Moving the Needle on Health Insurance Coverage: Evaluation of the Cities Expanding Health Access for Children and Families Project
Publisher: Princeton, NJ: Mathematica Policy Research
The passage of the Patient Protection and Affordable Care Act (ACA) in 2010 held great promise for expanding insurance coverage to millions of uninsured Americans. When the ACA was enacted, about 6.2 million children were uninsured; of those, nearly 70 percent were eligible for coverage through Medicaid or the Children’s Health Insurance Program (CHIP), but were not enrolled (Kenney et al. 2012). Viewing the ACA as an opportunity to find and enroll these children into coverage, in December 2012, the Atlantic Philanthropies granted $3.25 million to the National League of Cities’ (NLC) to launch a three-year project to engage cities on children’s coverage issues. The Cities Expanding Health Access for Children and Families (CEHACF) project was designed to capitalize on both cities’ responsibility for protecting the health and well-being of their residents and municipal leaders’ platform for engaging residents. The project’s overarching goal was to empower municipal leaders in competitively selected cities to partner with key stakeholders to find uninsured children—and, potentially, their adult parents who were newly eligible for coverage through ACA rules—and enroll them in Medicaid or CHIP. Beginning in January 2013, CEHACF engaged selected cities on children’s coverage issues through a three-stage, competitive grant-making process. NLC staff helped municipal leaders and their partners from participating cities to (1) learn more about the development and implementation of health insurance outreach and enrollment strategies, (2) develop business plans to implement outreach campaigns, and (3) implement those business plans. In 2014, Atlantic commissioned Mathematica Policy Research to evaluate the CEHACF project. This report is based primarily on interviews conducted in 2015 and 2016 with staff from participating cities and NLC, review of program documents, and analysis of monthly data collected between August 2014 and July 2016 from the eight cities that were selected to implement outreach and enrollment campaigns through the project.
- Cities can effectively conduct outreach and enrollment work: nearly 20,000 adults and children have enrolled in Medicaid or CHIP as a direct result of campaigns in four of the participating CEHACF cities.
- Developing partnerships with community organizations that were likely to serve uninsured children and families during the grant period was challenging; the most successful cities leveraged partnerships that predated their CEHACF campaigns.
- Cities worked to balance best practices in outreach and enrollment against the desire to develop innovative campaigns.
- Participating cities are developing strategies to sustain this work, including institutionalizing campaigns within existing city efforts and seeking additional funding sources.