First name
Kathleen
Middle name
G
Last name
Noonan

Title

Low-Income Working Families With Employer-Sponsored Insurance Turn To Public Insurance For Their Children.

Year of Publication

2016

Number of Pages

2302-2309

Date Published

2016 Dec 01

ISSN Number

1544-5208

Abstract

<p>Many families rely on employer-sponsored health insurance for their children. However, the rise in the cost of such insurance has outpaced growth in family income, potentially making public insurance (Medicaid or the Children's Health Insurance Plan) an attractive alternative for affordable dependent coverage. Using data for 2008-13 from the Medical Expenditure Panel Survey, we quantified the coverage rates for children from low- or moderate-income households in which a parent was offered employer-sponsored insurance. Among families in which parents were covered by such insurance, the proportion of children without employer-sponsored coverage increased from 22.5&nbsp;percent in 2008 to 25.0&nbsp;percent in 2013. The percentage of children with public insurance when a parent was covered by employer-sponsored insurance increased from 12.1&nbsp;percent in 2008 to 15.2&nbsp;percent in 2013. This trend was most pronounced for families with incomes of 100-199&nbsp;percent of the federal poverty level, for whom the share of children with public insurance increased from 22.8&nbsp;percent to 29.9&nbsp;percent. Among families with incomes of 200-299&nbsp;percent of poverty, uninsurance rates for children increased from 6.0&nbsp;percent to 9.2&nbsp;percent. These findings suggest a movement away from employer-sponsored insurance and toward public insurance for children in low-income families, and growth in uninsurance among children in moderate-income families.</p>

DOI

10.1377/hlthaff.2016.0381

Alternate Title

Health Aff (Millwood)

PMID

27920320

Title

Shared decision making in pediatrics.

Year of Publication

2013

Number of Pages

822

Date Published

2013 Apr

ISSN Number

1544-5208

DOI

10.1377/hlthaff.2013.0201

Alternate Title

Health Aff (Millwood)

PMID

23569065

Title

Mandates for Collaboration: Health Care and Child Welfare Policy and Practice Reforms Create the Platform for Improved Health for Children in Foster Care.

Year of Publication

2015

Number of Pages

316-22

Date Published

2015 Oct

ISSN Number

1538-3199

Abstract

<p>Improving the health of children in foster care requires close collaboration between pediatrics and the child welfare system. Propelled by recent health care and child welfare policy reforms, there is a strong foundation for more accountable, collaborative models of care. Over the last 2 decades health care reforms have driven greater accountability in outcomes, access to care, and integrated services for children in foster care. Concurrently, changes in child welfare legislation have expanded the responsibility of child welfare agencies in ensuring child health. Bolstered by federal legislation, numerous jurisdictions are developing innovative cross-system workforce and payment strategies to improve health care delivery and health care outcomes for children in foster care, including: (1) hiring child welfare medical directors, (2) embedding nurses in child welfare agencies, (3) establishing specialized health care clinics, and (4) developing tailored child welfare managed care organizations. As pediatricians engage in cross-system efforts, they should keep in mind the following common elements to enhance their impact: embed staff with health expertise within child welfare settings, identify long-term sustainable funding mechanisms, and implement models for effective information sharing. Now is an opportune time for pediatricians to help strengthen health care provision for children involved with child welfare.</p>

DOI

10.1016/j.cppeds.2015.08.006

Alternate Title

Curr Probl Pediatr Adolesc Health Care

PMID

26403650

Title

Quality of Health Insurance Coverage and Access to Care for Children in Low-Income Families.

Year of Publication

2016

Number of Pages

43-51

Date Published

2016 Jan 1

ISSN Number

2168-6211

Abstract

<p><strong>Importance: </strong>An increasing diversity of children's health coverage options under the US Patient Protection and Affordable Care Act, together with uncertainty regarding reauthorization of the Children's Health Insurance Program (CHIP) beyond 2017, merits renewed attention on the quality of these options for children.</p>

<p><strong>Objective: </strong>To compare health care access, quality, and cost outcomes by insurance type (Medicaid, CHIP, private, and uninsured) for children in households with low to moderate incomes.</p>

<p><strong>Design, Setting, and Participants: </strong>A repeated cross-sectional analysis was conducted using data from the 2003, 2007, and 2011-2012 US National Surveys of Children's Health, comprising 80 655 children 17 years or younger, weighted to 67 million children nationally, with household incomes between 100% and 300% of the federal poverty level. Multivariable logistic regression models compared caregiver-reported outcomes across insurance types. Analysis was conducted between July 14, 2014, and May 6, 2015.</p>

<p><strong>Exposures: </strong>Insurance type was ascertained using a caregiver-reported measure of insurance status and each household's poverty status (percentage of the federal poverty level).</p>

<p><strong>Main Outcomes and Measures: </strong>Caregiver-reported outcomes related to access to primary and specialty care, unmet needs, out-of-pocket costs, care coordination, and satisfaction with care.</p>

<p><strong>Results: </strong>Among the 80 655 children, 51 123 (57.3%) had private insurance, 11 853 (13.6%) had Medicaid, 9554 (18.4%) had CHIP, and 8125 (10.8%) were uninsured. In a multivariable logistic regression model (with results reported as adjusted probabilities [95% CIs]), children insured by Medicaid and CHIP were significantly more likely to receive a preventive medical (Medicaid, 88% [86%-89%]; P &lt; .01; CHIP, 88% [87%-89%]; P &lt; .01) and dental (Medicaid, 80% [78%-81%]; P &lt; .01; CHIP, 77% [76%-79%]; P &lt; .01) visits than were privately insured children (medical, 83% [82%-84%]; dental, 73% [72%-74%]). Children with all insurance types experienced challenges in access to specialty care, with caregivers of children insured by CHIP reporting the highest rates of difficulty accessing specialty care (28% [24%-32%]), problems obtaining a referral (23% [18%-29%]), and frustration obtaining health care services (26% [23%-28%]). These challenges were also magnified for privately insured children with special health care needs, whose caregivers reported significantly greater problems accessing specialty care (29% [26%-33%]) and frustration obtaining health care services (36% [32%-41%]) than did caregivers of children insured by Medicaid, and a lower likelihood of insurance always meeting the child's needs (63% [60%-67%]) than children insured by Medicaid or CHIP. Caregivers of privately insured children were also significantly more likely to experience out-of-pocket costs (77% [75%-78%]) than were caregivers of children insured by Medicaid (26% [23%-28%]; P &lt; .01) or CHIP (38% [35%-40%]; P &lt; .01).</p>

<p><strong>Conclusions and Relevance: </strong>This examination of caregiver experiences across insurance types revealed important differences that can help guide future policymaking regarding coverage for families with low to moderate incomes.</p>

DOI

10.1001/jamapediatrics.2015.3028

Alternate Title

JAMA Pediatr

PMID

26569497

Title

Increasing pediatrician participation in EHR incentive programs.

Year of Publication

2015

Number of Pages

e1-4

Date Published

01/2015

ISSN Number

1098-4275

DOI

10.1542/peds.2014-2438

Alternate Title

Pediatrics

PMID

25548326

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