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

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.