This article examines the impact of various outreach strategies on enrollment of children in California public health insurance programs. Enrollment rates in 25 California counties are linked to the various outreach and enrollment strategies employed by each county.

The authors analyzed data from California's three public insurance programs for children: Medi-Cal, Healthy Families and Healthy Kids. They conducted group interviews with key stakeholders to identify eight strategies to increase enrollment and then conducted multivariate analyses on enrollment data from 2001 and 2007 to identify links between outreach strategies and enrollment increases.

Key Findings:

• Technology-based and school-based outreach strategies were the most effective strategies to increase enrollment. Technology-based outreach resulted in 10-11 percent increases in new enrollments. School-linked outreach and enrollment efforts resulted in a 12 percent increase in new enrollment.
• Non-technological outreach strategies included the use of media campaigns, community health workers, clinical targeting, school resources and lists of potentially eligible children. Technological outreach strategies included the Health-e-App, One-e-App and county data systems.
• Enrollment increased substantially in Medi-Cal and Healthy Families between 2001 and 2007. Enrollment in Healthy Kids increased through 2006 and then declined in 2007 as counties closed enrollment due to budget cuts.

Technological and school-based outreach strategies were the most effective techniques to increase enrollment of children in California's public insurance programs.

This article appears in a special issue of the journal HSR: Health Services Research. The study was carried out through the Robert Wood Johnson Foundation’s State Health Access Reform Evaluation (SHARE). SHARE guides the implementation of health reform and supports research on the expansion of health insurance coverage.