205509 Did the Los Angeles Children's Health Initiative outreach effort increase enrollment in Medi-Cal?

Wednesday, November 11, 2009

Anna S. Sommers, PhD , The Hilltop Institute, University of Maryland, Baltimore County, Baltimore, MD
Ariel E. Klein, BA , Health Policy Center, The Urban Institute, Washington, DC
Ian T. Hill, MPA, MSW , Health Policy Center, The Urban Institute, Washington, DC
Joshua McFeeters, MPP , The Lewin Group, Falls Church, VA
In 2003, the Children's Health Initiative of Greater Los Angeles (CHI) launched the Healthy Kids Program to cover children in families with incomes up to 300 percent of the federal poverty level regardless of immigration status. With the launch, the CHI also provided contracts to community-based organizations to support outreach to uninsured children eligible for any public program, including Medi-Cal (California's Medicaid program). Thus, an important policy question was whether, in addition to new enrollment in Healthy Kids, outreach efforts generated “spillover” enrollment into Medi-Cal? We address this question by presenting trends in total enrollment, new enrollment, and disenrollment over a five-year period, set against broader economic trends represented by the unemployment rate. We find that new Medi-Cal enrollment increased after the initial launch of Healthy Kids to children ages 0 through 5, and continued its steady growth after the program's expansion to children ages 6 through 18. This upward trend occurred during a period of economic recovery when we might otherwise have expected new enrollment to decline. Disenrollment from Medi-Cal also increased after both the launch and expansion of the program, possibly due to a reduction in the number of eligible children as the economy improved. Total enrollment rose after the Healthy Kids launch but remained steady after its expansion. Our findings suggest that CHI outreach did contribute to modest increases in new Medi-Cal enrollment that were somewhat offset by corresponding increases in disenrollment. This evidence underscores the complexity of measuring the enrollment effects of outreach initiatives.

Learning Objectives:
-Explain how outreach efforts contributed to enrollment trends in Medi-Cal. -Describe how economic trends influence the impact of outreach efforts on enrollment. -Discuss the challenge of accurately measuring the impacts on enrollment of outreach initiatives that work across state programs, county agencies, and community-based organizations.

Keywords: Medicaid, Children's Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked on the evaluations of Children's Health Initiatives in Los Angeles and San Mateo Counties, as well as the evaluation of outreach activities in the Covering Kids and Families initiative. I performed the quantitative analysis for this research and worked with the other authors to design the analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.