Carol V. Irvin

Access for Low-income Children: Is Health Insurance Enough?

Objective. The Balanced Budget Act of 1997 authorizes

Effects of a Discharge Planning Program on Medicaid Coverage of State Prisoners With Serious Mental Illness

20 billion for states to expand health insurance coverage among uninsured low-income children. This study identifies lessons learned from the Medicaid Extension Demonstration, which was authorized by Congress to experiment with innovative approaches to providing health care coverage for low-income children. The three programs compare and contrast a variety of features that may enhance or detract from access, including a traditional Medicaid expansion, a private indemnity 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 participating. Descriptive and multivariate analyses were conducted to determine the impact of the demonstration on access to care. Results. Compared with those who were uninsured, children in the managed care program were more likely to have a medical home and a physician visit and 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 private indemnity insurance card is not enough to ensure access to care. Future initiatives also need to consider the structure of the delivery system, especially the availability of a medical home (with adequate after-hours care), as well as the impact of discontinuous insurance coverage on access to and continuity of care.

Implementation of the State Children's Health Insurance Program: Momentum Is Increasing After a Modest Start

OBJECTIVE Many inmates with serious mental illness leave prisons without health insurance, which reduces their access to health care and therefore places them at risk of relapse and rearrest. This study assessed the effectiveness of a discharge planning program implemented in three Oklahoma state prisons to assist inmates with serious mental illness to enroll in Medicaid on the day of release or soon thereafter. METHODS Administrative data containing demographic characteristics, Medicaid enrollment status, and mental health service use were collected for 686 inmates with serious mental illness released from Oklahoma state prisons between 2004 and 2008. Regression-adjusted difference-in-difference estimates were used to compare postrelease Medicaid enrollment and service use of 77 inmates eligible for program services with those of inmates with mental illness of similar severity in three comparison groups. RESULTS In facilities implementing the program, the percentage of inmates with serious mental illness who enrolled in Medicaid on the day of release increased from 8% during the baseline period to 25% after program implementation. The difference-in-difference estimates, which adjusted for trends in Medicaid enrollment and inmate demographic and prison stay characteristics, indicated that the program increased Medicaid enrollment by 15 percentage points (p=.012) and increased Medicaid mental health service use by 16 percentage points (p=.009). CONCLUSIONS Although additional research is needed to assess the programs long-term effects on health care utilization and rearrest, this study illustrated that with careful planning, interagency collaboration, and dedicated staff, states can successfully increase Medicaid coverage among inmates with serious mental illness on their release from prison.