1. Children’s Health Insurance Matters: Findings from Surveys of Healthy Kids Participants Grantmakers in Health Site Visit Meeting Christopher Trenholm Mathematica Policy Research September 25, 2008

2. Presentation Will Focus on: Overview of Healthy Kids Surveys - Focus on Santa Clara County (for clarity) Impacts of Healthy Kids After Children’s First Year of Coverage – –Findings for Santa Clara County – –Findings for other rigorously evaluated programs   San Mateo County   Los Angeles County Changes in Outcomes For Children Who Remained Enrolled For Several (~4) Years

3. Healthy Kids Surveys (Santa Clara County)

4. Initial Survey Conducted in 2003-2004 Interviewed parents of two groups of children: – –625 “established” children: enrolled in HK for about 1 yr – –609 “new” children: newly enrolled/waitlisted for HK Measured Healthy Kids’ impact by comparing outcomes (access, etc) for these two groups: – –Established children: focused on past 6 months with HK – –New children: focused on 6 months before (without) HK

5. Followup Survey Conducted in 2006-2007 (approx 3 years later) Focused on 405 of the original 625 “established” children who remained enrolled – –225 had disenrolled (mostly due to age or relocating) Completed interviews with parents of 372 of these 405 children (92%) Examined changes in outcomes for these children by comparing initial & followup survey data

6. Demographics of Health Kids Participants (based on initial survey)

7. Percentage SOURCE: Tabulations from 2003-04 Survey of Santa Clara County Healthy Kids Enrollees Most Healthy Kids Children Are From Two Parent Working Families

8. Percentage SOURCE: Tabulations from 2003-04 Survey of Santa Clara County Healthy Kids Enrollees Typical Enrollee Family Has Lived in Santa Clara For Years Years Residing in Santa Clara at Enrollment

9. Most Children Were Uninsured For At Least Six Months Before Enrolling Percentage SOURCE: Tabulations from 2003-04 Survey of Santa Clara County Healthy Kids Enrollees Coverage in (any) of the six months before enrolling

10. Impact of Healthy Kids After Children’s First Year of Coverage ( based on initial survey)

11. Percentage SOURCE: Tabulations from 2003-04 Survey of Santa Clara County Healthy Kids Enrollees Healthy Kids Sharply Increased Access to a Usual Source of Care (USC) *** Difference is statistically significant at p-value <.01 *** Santa Clara Healthy Kids

12. Percentage with a Usual Medical Source Large USC Gains Also Evident in San Mateo and LA Programs *** ***Difference is statistically significant at p-value < 0.01. Los Angeles reflects children ages 0 to 5; San Mateo and Santa Clara reflect children ages 0 to 18

13. Percentage SOURCE: Tabulations from 2003-04 Survey of Santa Clara County Healthy Kids Enrollees Healthy Kids Significantly Increased Medical Care Visits *** Difference is statistically significant at p-value <.01 *** Santa Clara Healthy Kids

14. Percentage with a Medical Visit in Past Six Months ** *** ***/** Difference is statistically significant at p-value < 0.01/0.05 Los Angeles reflects children ages 0 to 5; San Mateo and Santa Clara reflect children ages 0 to 18 Gains in Medical Care Use Also Evident in San Mateo and LA Programs

15. Percentage SOURCE: Tabulations from 2003-04 Survey of Santa Clara County Healthy Kids Enrollees Healthy Kids Also Sharply Increased the Use of Dental Services *** Difference is statistically significant at p-value <.01 *** Santa Clara Healthy Kids

16. Gains in Preventive Dental Care Also Evident in San Mateo Program.. *** ***Difference is statistically significant at p-value < 0.01. San Mateo study includes children ages 4 to 18; Santa Clara includes ages 3 to 18. Percentage with a Dental Checkup in Past Six Months

17. *** ***Difference is statistically significant at p-value < 0.01. San Mateo study includes children ages 4 to 18; Santa Clara includes ages 3 to 18...Along With the Major Increase in Dental Treatments Percentage with a Cavity Filling or Tooth Extraction in Past Six Months

18. Percentage SOURCE: Tabulations from 2003-04 Survey of Santa Clara County Healthy Kids Enrollees Healthy Kids Reduced Levels of Unmet Need *** Difference is statistically significant at p-value <.01 *** Santa Clara Healthy Kids

19. ***Difference is statistically significant at p-value < 0.01. Los Angeles reflects children ages 0 to 5; San Mateo and Santa Clara reflect children ages 0 to 18 Reductions in Unmet Need Also Evident in San Mateo and LA Programs *** Percentage with an Unmet Medical Need in Past Six Months

20. Percentage SOURCE: Tabulations from 2003-04 Survey of Santa Clara County Healthy Kids Enrollees Healthy Kids Increased Confidence and Satisfaction *** Difference in statistically significant at p-value <.01 *** Santa Clara Healthy Kids

21. Gains in Well-Being Also Evident in San Mateo and LA Programs ** **Difference is statistically significant at p-value < 0.01. Los Angeles reflects children ages 0 to 5; San Mateo and Santa Clara reflect children ages 0 to 18 Percentage of Parents Reporting Being Very Confident Child Can Get Needed Care

22. Percentage SOURCE: Tabulations from 2003-04 Survey of Santa Clara County Healthy Kids Enrollees (limited to children who enrolled for a reason other than unmet need) And There Is Evidence Healthy Kids Improved the Children’s Health * difference is statistically significant at p-value <.05 * * Santa Clara Healthy Kids

23. Changes in Outcomes With Continued Healthy Kids Coverage (from initial & followup surveys)

24. Percentage SOURCE: Tabulations from 2003-04 and 2006-2007 Surveys of Santa Clara County Healthy Kids Enrollees Access to Care Remains High * * difference is statistically significant at p-value < 0.10 Santa Clara Healthy Kids

25. Percentage SOURCE: Tabulations from 2003-04 and 2006-2007 Surveys of Santa Clara County Healthy Kids Enrollees Most Children Have a Recent Health Care Visit (Last Six Months) Santa Clara Healthy Kids

26. Percentage SOURCE: Tabulations from 2003-04 and 2006-2007 Surveys of Santa Clara County Healthy Kids Enrollees Medical Care: Checkups Rise Significantly.. * difference is statistically significant at p-value < 0.10 * Santa Clara Healthy Kids

27. Percentage SOURCE: Tabulations from 2003-04 and 2006-2007 Surveys of Santa Clara County Healthy Kids Enrollees..And Multiple Sick Visits Decline ** difference is statistically significant at p-value <0.05 ** Santa Clara Healthy Kids

28. Percentage SOURCE: Tabulations from 2003-04 and 2006-2007 Surveys of Santa Clara County Healthy Kids Enrollees Dental Care: Dental Treatments Remain Common Santa Clara Healthy Kids

29. Percentage SOURCE: Tabulations from 2003-04 and 2006-2007 Surveys of Santa Clara County Healthy Kids Enrollees Unmet Need Shows A Pattern of Decline ** difference is statistically significant at p-value <0.05 ** Santa Clara Healthy Kids

30. Percentage SOURCE: Tabulations from 2003-04 and 2006-2007 Surveys of Santa Clara County Healthy Kids Enrollees Parents’ Well-Being Continues to Improve *** difference is statistically significant at p-value <.01; * at p-value < 0.10 * *** Santa Clara Healthy Kids

31. Percentage SOURCE: Tabulations from 2003-04 and 2006-2007 Surveys of Santa Clara County Healthy Kids Enrollees Most Children Remain Healthy Santa Clara Healthy Kids

32. Summary Nearly all families on Healthy Kids are working and most have lived in their counties for years Healthy Kids dramatically improved the outcomes of children after just one year – –Huge gains in access to and use of health care – –Large reductions in unmet needs – –Evidence of improved health, fewer missed school days Gains continued as children remained enrolled in Healthy Kids