1. Evaluating Policy Initiatives for Expanding Health Insurance and Improving Access for Uninsured Children in California and Los Angeles October 21, 2004 USC Division of Community Health cousinea@usc.edu cousinea@usc.edu (213) 743-1588 cousinea@usc.edu

2. 2 CCP Evaluation 2 2 Funded by The California Endowment, The California Endowment, First 5 California and First 5 LA First 5 California and First 5 LA

3. 3 CCP Evaluation 3 3 Health Insurance Status of Children in California, 2001 Source: 2001 California Health Interview Survey

4. 4 CCP Evaluation 4 4 Uninsured Children In California 1 Million children (about 10%) in California are uninsured. 1 Million children (about 10%) in California are uninsured. Two thirds are eligible for existing programs Medi-Cal or Healthy Families Two thirds are eligible for existing programs Medi-Cal or Healthy Families Others are ineligible due to immigration status, family income Others are ineligible due to immigration status, family income Rate uneven throughout the State - high in parts of Los Angeles County) Rate uneven throughout the State - high in parts of Los Angeles County)

5. 5 CCP Evaluation 5 5 Variation among California Counties in Percent of Uninsured Children (Source: 2001 CHIS)

6. 6 CCP Evaluation 6 6 California Children’s Coverage Program A wide ranging plan to achieve 100% coverage of children in California A wide ranging plan to achieve 100% coverage of children in California Policy and programmatic strategies, Policy and programmatic strategies, Premium support Premium support Builds on 18 county-based programs that round out state and federal child health insurance programs Builds on 18 county-based programs that round out state and federal child health insurance programs Expansion, simplification, consolidation, ? State only programs Expansion, simplification, consolidation, ? State only programs Public program expansion with unknown employer role Public program expansion with unknown employer role A plan with basic benefit package and low or $0 premiums A plan with basic benefit package and low or $0 premiums

7. 7 CCP Evaluation 7 7 The California Endowment (Premium support and infrastructure) Development The California Endowment (Premium support and infrastructure) Development State and federal support, unknown State and federal support, unknown Counties – Counties – Tobacco Settlement First 5 (Proposition 10) Tobacco Settlement First 5 (Proposition 10) Other Foundations (Blue Shield, Packard) Other Foundations (Blue Shield, Packard) Local Initiatives (LA Care Health Plan) Local Initiatives (LA Care Health Plan) Funding

8. 8 CCP Evaluation 8 8 Purpose of the Evaluation Document the process and outcomes of the CCP in its effort to expand coverage, improve access and child health Document the process and outcomes of the CCP in its effort to expand coverage, improve access and child health Develop a plan once the initiative is underway for collecting quantitative and qualitative data from which to answer policy relevant questions, what works and Develop a plan once the initiative is underway for collecting quantitative and qualitative data from which to answer policy relevant questions, what works and Natural experiment, 58 counties Natural experiment, 58 counties Keys and obstacles to success Keys and obstacles to success Enrollment retention, crowd out, costs and utilization ands quality Enrollment retention, crowd out, costs and utilization ands quality

9. 9 CCP Evaluation 9 9 Methods and Strategies 1. Longitudinal Analysis of existing population and administrative data 2. Inventory of local projects, and evaluation and research activities 3. Comparative case studies, CHIs  Site visits and structured interviews 4. Surveys of elected officials and populations

10. 10 CCP Evaluation 10 Is Coverage Expanding? Create models (based on goals of CCP) using population survey data for deriving expected values and use survey data and enrollment data for comparing actual enrolled to the expected number, Create models (based on goals of CCP) using population survey data for deriving expected values and use survey data and enrollment data for comparing actual enrolled to the expected number,  Changes in health insurance for children and their families  Track participation in public programs Data Sources: Population surveys (CHIS, CPS, local surveys) Population surveys (CHIS, CPS, local surveys) Enrollment and administrative data (Medi-Cal, Healthy Families, Healthy Kids, and other state and local programs) Enrollment and administrative data (Medi-Cal, Healthy Families, Healthy Kids, and other state and local programs)

11. 11 CCP Evaluation 11 Improving Access and Health: What else should we be measuring? Review of existing data sources Review of existing data sources  Vital statistics and population-based surveys  First 5 programs Opportunities for data development Opportunities for data development Convening of experts and data specialists Convening of experts and data specialists  Consensus-based decision-making process

12. 12 CCP Evaluation 12 Political Capacity & Commitment Has CCP expanded support among policy makers for expanding health access? Has CCP expanded support among policy makers for expanding health access? Data Source: During Phase I, survey of state and local legislators to assess levels of awareness and commitment to children’s health policy, and gauge political will and support for the CCP. During Phase I, survey of state and local legislators to assess levels of awareness and commitment to children’s health policy, and gauge political will and support for the CCP. The survey will be repeated in Phase 2 to ascertain changes. The survey will be repeated in Phase 2 to ascertain changes.

13. 13 CCP Evaluation 13 Policy Reform What programs and resources have been mobilized? What programs and resources have been mobilized? What regulations adopted? What regulations adopted? What laws changed? State and local levels What laws changed? State and local levels Flow from the policy agenda put in place Flow from the policy agenda put in place Data Source : Environmental and legislative monitoring and scan Environmental and legislative monitoring and scan

14. 14 CCP Evaluation 14 Health Systems Change Research Questions: How has CCP changed health care systems - providers and local plans? How has CCP changed health care systems - providers and local plans? Data Source: Case Studies of Selected Counties Case Studies of Selected Counties  Interviews with health plans and providers  Document review  Participant observations

15. 15 CCP Evaluation 15 Network and Support Systems Research Questions: How has network and collaboration among local organizations within counties affected CHIs? How has network and collaboration among local organizations within counties affected CHIs? What is the role of foundations and other funders and how have they affected CHIs and the CCP? What is the role of foundations and other funders and how have they affected CHIs and the CCP? Data Source: Case studies of selected counties Case studies of selected counties  Interviews with health plans and providers  Document review  Participant observations

16. 16 CCP Evaluation 16 Studying the LA Children’s Health Initiative Outreach and enrollment Outreach and enrollment Utilization Utilization Quality Quality Partnerships Partnerships

17. 17 CCP Evaluation 17 Child Health Policy Research Collaborative USC, Division of Community Health (lead, California) – USC, Division of Community Health (lead, California) – USC, Tomás Rivera Policy Institute – USC, Department of Preventive Medicine, Institute for Prevention Research -. USC, Tomás Rivera Policy Institute – USC, Department of Preventive Medicine, Institute for Prevention Research -. USC Children’s Hospital Los Angeles, Division of Research on Children Youth and Families, USC Children’s Hospital Los Angeles, Division of Research on Children Youth and Families, University of California San Diego, Department of Family and Preventive Medicine - University of California San Diego, Department of Family and Preventive Medicine - Johns Hopkins University, School of Public Health - Johns Hopkins University, School of Public Health - Urban Institute, (lead, Los Angeles) Urban Institute, (lead, Los Angeles) Mathematica Mathematica UCLA Center for Healthier Children, Families and Communities UCLA Center for Healthier Children, Families and Communities USC USC

18. 18 CCP Evaluation 18 Research Team (both California and LA Studies) USC. Michael R. Cousineau, Principal Investigator, Gregory Stevens, Ph.D., Eriko Wada, MPP and Lori Nascimento, MPH USC. Michael R. Cousineau, Principal Investigator, Gregory Stevens, Ph.D., Eriko Wada, MPP and Lori Nascimento, MPH USC, Department of Preventive Medicine, Institute for Prevention Research - Tom Valente, Ph.D. and Lourdes Baezcandi-Garbanati,Ph.D Urban Institute, USC, Department of Preventive Medicine, Institute for Prevention Research - Tom Valente, Ph.D. and Lourdes Baezcandi-Garbanati,Ph.D Urban Institute, USC, Tomás Rivera Policy Institute - Harry Pachon, Ph.D, Jongho Lee, Ph.D., and Hayley Buchbinder, MPP & MPH Mathematica, Ian Hill, USC, Tomás Rivera Policy Institute - Harry Pachon, Ph.D, Jongho Lee, Ph.D., and Hayley Buchbinder, MPP & MPH Mathematica, Ian Hill, USC Children’s Hospital Los Angeles, Division of Research on Children Youth and Families, Department of Pediatrics - Michele Kipke, Ph.D., Ellen Iverson, Ph.D., and Angela Hegeman, Ph.D USC Children’s Hospital Los Angeles, Division of Research on Children Youth and Families, Department of Pediatrics - Michele Kipke, Ph.D., Ellen Iverson, Ph.D., and Angela Hegeman, Ph.D UCLA, Neal Halfon, MD, Moira Inkeles, Ph.D., Patrica Barreto, MD UCLA, Neal Halfon, MD, Moira Inkeles, Ph.D., Patrica Barreto, MD University of California San Diego, Department of Family and Preventive Medicine - Richard Kronick, Ph.D. and Tom Gilmore, Ph.D University of California San Diego, Department of Family and Preventive Medicine - Richard Kronick, Ph.D. and Tom Gilmore, Ph.D Johns Hopkins University, School of Public Health - Tom Oliver, Ph.D. Johns Hopkins University, School of Public Health - Tom Oliver, Ph.D.