Summary
In this brief, the authors explore whether instituting 12-month continuous eligibility in California's Medicaid program for children (Medi-Cal) has directly benefited enrollees by improving their process of care. Using a difference-in-differences approach, the authors analyzed Medi-Cal eligibility files and claims data to evaluate health care utilization before and after the 12-month continuous eligibility policy was put into place, comparing the utilization changes for continuously covered children with utilization changes for children with discontinuous coverage.
Findings: The authors found that children with past and predicted breaks in their coverage had fewer doctor visits (both for well-checks and for any visit) than children with continuous coverage, both before and after the implementation of continuous eligibility. Upon closer inspection, however, the numbers reveal more nuanced results: The utilization of doctor visits (“any”) did increase for children with discontinuous coverage (28.67% to 29.53%), but this utilization decreased for children with continuous coverage between the pre- and post- intervention periods (58.23% to 55.93%). However, a decrease in doctor visits (“any”) for the continuous care group would not be expected as an effect of the intervention. Well-check visits, on the other hand, increased for both the continuous and discontinuous coverage groups – from 11.26% to 12.80% for continuous coverage, and from 4.33% to 5.41% for discontinuous coverage. This would indicate that the intervention may have encouraged improved outcomes on this measure for the discontinuous group. However, the outcome for the continuous care group is once again surprising.
The findings above demonstrate a clear public health benefit of 12-month continuous eligibility — through this administrative method, more children gain continuous coverage and have a higher likelihood of seeing a doctor during the year as per recommended guidelines from the American Academy of Pediatrics. That continuously enrolled children also tend to use emergency rooms more often may indicate avoidance of any medical care by discontinuously insured children. It also represents an avenue for improvement in Medicaid, as parents will use emergency departments less when there is adequate access to a doctor’s office.
