of Health Services, Healthy Families and Medi-Cal for Children Outreach and Education Campaign, 2000 Report to the Legislature, (Sacramento: DHS, 2000).
29. This estimate is based on the fact that schools represent 42 percent of all organizations paid on a contract basis (31 of 74), and contractors as a group accounted for roughly 10 percent of applications during the period. This estimate is likely an upper bound, as only seven contract-based organizations were among the top twenty-five entities in terms of total applications submitted in 2000-01, and none of the seven were schools. Healthy Families, Application Assistance Factbook..
30. This success rate is far below official reports; ibid. Official figures put success rates for assisted application at about 79 percent (compared with 63 percent for unassisted applications). Some of the discrepancy is from the double counting of resubmitted applications thatwere initially deemed incomplete. Some might also stem from double counting applications that are forwarded to both Healthy Families and Medi-Cal for eligibility determination.
31. This is consistentwith experiences in other states that use schools for SCHIP outreach. See Rosenbach et al., "Implementation."
32. Aizer, "Public Health Insurance";
33. Perry et al., Medicaid and Children;
34. and Stuber et al., Beyond Stigma.
35. Data limitations prevented us from assessing subsequent utilization. Brokers, although better than other EE types at enrolling children in public health insurance, might, for example, be less efficient at ensuring access to care.
36. Details about the regression specification and the full results are presented in an online appendix at http://content.healthaffairs.org/cgi/content/ full/26/2/538/DC1.
37. D.W. Garnick, K. Swartz, and K.C. Skwara, "Insurance Agents: Ignored Players in Health Insurance Reform," Health Affairs 17, no. 2 (1998): 137-143;
38. J.M. Yegian et al., "The Health Insurance Plan of California: The First Five Years," Health Affairs 19, no. 5 (2000): 158-165;
39. and M.A. Hall, "The Role of Independent Agents in the Success of Health Insurance Market Reforms," Milbank Quarterly 78, no. 1 (2000): 23-45.
40. Rosenbach et al., Implementation.