Objective-Gaps in health insurance coverage compromise access to health care services, but it is unclear whether the length of time without coverage is an important factor. This article examines how coverage gaps of different lengths affect access to health care among low-income children.Methods-We conducted a multivariable, cross-sectional analysis of statewide primary data from families in Oregon's food stamp population with children presumed eligible for publicly funded health insurance. The key independent variable was length of a child's insurance coverage gap; outcome variables were 6 measures of health care access.Results-More than 25% of children reported a coverage gap during the 12-month study period. Children most likely to have a gap were older, Hispanic, lived in households earning between 133% and 185% of the federal poverty level, and/or had an employed parent. After adjusting for these characteristics, in comparison with continuously insured children, a child with a gap of any length had a higher likelihood of unmet medical, prescription, and dental needs; no usual source of care; no doctor visits in the past year; and delayed urgent care. When comparing coverage gaps, children without coverage for longer than 6 months had a higher likelihood of unmet needs compared with children with a gap shorter than 6 months. In some cases, children with gaps longer than 6 months were similar to, or worse off than, children who had never been insured.Conclusions-State policies should be designed to minimize gaps in public health insurance coverage in order to ensure children's continuous access to necessary services. Keywords HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptPoint-in-time estimates reveal that approximately 9 million children are without health insurance. When including children with gaps in coverage during the year, the number of uninsured children almost doubles. -Although many uninsured children are eligible for public insurance programs, children are more likely than adults to have episodes without coverage. -Therefore, it is crucial to study how these health insurance coverage gaps affect access to health care, especially among children eligible for Medicaid and the State Children's Health Insurance Program (SCHIP).Current reports are mixed about how insurance gaps affect children's access to care. Gaps are associated with discontinuities in receipt of recommended primary care and a higher likelihood of delayed medical care. -In contrast, some evidence suggests that insurance gaps do not predict worsening of specific outcome markers, such as emergency department utilization rates or hospitalization for asthma. , Less is known about how the duration of time without coverage affects health care access for low-income children.Establishing the significance of the length of time without insurance among children eligible for public coverage has important policy implications. Oregon is a key state to highlight in this endeavor because Oregon has a...

Objectives. To determine the impact of introducing copayments on medical care use and expenditures for low‐income, adult Medicaid beneficiaries. Data Sources/Study Setting. The Oregon Health Plan (OHP) implemented copayments and other benefit changes for some adult beneficiaries in February 2003. Study Design. Copayment effects were measured as the “difference‐in‐difference” in average monthly service use and expenditures among cohorts of OHP Standard (intervention) and Plus (comparison) beneficiaries. Data Collection/Extraction Methods. There were 10,176 OHP Standard and 10,319 Plus propensity score‐matched subjects enrolled during November 2001–October 2002 and May 2003–April 2004 that were selected and assigned to 59 primary care‐based service areas with aggregate outcomes calculated in six month intervals yielding 472 observations. Results. Total expenditures per person remained unchanged (+2.2 percent, p=.47) despite reductions in use (−2.7 percent, p<.001). Use and expenditures per person decreased for pharmacy (−2.2 percent, p<.001; −10.5 percent, p<.001) but increased for inpatient (+27.3 percent, p<.001; +20.1 percent, p=.03) and hospital outpatient services (+13.5 percent, p<.001; +19.7 percent, p<.001). Ambulatory professional (−7.7 percent, p<.001) and emergency department (−7.9 percent, p=.03) use decreased, yet expenditures remained unchanged (−1.5 percent, p=.75; −2.0 percent, p=.68, respectively) as expenditures per service user rose (+6.6 percent, p=.13; +7.9 percent, p=.03, respectively). Conclusions. In the Oregon Medicaid program applying copayments shifted treatment patterns but did not provide expected savings. Policy makers should use caution in applying copayments to low‐income Medicaid beneficiaries.

Many state Medicaid programs are implementing cost-saving mechanisms, but little is known about the impact of those strategies on low-income people. Recent increases in cost sharing for Oregon Health Plan (OHP, Oregon's Medicaid program) members have created a natural experiment that is ideal for examining such impacts. Early results from an ongoing cohort study suggest that cost-sharing increases led to a large reduction in OHP membership. Those who left OHP because of the cost-sharing increase reported inferior access to needed care, used primary care less often, and used hospital emergency rooms more often than those who left OHP for other reasons.

In 2012, Oregon initiated a significant transformation of its Medicaid program, catalyzed in part through an innovative arrangement with the Centers for Medicare and Medicaid Services (CMS), which provided an upfront investment of $1.9 billion to the state. In exchange, Oregon agreed to reduce the rate of Medicaid spending by 2 percentage points without degrading quality. A failure to meet these targets triggers penalties on the order of hundreds of millions of dollars from CMS. We describe the novel arrangement with CMS and how the CCO structure compares to Accountable Care Organizations (ACOs) and managed care organizations (MCOs).