241338 Using CAHPS and HEDIS to identify access barriers: Assessing the quality of care and health services received by undocumented immigrant children in a large urban Medicaid health plan, 2008-2010

Tuesday, November 1, 2011: 12:42 PM

Maryam Maleki, BS , Healthcare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
Irene Lee , Healthcare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
Shawnalynn Smith Thomas, MPIA , Project Administration / Product Management Department, L.A. Care Health Plan, Los Angeles, CA
S. Rae Starr, MPhil, MOrgBehav , Healthcare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
The health status of undocumented immigrant children is a persistent concern of public health administrators. From 2000 forward, California counties have explored ways to provide better health care access for children.

In Los Angeles County, the Healthy Kids program was launched in 2003 and was specifically designed to provide coverage for children in low-income families that are ineligible for state/federal coverage under Medicaid or the Children's Health Insurance Program (CHIP), either due to income thresholds and without regard to parents' undocumented immigration status.

(1) The briefing will discuss the quality of care and services reported by parents of Healthy Kids members in a large and diverse urban health plan in Los Angeles County. The briefing will compare differences in the barriers and assessments of the care and health services reported by largely low-income undocumented immigrants and other low-income populations.

(2) The challenge of demographic attribution: A shared belief among program administrators and researchers who study the California programs, is that the programs often serve the uninsured children of undocumented immigrants. That conclusion is reached via a logic model by a process of elimination: Uninsured applicants who qualify for Medicaid and CHIP are encouraged to apply for those federally-funded programs. It follows that children who remain in Healthy Kids remain, in part due to undocumented status. Some inherent noise remains, because Healthy Kids covers somewhat higher income thresholds than CHIP.

(3) Analyses: The briefing will compare the quality of care and health services reported by parents of children in Healthy Kids, versus children in Medicaid and CHIP on various measures in CAHPS and HEDIS from 2008-2010.

(4) Barriers: The briefing will then contrast differences in barriers reported by parents for Healthy Kids versus Medicaid and CHIP -- addressing barriers that prevented getting well-care visits, and assessments of cultural competence among doctors.

Learning Areas:
Assessment of individual and community needs for health education
Biostatistics, economics
Diversity and culture
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
1. Evaluate differences in health care and health services received among low-income populations, comparing undocumented immigrant children versus other pediatric patients. 2. Describe which measures of clinical quality (HEDIS) best differentiate on immigration status. 3. Describe which measures of health care service quality (CAHPS) best differentiate on immigration status. 4. Identify which barriers to health care access for low-income patients are more frequently reported by parents of undocumented immigrant children than by other parents.

Keywords: Immigrants, Barriers to Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Experience: Six years as the Senior Biostatistician at L.A. Care Health Plan, managing the CAHPS survey for L.A. Care Health Plan from 2006 to 2011, including all facets of the survey to be discussed in the presentation. Setting: L.A. Care Health Plan is a public entity serving Los Angeles County, California, and the largest public health insurer in the United States. L.A. Care's CAHPS survey in a typical year represents approximately 850,000 Medicaid and SCHIP members in an ethnically diverse, urban county in the southwest United States. L.A. Care also administers, Healthy Kids, a program tailored toward children in low income families who are not eligible for federal/state health insurance programs due to income or immigration status. The challenges addressed at L.A. Care likely reflect those of other urban Medicaid insurers, and of state agencies that sponsor the CAHPS survey directly. Education: Master of Philosophy in Policy Analysis from the RAND Graduate School of Policy Analysis (Santa Monica CA); Master of Organizational Behavior from Brigham Young University (Provo, UT); Bachelor of Political Science with Honors from Brigham Young University (Provo UT).
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.