Medicaid re-enrollment policies and children's risk of hospitalizations for ambulatory care sensitive conditions.
BACKGROUND
Many poor children rotate through the Medicaid program with periods of being uninsured.


OBJECTIVE
To determine health and cost consequences of a Medicaid policy change that extended the Medicaid eligibility redetermination period for children in California from 3 to 12 months.


METHODS
A pre/postevaluation with a comparison group of a natural experiment.


METHODS
All California children ages 1-17 years who received a minimum of 1 month of Medicaid coverage in 1999-2000 (3,288,171) and/or 2001-2002 (3,230,120).


METHODS
The percentage of children with continuous Medicaid coverage and the hospitalization rate and costs for ambulatory care sensitive conditions in each time period.


RESULTS
In the 2 years before the policy change, 49% of children had continuous Medicaid coverage compared with 62% in the 2 years afterward (P < 0.0001). After adjusting for demographic and programmatic differences in the population of children in each time period, the relative hazard of a hospitalization for an ambulatory care sensitive condition for a child with at least 1 month of Medicaid coverage decreased to 0.74 (P < 0.0001) after the extension of the Medicaid enrollment period. There was dollars 17 million less in estimated hospitalization costs for ambulatory care sensitive conditions with less frequent eligibility redetermination that partially offset the estimated dollars 150 million in additional costs to Medicaid for providing more continuous coverage.


CONCLUSIONS
Reducing the frequency of eligibility redetermination for children in Medicaid was associated with higher costs to the program but more continuity of insurance coverage, improvements in health, and lower hospital spending.
Bindman
Andrew B
AB
Primary Care Research Center and Division of General Internal Medicine, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California 94110, USA. abindman@medsfgh.ucsf.edu.
Chattopadhyay
Arpita
A
Auerback
Glenna M
GM
D000293:Adolescent; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D002140:California; D002648:Child; D002662:Child Health Services / Q000145:classification / Q000191:economics*; D002675:Child, Preschool; D015331:Cohort Studies; D004608:Eligibility Determination; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006300:Health Services Misuse / Q000191:economics* / Q000706:statistics & numerical data; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D011203:Poverty / Q000706:statistics & numerical data*; D015397:Program Evaluation; D016016:Proportional Hazards Models; D018570:Risk Assessment; D014481:United States