Quality assessment in California's child health insurance expansions

Federal and state governments have restrictions that limit their ability to cover subgroups of uninsured children (including undocumented children). Consequently, several California counties have formed children's health initiatives (CHIs) to expand coverage by offering comprehensive health insurance products for children, known as Healthy Kids programs (HKP). The aim of this study was to assess the performance of HKP with regard to utilization, access, and quality, and offer insight to future evaluations and other counties and states considering expansion. A set of ten indicators was selected for assessing performance. CHIs operating in 2005 (n=12), were asked to provide HKP data for each indicator, including comparison data for Medicaid and the State Children's Health Insurance Program (SCHIP) in their counties. Programs could not report rates for all of the indicators; nonetheless some trends emerged. HKP scores were similar to statewide Medicaid and SCHIP rates for well-child and adolescent visits. The average HKP rates reported for dental visits for all age groups (range: 59-74%) were much higher than national Medicaid comparisons (38-48%). Average HKP rates for emergency department visits by age group (0-5 years: 16%, 6-18 years: 9%) were consistently lower than for state Medicaid (38%, 25%, respectively) and SCHIP (27%, 18%) in the same counties. Evidence from California's county health initiatives demonstrates likely benefits of expanding coverage for children who do not qualify for state Medicaid and SCHIP. Assessing quality outcomes is difficult given local operational variations. A compulsory state-level evaluation could improve the assessment of these programs' contributions.