Study Out Next Week on Continuous Coverage

In a study to be released Thursday, a UCLA researcher drew some interesting conclusions about the impact of California’s 12-month continuous Medicaid eligibility policy on continuity of care.

Shana Lavarreda, Director of Health Insurance Studies at UCLA’s Center for Health Policy Research, just completed a study funded by SHARE (the State Health Access Reform Evaluation, a program of the Robert Wood Johnson Foundation). It tracked where children received care in 2000 and 2001, to measure the effect of the continuous care policy implemented in 2000.

First, she said, one finding really surprised her: “One big finding was that there were still half a million children in California who had discontinuous coverage,” Lavarreda said. “With the huge surge in coverage [after the continuous coverage policy went into effect], we thought children would be covered and remain covered — but you still had kids that were on and off the program.”

Clearly, she said, there were factors that were causing some children to lose coverage and then come back onto coverage. That could be an important piece for state officials to look at, she said. “Because it costs money to re-enroll them,” Lavarreda said.

The program was designed to move children’s care out of emergency departments by covering well-child visits in physicians’ offices, with the goal of improving care and saving money.

“What we found is that kids with continuous coverage still had higher ER use than those with discontinuous coverage,” Lavarreda said.

“Kids with Medi-Cal are using the ER much more often than they should be,” Lavarreda said. “One other thing we saw is that kids with discontinuous  care had much lower usage of the ER — and most likely that’s because they’re avoiding care entirely.”

In the continuous care group, there was a measure of success with managed care patients, she said.

“Kids who had managed care had less visits to the ER and more well-child checkups,” she said. “We saw that managed care made a difference.”

The study only looked at changes over a relatively short time period, and that was a decade ago. Those usage patterns may have changed since then, Lavarreda said — but it’s important data to have, she said, because it might give state officials a sense of where to focus their efforts.

“We saw that the new enrollees do use the ER less,” she said. “But in general, among those who have used Medi-Cal a lot, those people tend to use the ER more. Even with their Medi-Cal coverage, they still use the ER. I don’t think anyone prefers to go to the ER,” she said, “it’s just an access issue.”

The results will be discussed in a SHARE webinar on Thursday, and a policy brief will be issued later this month, she said. Lavarreda will discuss the results along with Michael Cousineau of the Keck School of Medicine at the University of Southern California.

“At the national level, we’re talking about what we want Medicaid to look like,” Lavarreda said. “It kind of presumes that continuous coverage just happens. There’s a question about whether that will be a national standard or not, and this research can help inform that discussion.”

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