1. Children’s Health Insurance Matters: Findings from Surveys of Healthy Kids Participants Symposium: Status on Children’s Health in Santa Clara County May 4, 2011 Christopher Trenholm

2. What Have We Learned About Healthy Kids? Impact of Santa Clara Healthy Kids After Children’s First Year of Coverage Longer-Term Outcomes for Santa Clara Healthy Kids Children Impact of Healthy Kids Programs Beyond Santa Clara County

3. Impact of the Santa Clara Healthy Kids Program (First Year of Coverage)

4. How Did We Measure These Effects? Household survey conducted in 2003-2004 – –Demographics of HK children and their families – –Children’s health and health care outcomes Interviewed parents of two groups of children: – –625 “established enrollees”: on HK for about 1 yr – –609 “new enrollees”: new to/waiting to join HK Measured Healthy Kids’ effects by comparing outcomes (access, etc) for these two groups

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

6. 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

7. 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

8. 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 ***

9. 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 ***

10. 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 ***

11. 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 ***

12. 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 ***

13. 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 * *

14. Longer-Term Outcomes of Healthy Kids Children

15. How Did We Measure These Longer-Term Outcomes? Followup survey conducted in 2006-2007 – –Approximately three years after initial survey Focused on 405 “established enrollees” who remained covered by Healthy Kids – –Completed interviews with 372 (92%) of them Compared outcomes of these children between the two surveys

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

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

18. Percentage SOURCE: Tabulations from 2003-04 and 2006-2007 Surveys of Healthy Kids Enrollees Multiple Sick Visits Declined ** difference is statistically significant at p-value <0.05 **

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

20. Percentage SOURCE: Tabulations from 2003-04 and 2006-2007 Surveys of Healthy Kids Enrollees Unmet Need Continues to Decline ** difference is statistically significant at p-value <0.05 **

21. Percentage SOURCE: Tabulations from 2003-04 and 2006-2007 Surveys of Healthy Kids Enrollees Children Remain Healthy

22. Comparisons With Privately Insured Children

23. Percentage SOURCE: Tabulations from 2006-2007 Survey of Healthy Kids Enrollees and 2005 California Health Interview Survey Healthy Kids Children Have Similar Access to Privately Insured

24. Percentage SOURCE: Tabulations from 2006-2007 Survey of Healthy Kids Enrollees and 2005 California Health Interview Survey Well Child Visits Are Similar Too

25. Percentage SOURCE: Tabulations from 2006-2007 Survey of Healthy Kids Enrollees and 2005 California Health Interview Survey And Younger Healthy Kids Children Visit The Dentist More Often

26. Impact of Healthy Kids Beyond Santa Clara County

27. How Were Outcomes Beyond Santa Clara Studied? Healthy Kids expanded rapidly from Santa Clara to counties throughout California – –2005 (9 programs); 2007 (25); 2008 (30) Two studies examined additional Healthy Kids programs: Los Angeles and San Mateo – –Led by The Urban Institute Similar approach to Santa Clara study – –LA survey (2005); San Mateo survey (2006-07) – –Compared outcomes of established and new enrollees

28. P er centage Persistent Gains in Access to Care… *** **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 Has a Usual Source of Medical Care

29. Percentage ** *** ***/** 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 …And in Medical Care Use… Had Recent Medical Visit (last 6 mos)

30. *** ***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...and Critical Dental Care.. Percentage Had Cavity Filled or Tooth Extracted (last 6 mos)

31. ***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 All Leads to Persistent Reductions in Unmet Need *** Percentage Had an Unmet Medical Need (last 6 mos

32. Healthy Kids: Takeaways Overwhelming evidence that Healthy Kids has improved the well-being of children and families in Santa Clara County and throughout the state Health reform will not address the lack of other coverage options for the vast majority of children covered by Healthy Kids

33. For More Information Christopher Trenholm – –ctrenholm@mathematica-mpr.com CHI Evaluation Webpage – –www.mathematica-mpr.com/Health/chi.asp