Evaluation of the San Mateo County Children’s Health Initiative: Second Annual Report Embry Howell, Urban Institute Dana Hughes, University of California San Francisco Genevieve Kenney, Urban Institute Jennifer Sullivan, Urban Institute Jamie Rubenstein, Urban Institute August 2005 Submitted to: San Mateo County Children’s Health Initiative Coalition 225 37th Ave. San Mateo, CA 94403 ACKNOWLEDGMENTS The following individuals and organizations provided data for this report, and we appreciate their assistance: • Staff of Mathematica Policy Research, under the leadership of Martha Kovac, who collected client survey data. • Staff of the Aguirre Group, under the leadership of Carmen Sum, who collected parent focus group data. • Vicki Shih and Sam Tobin of the Health Plan of San Mateo, who processed data from the plan. • Members of the Hospital Consortium of San Mateo County, led by Francine Serafin-Dickson, as well as Lucile Packard Children’s Hospital, who provided aggregate data from their hospitals. • A large number of individuals involved in the San Mateo County Children’s Health Initiative, who were interviewed and provided their time and much of the information in the report. • The parents, physicians, and dentists who were interviewed or participated in focus groups, providing their impressions of the Children’s Health Initiative in order to help to improve the program. • The funders for the evaluation: the San Mateo County First 5 Commission, the Lucile Packard Foundation for Children’s Health, and the Peninsula Community Foundation. CONTENTS Executive Summary................................................................................................... i Introduction................................................................................................................ 1 The Context and Implementation of the Children’s Health Initiative (CHI) in 2004 3 Question 1: Which Children Are Served by the CHI, and What Are Their Demographic and Health Status Characteristics?...................................................... 23 Question 2: What Was the Children’s Health Insurance Coverage Before Enrolling in Healthy Kids, and What Access Do Enrollees Have to Employer-Sponsored Coverage?................................................................................ 36 Question 3: How Well Are Healthy Kids Enrollees Able to Access Health Services? ............................................................................................................ 44 Question 4: What Services Do Healthy Kids Enrollees Receive, and How Does Their Use Compare with Medi-Cal and Healthy Families Children’s Use?............. 51 Question 5: What Is the Cost for Care for Healthy Kids Enrollees, and How Does It Compare with the Cost of Care for Medi-Cal and Healthy Families Children?.................................................................................................................... 60 Question 6: What Are Parents’ Experiences with the Healthy Kids Program, and Are They Satisfied with the Services Their Children Receive?................................ 66 Question 7: Are Providers Satisfied with the Program?........................................ 79 Question 8: How Does the CHI Affect the Financial Status of San Mateo County Providers?...................................................................................................... 88 Conclusions................................................................................................................ 93 LIST OF TABLES Table 1: Enrollment Process for Healthy Kids Children, January 2004................. 11 Table 2: Membership of Policy Committees........................................................... 14 Table 3: Key Features of the Healthy Kids Program.............................................. 16 Table 4: Financing for the Children’s Health Initiative, 2004................................ 19 Table 5: Characteristics of Healthy Kids, Healthy Families, and Medi-Cal Enrollees, 2004.......................................................................................... 24 Table 6: Age, Ethnicity, Language, and Citizenship, Healthy Kids Enrollees and Parents, 2004............................................................................................. 26 Table 7: Family Composition, Parent Education and Employment, and Length of Time in San Mateo County, Healthy Kids Enrollees, January 2004.... 28 Table 8: Health Status, Healthy Kids Enrollees, January 2004............................... 30 Table 9: Prevalence of Selected Diagnoses and Most Expensive Diagnoses for Children Enrolled In the Health Plan of San Mateo, 2004.................. 35 Table 10: Selected Characteristics of Healthy Kids Enrollees by Income, January 2004........................................................................................................... 39 Table 11: Coverage Status of Children Just Before