For children, as for adults, medical insurance facilitates access to appropriate health services. Whether or not children have insurance coverage has potential lifelong implications.

Children who lack coverage are less likely either to have a regular source of care or to access needed care than are children with insurance. Health coverage can contribute to the early identification and appropriate management of childhood developmental problems. Finally, insurance coverage can determine whether children receive necessary dental services.

Approximately 500,000 uninsured California children are ineligible for existing state coverage programs such as Medi-Cal and Healthy Families (California's version of the State Children's Health Insurance Program, or S-CHIP). In recent years, county-based programs in many parts of California have been launched with the goal of providing health insurance for children who are ineligible, due to immigration status or income level, for state programs. Such county programs have been designed and are governed by coalitions of local leaders. They are typically financed through a patchwork of local public funding streams combined with private philanthropic support.

To respond to local needs, take advantage of local funding opportunities, and manage within funding constraints, programs in different counties and regions around the state have pursued different approaches. Many have developed "Healthy Kids" products with comprehensive benefits and low cost sharing that mirror those of the Healthy Families programs, and that partner either with a Medi-Cal Local Initiative, a County-Organized Health System, or a commercial health plan. Others have partnered with CaliforniaKids (CalKids), a program founded in 1992 that covers a more limited set of benefits and requires higher family cost sharing for many services. Differences in program design and cost have allowed local decision-makers flexibility to pursue disparate approaches for expanding children's access to affordable care and coverage. There is considerable evidence, from family satisfaction surveys and local leaders, that both approaches make important improvements in health service use and increase confidence that families will be able to manage unexpected medical needs.

Local coverage programs in California share the goal of expanding children's access to medical care, yet they have taken different paths toward this goal. As local program directors and policymakers continue to grapple with funding limitations, questions inevitably arise about cost and access among children's coverage programs.

To provide background on these issues, the California HealthCare Foundation funded Mathematica Policy Research to assemble health services utilization data and observations about access to care among children's coverage programs. Study findings include:

• Similar utilization levels: Medi-Cal and Healthy Families enrollees make substantial and well-documented use of outpatient care. Available survey and health plan data, while limited, suggest that use of outpatient care among children enrolled in local programs is at or near that for state programs. Children covered through local Healthy Kids programs and CalKids use outpatient services, well-child services, and dental services at roughly similar levels. Hospitalization rates are quite low for children in all the programs.
• Similar experiences accessing care: The analysis uncovered few substantial differences in how families of children with significant medical conditions would typically access services. The greatest potential difference was for a child with an emergent condition such as appendicitis. Relative to beneficiaries in state public programs or most local Healthy Kids programs, CalKids enrollees might experience additional paperwork at intake.
• Local experts suggest that differences in patient experiences are as likely to be associated with the local delivery system and provider network as with benefit design: Few differences in care coordination and access for children with serious chronic diseases were identified; where concerns arose, they were attributed to variations in county health care systems rather than differences in the coverage model.

The analysis, based on an initial exploration of available data, describes what is known about access and use of services across subsidized insurance programs in California. The scope of the analysis limits its conclusions, but the authors offer ideas for further study that might address some of those limitations.

More information about the study approach, limitations, and findings can be found in the full report, Health Care Access and Use among Low-Income Children on Subsidized Insurance Programs in California, available on the Mathematica Policy Research site through the link below.

Further evaluations of local programs are available: Evaluation of the Los Angeles CalKids Program on www.chcf.org and Santa Clara County Children's Health Initiative on www.mathematica-mpr.com.