The effects of Medicaid and CHIP policy changes on receipt of preventive care among children

Abstract

Objective: To examine changes in children's receipt of well-child and preventive dental care in Medicaid/Children's Health Insurance Program (CHIP) in two states that adopted policies aimed at promoting greater preventive care receipt.

Data sources: The 2004-2008 Medicaid/CHIP claims and enrollment data from Idaho and Kentucky.

Study design: Logistic and hazard pre-post regression models, controlling for age, gender, race/ethnicity, and eligibility category.

Data extraction methods: Claims and enrollment data were de-identified and merged.

Principal findings: Increased reimbursement had a small, positive association with well-child care in Idaho, but no consistent effects were found in Kentucky. A premium forgiveness program in Idaho was associated with a substantial increase (between 20 and 113 percent) in receipt of any well-child care and quicker receipt of well-child care following enrollment. In Kentucky, children saw modest increases in receipt of preventive dental care and received such care more quickly following increased dental reimbursement, while the move to managed care in Idaho was associated with a small increase in receipt of preventive dental care.

Conclusions: Policy changes such as reimbursement increases, incentives, and delivery system changes can lead to increases in preventive care use among children in Medicaid and CHIP, but reported preventive care receipt still falls short of recommended levels.