Managing access: extending Medicaid to children through school-based HMO coverage.

Area of Science:

• Public Health
• Health Services Research
• Health Policy

Background:

• Indigent children face significant barriers to healthcare access.
• Health Maintenance Organizations (HMOs) can potentially improve care management and access.
• School-based health coverage models offer a novel approach to reach underserved populations.

Purpose of the Study:

• To evaluate the impact of the Florida Healthy Kids (FHK) demonstration on healthcare access for indigent children.
• To assess the utilization, cost, and satisfaction levels of Medicaid-like HMO coverage in a school-based setting.
• To explore the role of HMO capacity and incentives in managing care and improving access.

Main Methods:

• Quasi-experimental study design evaluating the FHK demonstration in Volusia County, Florida.
• Analysis of changes in uninsured student months before and after program implementation.
• Comparison of utilization, cost, and access measures between FHK enrollees and privately insured children.

Main Results:

• Uninsured student months were reduced by approximately 50% in Volusia County public schools.
• Utilization and cost metrics for indigent FHK enrollees were similar to commercial clients.
• Access, utilization, and satisfaction levels for FHK enrollees met or exceeded those of privately insured non-enrollees.

Conclusions:

• Schools serve as an effective platform for delivering health coverage to indigent children.
• Managed care strategies within HMOs can successfully address non-financial barriers to healthcare access.
• The FHK model demonstrates the potential for improving health equity and outcomes for vulnerable student populations.