Medicine and Health Sciences Commons^™

Did Medicaid Expansion Under The Affordable Care Act Reduce The Likelihood That People Report Employment Status Changes Due To Health, U.S., 2009-2017, Songyuan Deng

Theses and Dissertations

Medicaid expansion of Affordable Care Act (ACA) extended coverage to low-income working adults. While Medicaid expansion led to increased healthcare use and national healthcare expenditures, current studies do not examine the effects of Medicaid expansion on health status from the perspective of social roles, for example, changes in employment status. This study use data from the Current Population Survey to examine the association between Medicaid expansion and the probability to attribute part-time work or not-in-labor- force to health issues among people with family annual income no more than 138 of Federal Poverty Level, with a difference-in-differences study design. We found …

Sociodemographic And Health Status Characteristics Of Maine's Newly Eligible Medicaid Beneficiaries [Data Brief], Zachariah T. Croll Mph, Erika C. Ziller Phd, Barbara Leonard Mph

Medicaid

This data brief identifies key characteristics of groups who will gain access through MaineCare expansion. Researchers Croll and Ziller at the University of Southern Maine, along with Leonardson of the Maine Health Access Foundation present a statistical analysis of uninsured non-elderly adults age 18 – 64 with no children and lower incomes, the population newly eligible for MaineCare through expansion. Drawing from five years of data from Maine’s Behavioral Risk Factor Surveillance System, the report addresses sociodemographic characteristics, health status, and access to care. The survey indicates that those who are likely eligible for expanded MaineCare coverage are twice as …

Innovative Solutions For State Medicaid Programs To Leverage Their Data, Build Their Analytic Capacity, And Create Evidence-Based Policy, Lauren Adams, Susan Kennedy, Lindsay Allen, Andrew Barnes, Tom Bias, Dushka Crane, Paul Lanier, Rachel Mauk, Shamis Mohamoud, Nathan Pauly, Jeffery C. Talbert, Cynthia Woodcock, Kara Zivin, Julie Donohue

Pharmacy Practice and Science Faculty Publications

As states have embraced additional flexibility to change coverage of and payment for Medicaid services, they have also faced heightened expectations for delivering high-value care. Efforts to meet these new expectations have increased the need for rigorous, evidence-based policy, but states may face challenges finding the resources, capacity, and expertise to meet this need. By describing state-university partnerships in more than 20 states, this commentary describes innovative solutions for states that want to leverage their own data, build their analytic capacity, and create evidence-based policy. From an integrated web-based system to improve long-term care to evaluating the impact of permanent …

Implementing School-Based Education Programs To Combat Lack Of Access To Psychiatric Facilities In The United States, Marisa L. Sparbanie

Kentucky Journal of Undergraduate Scholarship

One in five Americans are diagnosed with a mental illness, yet only 41% of adults received healthcare services in the past year. Due to barriers in accessing care, services are costly, wait times are long, and appointment times are inconvenient. Lack of access to quality, affordable care disproportionately affects those in rural areas and individuals with low socioeconomic status. School-based mental health education programs should be developed as a beginning step to combat increasing mental health conditions and limited access to healthcare facilities. Lack of access to care may lead to occupational injustices such as: occupational alienation, deprivation, and imbalance. …

Factors That Predict Lien Payouts, Viktoria Chudsky

Theses and Dissertations

The purpose of this research is to find ways to increase Medicaid collections in order to promote citizens’ access to government sponsored programs. This research paper is written to observe which variables increase reimbursement funds that will be reinjected into Medicaid and Public Assistance programs. The study looks at client and law firm characteristics such as the settlement amount, the client’s age, how long the case has been open in the MAESTRO system for, the client’s borough of residence, and the defending law firm’s location to identify if any of these characteristics influence the amount of recoupment. The firms’ names …

Prescription Opioid Use Patterns, Use Disorder Diagnoses, And Addiction Treatment Receipt After The 2014 Medicaid Expansion In Oregon, Rachel Springer, Miguel Marino, Steffani R. Bailey, Heather Angier, Jean O'Malley, Megan Hoopes, Stephan Lindner, Jennifer E. Devoe, Nathalie Huguet

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background/Aims: Evidence suggests Medicaid beneficiaries in the USA are prescribed opioids more frequently than are people who are privately‐insured, but little is known about opioid prescribing patterns among Medicaid enrollees who gained coverage via the Affordable Care Act Medicaid expansions. This study compared the prevalence of receipt of opioid prescriptions and opioid‐use‐disorder (OUD), along with time from OUD diagnosis to medication‐assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014, or returned to Medicaid coverage after expansion.

Design: Cross‐sectional study using inverse‐propensity weights to adjust for …

Effects Of Pay For Performance On Performance Outcomes In Pennsylvania’S Medicaid Managed Care Program, Harry Zobel, David Kelley, Michele Robinson, Pauline Sanders, Jennifer Ibrahim

Research Day

Background and Purpose: A goal in healthcare is to reduce costs while improving quality of care, and population health. Pay for Performance (P4P) is one intervention being utilized by Medicaid programs to achieve this goal. While P4P has become a favorite among policymakers, its effectiveness in improving health outcomes is still under investigation. We assessed the role of P4P to improve provider performance by evaluating Pennsylvania’s Medicaid Managed Care (MMC) Program.

Methods: We conducted a retrospective longitudinal analysis of providers within the HealthChoices MMC Program in Pennsylvania. We examined annual provider performance outcomes for seven providers across six …

The Health Care Costs Of Financial Exploitation In Maine, Kimberly I. Snow Mhsa, Yvonne Jonk Phd, Deborah Thayer Mba, Catherine Mcguire Bs, Stuart Bratesman Mpp, Charles A. Smith Phd, Erika C. Ziller Phd

Disability & Aging

This study sought to determine the Medicare and Medicaid costs experienced by dual eligible older adults in Maine for whom Maine Adult Protective Services (APS) substantiated allegations of elder financial exploitation and to compare them to those of Maine’s general older population. The analysis is an important step forward in estimating the medical costs associated with elder abuse.

Elder financial exploitation may result in significant public burden on Medicare and Medicaid, shouldered by taxpayers. Efforts to detect, investigate, prosecute, and mitigate this abuse will benefit not only the victims, but also the financial stewardship of these public programs.

Why Doula Services Should Become An Essential Health Benefit In New York State, Jalisha Hanshaw, Amy White

Publications and Research

Doulas are birth workers who assist expecting mothers through pregnancy, birth and postpartum using holistic techniques. Techniques include: prenatal yoga, birth affirmations and induction acupuncture. Doulas are underrated healthcare providers who deserve the same respect as clinical and non-clinical providers. Doulas are well-rounded alternative care providers who focus on mental, emotional, and physical well being of mothers. Also, they know special alternative medical techniques that prevent mothers from maternal mortality among other negative health outcomes. The amount of time and effort doulas perform with expecting mothers are equal or more than the average medical healthcare provider and should be a …

Restricted Access And Delays To Hcv Treatment Among Medicaid Patients In Louisiana, Morris M. Kim, Keanan M. Mcgonigle

Journal of Health Disparities Research and Practice

Background: Many people living with chronic Hepatitis C Virus (HCV) have seen delays in accessing treatment or been denied entirely due to Medicaid restrictions requiring patients to meet certain criteria prior to receiving approval for medication pre-authorization.

Methods: This study identified a cohort of Medicaid-insured patients with chronic HCV infection within New Orleans, LA. Patient medical records were reviewed and information regarding HCV care was gathered. This study sought to determine the degree to which HCV care was delayed for this population and describe common reasons for prior-authorization denials for direct-acting antiviral (DAA) medications.

Results: For this population of Medicaid-insured …

Impact Of Medicaid Coverage Expansion Under The Affordable Care Act On Mammography And Pap Tests Utilization Among Low-Income Women, Abeer G. Alharbi, M. Mahmud Khan, Ronnie Horner, Heather M. Brandt, Cole Garrett Chapman

Faculty Publications

Introduction The Affordable Care Act (ACA) expanded the coverage of Medicaid to include entire population with income below 138% of federal poverty line. It remains unclear whether this policy change has improved access to and utilization of health care, particularly use of mammography and Pap tests among poor women.

Methods We used a difference-in-difference (DID) design to estimate the impact of Medicaid expansion on mammography and Pap tests utilization among low-income women. Expansion states are the treatment group and non-expansion states are the control group. The years 2012–13 are the pre-expansion period and 2015–16 are the post-expansion period for the …

Medicaid Spending Burden Among Beneficiaries With Treatment-Resistant Depression., Dominic Pilon, John J. Sheehan, Holly Szukis, David Singer, Philippe Jacques, Dominique Lejeune, Patrick Lefebvre, Paul E. Greenberg

College of Population Health Faculty Papers

AIM: To evaluate Medicaid spending and healthcare resource utilization (HRU) in treatment-resistant depression (TRD).

MATERIALS & METHODS: TRD beneficiaries were identified from Medicaid claims databases (January 2010-March 2017) and matched 1:1 with major depressive disorder (MDD) beneficiaries without TRD (non-TRD-MDD) and randomly selected patients without MDD (non-MDD). Differences in HRU and per-patient-per-year costs were reported in incidence rate ratios (IRRs) and cost differences (CDs), respectively.

RESULTS: TRD beneficiaries had higher HRU than 1:1 matched non-TRD-MDD (e.g., inpatient visits: IRR = 1.41) and non-MDD beneficiaries (N = 14,710 per cohort; e.g., inpatient visits: IRR = 3.42, p < 0.01). TRD beneficiaries incurred greater costs versus non-TRD-MDD (CD = US$4382) and non-MDD beneficiaries (CD = US$8294; p < 0.05).

CONCLUSION: TRD is associated …

The Prescribing Patterns Of Gabapentin And Pregabalin In A Medicaid Population Amid The Opioid Epidemic, Sarah Sullivan

Theses and Dissertations

OBJECTIVE: Drug overdoses continue to be the leading cause of accidental death in the United States resulting in a nationwide crisis. Opioids, many of them prescription, are now the primary cause of drug overdose related deaths. Gabapentinoids are being promoted by the Centers for Disease Control and Prevention as a safer alternative to opioids and have steadily been rising in prescribing rates. However, growing concern is mounting on the potential for gabapentinoid misuse. The goal of this dissertation was to deepen the knowledge and understanding of how gabapentinoids are currently being prescribed, with an emphasis on their co-prescribing with an …

Adverse Birth Outcomes Among Women With Physical Disabilities: A Retrospective Cohort Study In South Carolina, Iffat Nahar

Theses and Dissertations

Motherhood is precious in women’s lives. Among women, ages 21-64, 12.5% are living with a disabling condition, according to the Disability Status report: SC 2008. Although childbearing among women with disabilities is increasing, there are limited publications about the pregnancy outcomes. The objective of this study is to document the adverse neonatal outcomes of the pregnancies and to evaluate if early prenatal care is a protective factor for low birthweight and prematurity among the women with physical disabilities. This study used a retrospective cohort study design, with data from linked hospital discharge records and vital records (birth certificates) for all …

Medicaid Work Requirements: State-Based Innovation Or Punitive Policymaking?, Diane Sherwin

Honors Theses

In March 2017, officials appointed to the Center for Medicare and Medicaid Services by President Donald Trump signaled to state governments their intent to support states who would choose to utilize Medicaid’s Section 1115 waiver provision to alter their state’s Medicaid program by introducing a work requirement. As of October 1, 2018, 13 states have heeded this signal and proposed a work requirement component for their Medicaid programs. The purpose of this paper is to determine if Medicaid work requirements are an innovative policy approach to improve independence among Medicaid enrollees, or if these requirements are a punitive, partisan approach …

Biting The Hands That Feed “The Alligators”: A Case Study In Morbid Obesity Extremes, End-Of-Life Care, And Prohibitions On Harming And Accelerating The End Of Life, Michael J. Malinowski

Michael J. Malinowski

Obesity, recognized as a disease in the U.S. and at times as a terminal illness due to associated medical complications, is an American epidemic according to the Centers for Disease Control and Prevention (“CDC”), American Heart Association (“AHA”), and other authorities. More than one third of Americans (39.8% of adults and 18.5% of children) are medically obese. This article focuses on cases of “extreme morbid obesity” (“EMO”)—situations in which death is imminent without aggressive medical interventions, and bariatric surgery is the only treatment option with a realistic possibility of success. Bariatric surgeries themselves are very high risk for EMO patients. …

High Medicaid Nursing Homes: Organizational And Market Factors Associated With Financial Performance, Robert Weech-Maldonado, Justin Lord, Rohit Pradhan, Ganisher Davlyatov, Neeraj Dayama, Shivani Gupta, Larry Hearld

Faculty Publications

High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services’ (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. There were approximately 1108 facilities …

Disparities In Access To Primary Care And Emergency Department Utilization In A Large Medicaid Program, Natasha Parekh, Marian Jarlenski, David Kelley

Journal of Health Disparities Research and Practice

Identifying and eliminating disparities are priorities for State Medicaid programs, especially in the context of increased enrollment through Medicaid expansion. We assessed racial, ethnic, regional, and managed care organization (MCO) differences, as well as time trends before and after Medicaid expansion, in primary care and emergency department (ED) utilization in a large Medicaid program. We performed a cross-sectional evaluation of data from Pennsylvania Medicaid from 2011-2015. Three primary care outcomes included: 1) adult access to primary care; 2) adolescent access to primary care; and 3) pediatric access to dental care. Our fourth outcome reflected ED utilization. We observed significant racial …

Occupational Therapy Practitioner Knowledge And Use Of Medicaid Home And Community Based Service Waivers, Alyssa Zaffos

Occupational Therapy Program Student Theses, Dissertations and Capstones

Medicaid Home and Community Based Service (HCBS) waivers have allowed adults with intellectual and developmental disabilities (IDD) to remain in the community rather than transition to institutionalization. HCBS waivers vary drastically from state to state limiting consistency in services offered to adults with IDD within the community. Majority of HCBS waivers offered to adults with IDD do not fund occupational therapy as a habilitative service due to a variety of reasons. Many adults with IDD are negatively impacted by not receiving necessary services. After preliminary research, it was noted that there is limited information regarding occupational therapy practitioner knowledge of …

Care Intervention And Reduction Of Emergency Department Utilization In Medicaid Populations, Eno J. Rouse

Walden Dissertations and Doctoral Studies

Expansion of Medicaid and private health insurance coverage through passage of the Affordable Care Act of 2010 was expected to increase primary care access and reduce emergency department (ED) use by reducing financial burden and improving affordability of care. The aim of this study was to examine the differences in utilization patterns that exist among the Medicaid population that participated in an optimal level of care (OLC) intervention inclusive of appointments scheduled to primary care providers. Using the integrated behavior model as a theoretical framework, the key research question focused on determining if there was a difference in ED use …

Opioids And Converging Interests, Mary Crossley

Articles

Written as part of Seton Hall Law Review’s Symposium on “Race and the Opioid Crisis: History and Lessons,” this Essay considers whether applying the lens of Professor Derrick Bell’s interest convergence theory to the opioid crisis offers some hope of advancing racial justice. After describing Bell’s interest convergence thesis and identifying racial justice interests that African Americans have related to the opioid crisis, I consider whether these interests might converge with white interests to produce real racial progress. Taken at face value, white politicians’ statements of compassion toward opioid users might signal a public health-oriented approach to addiction, representing …

Everybody’S Working (But The Weakened): An Assessment Of Medicaid Work Requirements And Their Administrative Burdens, Samuel Misleh

MPA/MPP/MPFM Capstone Projects

Although Medicaid work requirements are currently halted in both Arkansas and Kentucky, this analysis utilizes the data available to make an assessment and estimate of what Kentucky’s Medicaid enrollment will look like if work requirements similar to those Arkansas had are ever implemented. The relative severity of the administrative burden of such requirements provide a tool for comparison, and a difference-in-differences analysis of the change in Medicaid enrollment between Arkansas and West Virginia, a state that has not implemented and currently has no plans to implement Medicaid work requirements, provide the bases for this estimate. After coding the work requirements …