Improving Health Outcomes for Children (IHOC): Summary of Pediatric Quality Measures for Children Enrolled in MaineCare FFY 2009 - FFY 2012

his report, authored by USM Muskie School research staff, presents the results of the 16 CHIPRA Core Measures that were collected using MaineCare claims or Vital Statistics data and reported in the State of Maine’s FFY 2012 CHIP Annual Report to the Centers for Medicare and Medicaid Services (CMS). Also included in this report are an additional three measures from the Improving Health Outcomes for Children (IHOC) project’s Master List of Pediatric Measures. In addition to presenting results in graphs and narrative, this report also provides measure definitions and background information about each measure topic. The goal of this document is to present the claims- and vital statistics-based CHIPRA and IHOC measure results in a user-friendly format for IHOC project stakeholders. Measures are grouped by topic. For each topic, a Background section provides a brief description and rationale for collection. (The background discussion for CHIPRA Core Measures is drawn from the Background Report for the Initial, Recommended Core Set of Children’s Healthcare Quality Measures for Voluntary Use by Medicaid and CHIP Programs

Children Served by MaineCare, 2007: Survey Findings

This report presents findings from a telephone survey of children currently enrolled in or recently disenrolled from MaineCare, the State‘s Medicaid and State Children‘s Health Insurance Program (SCHIP). The sample was randomly selected, and stratified to include children enrolled in MaineCare through the Medicaid eligibility category, and through two SCHIP eligibility categories, Medicaid Expansion and the Separate Child Health Program (CHP). 1 These three eligibility categories include children ages 18 or under living in households with income up to 200% of the Federal Poverty Level. Income eligibility limits are lowest for the Medicaid eligibility category, followed by the Medicaid Expansion and the Separate Child Health Program categories.2 Between May and September 2007 telephone interviews were completed with 1,531 parents of enrolled children and 259 parents of disenrolled children

Children served by MaineCare, 2012: Survey findings

The purpose of the annual Survey of Children Served by MaineCare is to monitor the quality of services delivered by MaineCare, the State\u27s Medicaid and CHIP program. The 2012 survey examines the experiences of families with children. ages 0-17, who are enrolled in MaineCare using a standardized survey instrument (Consumer Assessment of Healthcare Providers and Systems--CAHPS--4.0H Child Medicaid Health Plan Survey). MaineCare scores very favorably compared with national benchmarks on CAHPS measures of Getting Needed Care, Getting Care Quickly, and How Well the Child\u27s Doctors Community, with ratings at or above the 75th percentile on all the composites and individual items. Overall ratings of the child\u27s personal doctor, ratings of the child\u27s specialist, and ratings of all the child\u27s health care are also among the highest nationally. Areas for improvement included MaineCare customer service and care coordination. Continued administration of the CAHPS 4.0H Child Medicaid Health Plan Survey is recommended for 2013 and beyond to allow for ongoing monitoring of patient experience with and computation of trend results of the MaineCare program as well as ensuring that the MaineCare program complies with federal CHIPRA measure reporting requirements

Rural Children Experience Different Rates of Mental Health Diagnosis and Treatment

Research indicates that privately insured, rural adults have lower use of office-based mental health services, but higher use of prescription medicines than their urban counterparts. Patterns for rural children may be different from urban children because of the limited supply of pediatric mental health providers in rural areas, which may lead to reduced access and lower use of mental health services in rural areas versus urban. Using data on children ages 5-17 from the 2002-2008 of the Medical Expenditure Panel Survey, researchers from the Maine Rural Health Research Center find that rural children are significantly less likely to be diagnosed and treated for non-ADHD mental health problems than urban children and are less likely to receive mental health counseling. The rural-urban difference is greatest among those children scoring in the “possible impairment” range on the Columbia Impairment Scale

How Does the Rural Food Environment Affect Rural Childhood Obesity?

Objective: Assess the impact of the rural food environment on the eating behaviors and BMI of rural low-income children. Method: Statewide (Maine, 2009) household survey of parents of children on Medicaid (n=1722), oversampled in six rural communities, resulting in n=272 for six target communities. Food environment measured using modified Nutrition Environment Measures Survey in Stores (NEMS-S) for 46 retail food outlets. Multi-variate analysis assessed factors affecting home food environment, child\u27s eating behavior and BMI. Results: Home food behaviors (how often: family eats together, child eats breakfast, vegetables served) and parent food consumption were significantly associated with children\u27s healthy eating behaviors. The only significant predictor of childhood obesity was parent eating behavior. We observed several alternative strategies such as hunting, gathering and buying from local farmers. Parents who drove over 20 miles to shop were found to shop at stores with higher NEMS scores as compared to parents who drove shorter distances.Conclusion: Defining and identifying food deserts is not a promising approach to measuring the rural food environment due to long distance trips, careful price shopping, and local, alternative strategies. Strategies to place healthier food in the home should be combined with interventions directed at parents\u27 and families\u27 eating behaviors

Rural Families More Likely to be Uninsured and Have Different Sources of Coverage

This study used the 2001/2002 Medical Expenditure Panel Survey (MEPS), conducted by the Agency for Healthcare Research and Quality (AHRQ), to examine the patterns of insurance coverage within rural families and to assess differences in family-level insurance status for rural and urban families (including comparisons between rural families living adjacent to and not adjacent to an urban area). Among partially uninsured families, we examined rural-urban differences in the sources of family coverage for insured family members (Medicare, Medicaid/ SCHIP, private, or a combination)

Impact of Employment Transitions on Health Insurance Coverage of Rural Residents

Numerous studies have found that rural residents are more likely to be uninsured than urban residents. This coverage difference is generally due to more limited access for rural workers to employer-sponsored health insurance. Lower wages, and the tendency for rural residents to work for small employers, account for this reduced access. While we have substantial information on static insurance coverage rates for rural residents, our knowledge about how coverage changes with employment transitions is limited. Prior research indicates that loss of a job puts workers at greater risk of becoming uninsured, and there is some evidence that this risk is even greater for rural workers. Other studies suggest that access to health insurance plays an important role in determining whether a worker decides to change. Whether this relationship is any different for urban versus rural workers has not been well-studied. In the past 20 years, much of the federal-level policy attention related to health insurance coverage has emphasized ensuring continuity of coverage for individuals that experience an employment transition. For example, the Consolidated Omnibus Budget Reconciliation Act (COBRA), passed in 1985, ensured that those with employer-sponsored coverage could retain that coverage even if that employment ceased. Similarly, the 1996 Health Insurance Portability and Accountability Act (HIPAA) guaranteed individual coverage for those who leave a group plan. However, both of these key policy interventions are inapplicable to the smaller employers that are the backbone of rural economies. Thus, rural workers may be more likely than urban workers to experience disruptions in health insurance coverage following an employment transition. The Patient Protection and Affordable Care Act (ACA) provides a new background against which to consider the issues of job change, job loss, health insurance portability and coverage of rural residents. Understanding how changes in employment status impact insurance coverage for rural workers can help to identify potential challenges and opportunities for implementing ACA in rural areas

Many Urban and Rural Workers Lose Health Insurance During Job Transitions

Numerous studies have found that rural residents are more likely to be uninsured than urban residents, in part because rural workers are more likely to be employed by a small business or have low wages and thus have more limited access to employer coverage.1-5 Yet, our knowledge about how coverage changes with employment transitions is limited. Prior research indicates that loss of a job puts workers at greater risk of becoming uninsured,6 and there is some evidence that this risk is even greater for rural workers.7 In the past 20 years, much of the federal-level policy attention related to health insurance coverage (e.g. the Consolidated Omnibus Budget Reconciliation Act and the Health Insurance Portability and Accountability Act) has emphasized ensuring continuity of coverage for individuals that experience an employment transition. However, these key policy interventions do not apply to smaller employers that are the backbone of rural economies. !us, rural workers may be more likely than urban workers to experience disruptions in health insurance coverage following an employment transition. The purpose of this study was to explore the impact of changes in employment status on insurance coverage for rural and urban workers, and the factors behind any differences. !e Affordable Care Act (ACA) provides a new backdrop against which to consider the issues of job change, job loss, health insurance portability and coverage of rural residents. Our findings provide important information about the health insurance coverage challenges that rural workers may face, and may help to identify potential challenges and opportunities for implementing ACA in rural areas

Patterns of Care for Rural and Urban Children with Mental Health Problems

Introduction Research indicates that privately insured, rural adults have lower use of office-based mental health services, but higher use of prescription medicines than their urban counterparts. Similar studies for rural children have been limited to specific populations, diagnoses, or to single states. Patterns for rural children may be different than those of urban children and adults generally because of their high enrollment in Medicaid and the State Children\u27s Health Insurance Program, which tend to have more generous behavioral health benefits than private coverage and may equalize rural-urban treatment patterns. On the other hand, the more limited supply of specialty mental health providers in rural areas, particularly for children, could lead to lack of access and lower utilization of some types of mental health services in rural areas versus urban. Methods Using data on children ages 5-17 from the 2002-2008 Medical Expenditure Panel Survey, this study examines two research questions: 1) do patterns of children\u27s mental health diagnosis and service use (e.g., office visits and psychotropic medications) differ by rural-urban residence? and 2) what is the effect of income and insurance type on use of mental health services? Findings Controlling for demographic and risk factors, rural children are as likely as urban children to have an attention deficit or hyperactivity disorder (ADHD) diagnosis and less likely to have any other type of psychiatric diagnosis. Initially observed higher prevalence of mental health diagnoses among rural children is explained by underlying differences in demographic characteristics and risk factors, such as higher rates of poverty, public coverage, mental health impairment, and lower prevalence of minorities. Rural children with the highest mental health need are no more or less likely to be diagnosed or treated for mental health conditions. However, among those with a possible impairment, rural children are less likely to be diagnosed with a psychiatric illness other than ADHD and are less likely to receive counseling

Health Insurance Profile Indicates Need to Expand Coverage in Rural Areas

Key Findings: A greater percentage of rural residents than urban residents are uninsured, especially those living in remote areas Among adults over age 50, uninsured rates are highest in the most remote rural places Compared to urban adults, rural adults are less likely to be in employment situations where private coverage is offered