Measuring the impact of outreach and enrollment strategies for public health insurance in California

Abstract

OBJECTIVE AND STUDY SETTING: To evaluate the effectiveness of different approaches to outreach on public health insurance enrollment in 25 California counties with a Children's Health Initiative.

Data source: Administrative enrollment databases.

Study design: The use of eight enrollment strategies were identified in each quarter from 2001 to 2007 for each of 25 counties (county quarter). Strategies were categorized as either technology or nontechnology. New enrollments were obtained for Medi-Cal, Healthy Families, and Healthy Kids. Bivariate and multivariate analyses assessed the link between each strategy and new enrollments rates of children.

Data collection: Methods Surveys of key informants determined whether a specific outreach strategy was used in each quarter. These were linked to new enrollments in each county quarter.

Principal findings: Between 2001 and 2007, enrollment grew in all three children's health programs. We controlled for the effects of counties, seasons, and county-specific child poverty rates. There was an increase in enrollment rates of 11 percent in periods when technology-based systems were in use compared with when these approaches were inactive. Non-technology-based approaches, including school-linked approaches, yielded a 12 percent increase in new enrollments rates. Deploying seven to eight strategies yielded 54 percent more new enrollments per 10,000 children compared with periods with none of the specific strategies.

Conclusions and implications: National health care reform provides new opportunities to expand coverage to millions of Americans. An investment in technology-based enrollment systems will maximize new enrollments, particularly into Medicaid; nontechnological approaches may help identify harder-to-reach populations. Moreover, incorporating several strategies, whether phased in or implemented simultaneously, will enhance enrollments.

Figure 1

The Deployment of Nontechnology Outreach and Enrollment Strategies in California Counties by Quarters, 2001–2008. N=24 counties^{* *}Although 25 counties participated in the study, two counties participated as a region and were analyzed together; therefore, n=24.

Figure 2

The Use of Technology Tools for Outreach and Enrollment in California Counties, 2001–2008. N=24 counties^{* *}Although 25 counties participated in the study, two counties participated as a region and were analyzed together; therefore, n=24.

Figure 3

Average Monthly New Enrollments by Quarter. Medi-Cal,⁽¹⁾ Healthy Families,⁽²⁾ and Healthy Kids⁽³⁾ in California Counties, 2001–2007. N=24 counties^* Source: Enrollment data were provided separately for each program. They include the following: (1) California Department of Health Services, Medi-Cal Division, (2) Managed Risk Medical Insurance Board, (3) Healthy Kids Enrollment data were provided by each participating health plan. ^*Although 25 counties participated in the study, two counties participated as a region and were analyzed together; therefore, n=24.