Near-Universal Kids Coverage in Massachusetts: Lessons for the Nation
This week Massachusetts officials released the latest data from their 2010 state insurance survey. The survey provided continued good news: overall, 98.1 percent of all Massachusetts residents have health coverage. This compares to a national insurance rate of around 83 percent. Remarkably, insurance coverage increased from 2009, despite the deep recession.
But even more extraordinary was the finding on coverage for children. For kids, the 2010 insurance rate is an astonishing 99.8 percent — essentially universal coverage. Children’s health advocates in Massachusetts, who have been steadily working on step-by-step improvements to kids coverage programs, cheered the unprecedented results. We also reflected on how we achieved such success, and how our lessons can apply nationally.
We would identify three critical factors to the growth in children’s coverage:
- A strong base of public programs: Massachusetts has long been among the leaders in state public programs for children. Our 1996 legislation that expanded Medicaid eligibility for children up to 200 percent of the federal poverty level (FPL) inspired Senator Kennedy to introduce the federal CHIP law. Then in 2006, the state went further and expanded MassHealth, the state’s combined Medicaid and CHIP program, to all children in families earning up to 300 percent FPL. As a result, children’s enrollment grew from 435,000 in June 2006, to 529,000 today. In addition to MassHealth, the state also operates the Children’s Medical Security Plan, which provides basic pediatric primary care to all uninsured children ineligible for MassHealth due to immigration status or income. As a result, all children in Massachusetts are eligible for a public health care program.
- Extensive Community-based Outreach: Massachusetts put significant resources into outreach and enrollment assistance, using both a top-down and bottom-up approach. The top-down effort included mass media ads and partnerships with local icons such as the Boston Red Sox. These were somewhat targeted to the low-income and minority community; for example, bus and subway ads were placed on urban lines. The ads were augmented by grants to dozens of community organizations, focusing in areas of high uninsurance, particularly minority and non-English speaking communities. Urban Institute researcher Stan Dorn evaluated the program and found that “these ‘mini-grants’ helped develop a cadre of agencies and individuals who were knowledgeable about the state’s health coverage programs, trained in using the Virtual Gateway [online enrollment system] to complete applications on behalf of consumers, and skilled in culturally and linguistically competent strategies for working with diverse, low-income families.” We learned that having a trusted advisor from one’s own community is critical to build the confidence required to enter the enrollment process.
- Spill-Over from the Individual Mandate: While children are not included under the Massachusetts mandate, the extensive attention paid to the need for insurance coverage led many parents to enroll their children. The mandate sets up a social expectation that everyone in the Commonwealth should have health insurance coverage — kids, too. While much of the growth in coverage in Massachusetts was among groups exempt from the mandate — low-income adults and children, the cultural force of the mandate provided the backdrop to encourage enrollment.
— Brian Rosman, Guest Blogger Research Director, Health Care for All Massachusetts