Sustaining Health Insurance Coverage Expansion: A County Health Department's Role in Community Coalition Building

Background – In 2003, San Mateo County (SMC) became one of the first communities in the country to launch universal health coverage for children. By 2007, the number of uninsured children was reduced from 17,000 to 2,000. Despite policy changes that make enrollment processes more onerous, SMC has sustained its progress in coverage expansion through an intentional community coalition building approach.

Objective – Sustain health coverage expansion for children.

Methods –SMC has developed cross-community partnerships at multiple levels. Core strategies include a monthly community-based coalition meeting of all front-line staff, tracking and sharing of key metrics that measure progress, a robust training effort aimed at disseminating policy changes and promising practices, and a culture of staff and partner recognition aimed at highlighting unique efforts to assist families.

Results – At its five year mark, SMC has reduced the number of children without health insurance by 15,000 and maintained high retention (87%) in its locally tailored coverage product. The community coalition has informed policy deliberations at the State and Federal levels.

Lessons Learned-

1) Design communication and information-sharing vehicles that enlist all key partners.

2) Develop training approaches that can be tailored to specific settings as well as effective in large scale communication of policy changes.

3) Track and share data that can demonstrate the collective impact achieved.

LEARNING OBJECTIVES:

1. Define a community coalition building approach.

2. Discuss practical ways to build cohesion and collective responsibility for achievement of a community-wide goal.

3. Describe lessons learned in working across organizational boundaries.