Final Report of the Evaluation of the San Mateo County Children's Health Initiative

Final Report of the Evaluation of the San Mateo County Children's Health Initiative Embry Howell, Urban Institute Dana Hughes, University of California, San Francisco Louise Palmer, Urban Institute Genevieve Kenney, Urban Institute Ariel Klein, Urban Institute May 2008 Submitted to: San Mateo County Children’s Health Initiative 701 Gateway Blvd., Suite 400 South San Francisco, CA 94080 ACKNOWLEDGMENTS We acknowledge the invaluable assistance of numerous individuals and organizations in the course of the evaluation. Martha Kovac and Betsy Santos, of Mathematica Policy Research, oversaw the parent survey. Carmen Sum of JBS International, Inc., Aguirre Division led the parent focus groups. We interviewed numerous individuals who have been involved with the CHI from its beginning, or who could provide a perspective on the initiative. Many of these individuals or their organizations provided data to us. Particular thanks go to staff of the San Mateo County Health Department, the Health Plan of San Mateo, and the San Mateo Human Services Agency—especially ST Mayer, Marmi Bermudez, and Vicky Shih—as well as to all members of the CHI Oversight and Evaluation Committees. In addition, many parents of children enrolled in Healthy Kids participated in the focus groups or parent survey. A multitude of county agency personnel and representatives from other related organizations provided insights and perceptions during site visits. Without the time and effort of all of these individuals, the evaluation would not have been possible. Finally we thank the funders of the evaluation: First 5 San Mateo County, the Lucile Packard Foundation for Children’s Health, the David and Lucile Packard Foundation, and the County of San Mateo. i EXECUTIVE SUMMARY The San Mateo County Children’s Health Initiative (CHI) began in January 2003, as an effort to improve the health of low-income children in the county by assuring that they have health insurance coverage and access to care. Multiple public and private organizations have collaborated to fund and oversee the initiative. Among other activities, the CHI partners reach out to and enroll children in the health insurance program they are entitled to. The county has established the Healthy Kids program (administered by the Health Plan of San Mateo) to cover children who are not entitled to any other insurance program. In 2003 the county funded the Urban Institute—along with its partners, consultant Dana Hughes of the University of California, San Francisco; Mathematica Policy Research; and JBS International, Inc., Aguirre Division—to conduct a five year evaluation of the CHI. This report summarizes key findings from the evaluation. More information is contained in other evaluation reports and briefs. (See Appendix B for a project bibliography.) The CHI outreach and enrollment activities were implemented quickly in the first year, resulting in rapid enrollment growth in the new Healthy Kids program. Enrollment leveled off in subsequent years. As a result, the county has not yet had to establish a waiting list as has been done in other counties with Healthy Kids programs. Enrollment in Healthy Families (the California SCHIP program) has grown moderately since the CHI began, and enrollment in Medi-Cal has been steady (during a period of relative economic prosperity). Unfortunately, there are no accurate data to assess precisely how the initiative has affected the number of uninsured children in the county. The Healthy Kids program has had a substantial impact on the lives of enrolled children and their families. The program has resulted in: • Dramatic increases in the proportion of children with a usual source of medical and dental care (30 and 45 percentage point increases respectively). • Substantial increases in the proportion of children with a medical or dental visit in the past six months (18 and 41 percentage point increases respectively). • An almost 20 percentage point rise in the proportion of children with preventive care in the past six months. • Reductions in the proportion of children with an overnight hospital stay in the past six months (but no change in emergency room use). • Substantial reductions in unmet need for medical and dental care (13 and 10 percentage points respectively), as well as a virtual elimination of cost as a reason for unmet need of either type. • Reductions in the proportion of children who miss school due to health problems. ii Another positive finding from the evaluation is that the use of key services targeted by the CHI for improvement—preventive care and dental care—continues to improve after children have been enrolled in the program continuously for three years. Given the programs’ eligibility level of 400 percent of the Federal Poverty Level, one key goal for the CHI is to prevent crowd-out of private insurance. The evaluation shows that few children who enroll in Healthy Kids (or their family members) h