Child Health

Asthma is one of the most common chronic conditions among children in the United States, affecting nearly 10 percent of children in 2008. Medicaid and CHIP are covering a growing number of asthmatic children; by 2008, two-thirds of low-income asthmatic children were covered by Medicaid/CHIP. Our findings suggest that over the last decade, there has been a trend towards improvement in asthma-related outcomes and receipt of parental asthma management training for asthmatic children with Medicaid/CHIP coverage. Further expansions in health insurance coverage could lead to reductions in negative asthma outcomes and their associated costs, but other changes to the service delivery system would be needed as well.

This second case study of the implementation of Best Start LA finds that the place-based investment—designed to improve the well-being, development and care experienced by children ages five and under—has made good progress during its second year, gaining momentum as it has become more firmly established in the downtown Metro LA pilot community. Welcome Baby! home visiting appears to be a high-quality service that could serve as a model throughout Los Angeles County. Community strategies have been funded through a series of "first step" contracts with various local agencies. And systems-level efforts appear to be laying the groundwork for important changes that could make Los Angeles communities more family-friendly for parents with young children.

Urban Institute scholars from diverse disciplines tackle a simple-to-state, hard-to-answer question: How can solutions to our national and state budget crises fit the facts about children in the United States? In their responses, the contributors wrestle with recent and approaching economic and demographic challenges in different ways and bring very different experiences to bear.

Best Start LA is a place-based community investment in Los Angeles County designed to improve the well-being, development, and care experienced in children ages five and under. Focus groups with parents, home visitors, and community members -reveal that the investment is off to a good start. Mothers receiving "Welcome Baby!" home visiting were very satisfied with the education and support the service provides. Home visitors described the close bonds they form with their clients, but also feel that the program's model doesn't always meet families' extensive needs. Stakeholders involved in community mobilization efforts were excited about their early progress and shared vision for parents as the leaders.

A case study of the initial implementation of Best Start LA-a place-based community investment in Los Angeles County designed to improve the well-being, development, and care experienced by children ages five and under-finds mostly positive results, thus far. At the family level, home visiting for pregnant and parenting mothers is off to a strong start, rendering services to nearly 750 families by the end of 2010. Community-level efforts to mobilize community members and develop family-support strategies have been slower to develop. Systems-level investments to develop family-friendly policies and services across the county are proceeding on schedule.

This paper examines measures of Medicaid and Children’s Health Insurance Program (CHIP) coverage duration available for potential inclusion in a core set of children's health care quality measures as called for by the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009. The authors review possible measures and argue that prospective measures of duration and churning based on cohorts of new enrollees hold the most promise for producing valid estimates and that additional technical and financial resources and enhancements to administrative data systems will be needed to support state efforts in this area of quality assessment.

Maximizing insurance coverage for children under the Affordable Care Act will require considering how the new system and its rules will apply to children facing complex coverage scenarios. The purpose of this brief is to explore several scenarios in which children may face particular challenges in accessing health insurance coverage. We find that roughly 20 million children live in situations that create particular challenges in accessing insurance coverage due to within-family variation in eligibility for different types of coverage and that nearly 28 million children live apart from at least one of their parents, creating additional complexities in accessing coverage.

Health programs often fall short of their coverage goals. Even the Children's Health Insurance Program, now quite successful in reaching uninsured children, suffered low enrollment during its early years. By contrast, other programs rapidly achieved high participation by using reliable data to identify eligible consumers and qualify them for assistance. Federal policymakers implementing the Affordable Care Act could thus pursue a strategy with five parts:

1. A proactive national campaign to identify and enroll the uninsured via the tax system;
2. Basing eligibility on reliable data;
3. Providing hands-on application assistance; 
4. Consumer-friendly enrollment systems; and
5. Effective interagency coordination.