Access for low-income children: Is health insurance enough?

Objective. The Balanced Budget Act of 1997 authorizes $20 billion for state s to expand health insurance coverage among uninsured low-income children. This study identifies lessons learned from the Medicaid Extension Demonstra tion, which was authorized by Congress to experiment with innovative approa ches to providing health care coverage for low-income children. The three p rograms compare and contrast a variety of features that may enhance or detr act from access, including a traditional Medicaid expansion, a private inde mnity model, and a comprehensive managed care delivery system. Methodology. Two waves of telephone surveys were conducted with a sample of parents of children participating in the Medicaid Extension Demonstration, and a comparison group of parents of children who were eligible but not pa rticipating. Descriptive and multivariate analyses were conducted to determ ine the impact of the demonstration on access to care. Results. Compared with those who were uninsured, children in the managed ca re program were more likely to have a medical home and a physician visit an d were less likely to have an emergency room visit, and had lower levels of unmet need. Outcomes across the other two demonstration programs were less favorable. Conclusions. This study suggests that simply providing a Medicaid card or p rivate indemnity insurance card is not enough to ensure access to care. Fut ure initiatives also need to consider the structure of the delivery system, especially the availability of a medical home (with adequate after-hours c are), as well as the impact of discontinuous insurance coverage on access t o and continuity of care.