October 21, 2004 USC Division of Community Health cousinea@usc (213) 743-1588

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(213) 743-1588

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

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

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

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

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

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

8. Purpose of the Evaluation • 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 • Natural experiment, 58 counties • Keys and obstacles to success • Enrollment retention, crowd out, costs and utilization ands quality

9. Methods and Strategies • Longitudinal Analysis of existing population and administrative data • Inventory of local projects, and evaluation and research activities • Comparative case studies, CHIs • Site visits and structured interviews • Surveys of elected officials and populations

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, • Changes in health insurance for children and their families • Track participation in public programs Data Sources: • Population surveys (CHIS, CPS, local surveys) • Enrollment and administrative data (Medi-Cal, Healthy Families, Healthy Kids, and other state and local programs)

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

12. Political Capacity & Commitment • 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. • The survey will be repeated in Phase 2 to ascertain changes.

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

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

15. Network and Support Systems Research Questions: • 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? Data Source: • Case studies of selected counties • Interviews with health plans and providers • Document review • Participant observations

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

17. Child Health Policy Research Collaborative • USC, Division of Community Health (lead, California) – • 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, • University of California San Diego, Department of Family and Preventive Medicine - • Johns Hopkins University, School of Public Health - • Urban Institute, (lead, Los Angeles) • Mathematica • UCLA Center for Healthier Children, Families and Communities • USC

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, 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 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 • 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.