No abstract

Context: New, locally based health care access programs are emerging in response to the growing number of uninsured, providing an alternative to health insurance and traditional safety net providers. Although these programs have been largely overlooked in health services research and health policy, they are becoming an important local supplement to the historically overburdened safety net. Methods:This article is based on a literature review, Internet search, and key actor interviews to document programs in the United States, using a typology to classify the programs and document key characteristics.Findings: Local access to care programs (LACPs) fall outside traditional private and publicly subsidized insurance programs. They have a formal enrollment process, eligibility determination, and enrollment fees that give enrollees access to a network of providers that have agreed to offer free or reduced-price health care services. The forty-seven LACPs documented in this article were categorized into four general models: three-share programs, national-provider networks, county-based indigent care, and local provider-based programs.Conclusions: New, locally based health access programs are being developed to meet the health care needs of the growing number of uninsured adults. These programs offer an alternative to traditional health insurance and build on the tradition of county-based care for the indigent. It is important that these locally based, alternative paths to health care services be documented and monitored, as the number of uninsured adults is continuing to grow and

To improve the utility of estimates of Medicaid enrollment and uninsurance from the Current Population Survey (CPS) we use linked data from the CPS and the Medicaid Statistical Information System (MSIS) to build a probabilistic imputation model that partially corrects the public use data files for systematic under-reporting of Medicaid. We estimate the probability that a CPS survey case was enrolled in Medicaid, conditional on whether or not in the CPS the individual responded that they had Medicaid. We use the imputed data to develop adjusted estimates of Medicaid enrollment and uninsurance by demographic characteristics. The net Medicaid enrollment total using our imputation model for CY 2006 and 2007 is 41.0, compared to 34.0 million using the standard CPS variables. The resulting net adjusted uninsurance estimate is 4.5% below the unadjusted estimate.

The use of surname samples achieved the goal of having more persons who identify as Hispanic, Hmong, or Asian in the final sample. However, the use of surname oversamples is inefficient when considering the statistical power gained for minority group estimates.

Expansions in public health insurance programs between 1996 and 2005 increased health insurance coverage for Hispanic children but disparities between Hispanic and non-Hispanic White children persist.