Managing access: extending Medicaid to children through school-based HMO coverage
Coulam, R.F.; Irvin, C.V.; Calore, K.A.; Kidder, D.E.; Rosenbach, M.L.
Health Care Financing Review 18(3): 149-175
1997
ISSN/ISBN: 0195-8631 PMID: 10170346 Document Number: 477782
This study explores how a health maintenance organization's (HMO) capacity and incentives to manage care might be used to improve access. In the early 1990s, the Florida Healthy Kids (FHK) demonstration extended Medicaid-like HMO coverage to indigent children in the public schools of Volusia County, Florida. The study finds that uninsured student months in area public schools were likely reduced by one-half. Utilization and cost levels for these indigent enrollees proved to be indistinguishable from commercial clients; and measures of access, utilization, and satisfaction for enrollees were in line with (and in some cases, superior to) non-enrollees with private insurance. Overall, these results suggest the value of using schools as a medium for providing coverage, and the importance of taking deliberate steps to manage access to reduce non-financial barriers to care.