Social and Behavioral Sciences Commons^™

The Relationship Between Regulation And Care Access In The Doula Industry, Charissa Billings

University Honors Theses

Birth doulas are unregulated service providers in the United States, who provide informational, emotional, and physical support before, during, and after birth. Currently, the United States has the highest maternal mortality rate amongst the most developed nations, as well as a serious racial gap, with Black women being twice as likely to die due to pregnancy-related complications when compared to White women. Birth doulas can help close the gaps with trained support and advocacy. Since over 40% of the births in the US are covered by Medicaid, providing birth doula services to Medicaid recipients could result in improved birth outcomes. …

Measuring The Impact Of The Affordable Care Act Medicaid Expansion On Access To Primary Care Using An Interrupted Time Series Approach, Elizabeth A. Brown, Brandi M. White, Walter J. Jones, Mulugeta Gebregziabher, Kit N. Simpson

Health and Clinical Sciences Faculty Publications

BACKGROUND: The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care.

METHODS: We performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to …

Exploring Financial Situations And The Cliff Effect For Single-Mother Families In Allegheny County, Pennsylvania (Working Paper), Susan Crandall, Brian Beauregard, Sokha Eng, Emek Karakilic

Center for Social Policy Publications

The mitigation of the cliff effect is essential to effectively foster economic mobility and to address systemic racism facing low-income mothers in Allegheny County. The Pittsburgh Foundation’s report A Qualitative Study of Single Mothers in Allegheny County: A 100 Percent Pittsburgh Project revealed that 41% of single mother households earn below the poverty line. The report found that the cliff effect – the reduction of public benefits resulting from wage increases – presented a significant barrier to escaping poverty.

This report explores cliff effects in Allegheny County, Pennsylvania. First, simulations were conducted to better understand the nature and types of …

The Importance Of Understanding Functionality In Home- And Community-Based Care And The Impact On Costs As America Ages, Shannon Stanley

Walden Dissertations and Doctoral Studies

The United States is on a trajectory to reach 20% of citizens aged 65 and over by 2030. This hyper-aging population affects the costs of healthcare, but it is not adequately represented in current U.S. models. Studies indicate other hyper-aged nations have experienced this increase and implemented long-term care measures to counter the increase in aging populations and costs with system responsiveness. This study examined the role of Medicaid home -and community- based service (HCBS) contributions in states that have the fastest-aging populations. Using the established framework and data collected by the Centers for Medicare and Medicaid, the study looked …

Service Providers' Perceptions Of Stigma And Its Impact On Mental Health Services, Arthur Gabriel Montes

Walden Dissertations and Doctoral Studies

Stigma is one of the most significant barriers to access and utilization of mental health services in the United States. Delays in receiving mental health services significantly contribute to health disparities and poor health outcomes. Social workers play an integral part in implementing best practices within health care settings and reducing health inequities impacting vulnerable populations. The purpose of this qualitative action research study was to explore social work service providers perceptions' toward stigma and how it affects mental health services among patients in California's Medicaid program. Stigma theory was applied to gain an understanding of how stigma interacts and …

Prisons, Nursing Homes, And Medicaid: A Covid-19 Case Study In Health Injustice, Mary Crossley

Articles

The unevenly distributed pain and suffering from the COVID-19 pandemic present a remarkable case study. Considering why the coronavirus has devastated some groups more than others offers a concrete example of abstract concepts like “structural discrimination” and “institutional racism,” an example measured in lives lost, families shattered, and unremitting anxiety. This essay highlights the experiences of Black people and disabled people, and how societal choices have caused them to experience the brunt of the pandemic. It focuses on prisons and nursing homes—institutions that emerged as COVID-19 hotspots –and on the Medicaid program.

Black and disabled people are disproportionately represented in …

Disparities In Oral Health: Socioeconomic Status And Policies To Increase Access To Primary Dental Care, Mckenzie Nutter

Theses/Capstones/Creative Projects

Primary dental care is a patient-centered service consisting of routine dental checkups. The oral cavity is the first point of entrance to the body for many harmful pathogens. Therefore, primary dental care is essential to not only prevent and treat conditions in the mouth, but to also reduce the number of systemic diseases in the rest of the body. However, people with higher incomes or wealth have increased access to primary dental care. People with low socioeconomic status have decreased access to primary dental care, at least in part due to difficulties in paying for separate dental insurance. Disparities in …

Rurality Of Medical Provider And Race Of Patient As Risk Factors For Overdose In Opioid Use Disorder Populations, Christopher Vance, Colleen Mulligan, David Von Nordheim, Jodi Heaps-Woodruff Ph.D.

Undergraduate Research Symposium

Title: Rurality of medical provider and race of patient as risk factors for overdose in opioid use disorder populations

Background

This study examines the outcomes of medication assisted treatment (MAT) for opioid use disorders (OUD) based on location of treatment and race of the individual seeking treatment. Opioid use in the United States has been disproportionately rising in the last decade and there is evidence of unequal treatment based on different social disparities, namely rurality and race. Discriminatory distribution of medication and treatment for individuals seeking OUD along the lines of race and rurality is an issue of grave importance …

Perceptions Of Recovery While Delivering Medicaid Covered Rehabilitation Services, Zakia Clay, Anthony Zazzarino, Emilie Banz, Ann Reilly

Journal of Human Services: Training, Research, and Practice

Many states have shifted to Medicaid reimbursement methods to cover behavioral health services. In doing so, state mental health authorities have incorporated the concept of recovery into mental health policy. Thus, gaining a better understanding of practitioners’ perceptions of recovery in a new fiscal environment is warranted. This qualitative study explores how New Jersey practitioners transitioning to a new state-wide Medicaid payment structure perceive recovery from mental illness. Four themes emerged following a thematic analysis. Future studies that explore perspectives of individuals receiving services could provide useful information for policy makers, agencies, and community stakeholders.

The Impact Of The Aca Medicaid Expansion On Disability Program Applications, Lucie Schmidt, Lara D. Shore-Sheppard, Tara Watson

Economics: Faculty Publications

The Affordable Care Act (ACA) expanded the availability of public health insurance, decreasing the relative benefit of participating in disability programs but also lowering the cost of exiting the labor market to apply for disability benefits. In this paper, we explore the impact of expanded access to Medicaid through the ACA on applications to the Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) programs. Using the fact that the Supreme Court decision of June 2012 made the Medicaid expansion optional for the states, we compare changes in county-level SSI and SSDI caseloads in contiguous county pairs across a …

How Government Created And Shaped The U.S. Nursing Home Industry, Leslie King

Sociology: Faculty Publications

Beginning in the 1960s, U.S. government policy largely created, and subsequently facilitated the corporatization of, a powerful, multi-billion dollar nursing home industry. Using data from trade publications, government agency reports, Congressional hearings, newspaper reports and existing scholarly research, I chart the relationship between the state and the U.S. nursing home industry over four time periods to reveal how, at different moments, government policy contributed to first the creation, then the corporatization and consolidation of the industry. I argue that the trajectory of Medicare and Medicaid policy is not wholly neoliberal but neither should it be considered progressive.

The Full Impact Of The Affordable Care Act On Political Participation, Charles J. Courtemanche, James Marton, Aaron Yelowitz

Economics Faculty Publications

This article examines the impact of both the Medicaid expansion and the private insurance-related components of the Affordable Care Act (ACA) on voter turnout and registration. We employ a difference-in-difference-in-differences identification strategy exploiting variation over time, state Medicaid expansion status, and within-state local area pre-ACA uninsured rates. Using data between 2006 and 2016 from the November Current Population Survey and the Census Bureau's Small Area Health Insurance Estimates, our results suggest little effect of the ACA on voter turnout or registration.

Medical Resource Use And Costs Of Treating Sickle Cell-Related Vaso-Occlusive Crisis Episodes: A Retrospective Claims Study, Nirmish Shah, Menaka Bhor, Lin Xie, Jincy Paulose, Huseyin Yuce

Publications and Research

Background: The study investigated the economic burden of vaso-occlusive crisis (VOC) among sickle cell disease (SCD) patients, through assessment of overall utilization and costs and costs per VOC episode (regarding the number of VOC episodes and health care setting, respectively).

Methods: Using the Medicaid Analytic Extracts database, the first SCD-related diagnosis claim (index claim) between June 1, 2009–December 31, 2012 was identified among eligible adults. Patients were required to have continuous medical and pharmacy benefits for 6 months pre- and 12 months post-index. Discrete VOC claims identified within a 3-day gap were combined as a single VOC episode. Annual all-cause …

How Did Medicaid Expansion Affect The Provider Labor Market?, Aaron Wu

Honors Theses

One provision of the Affordable Care Act was to expand Medicaid eligibility for a greater number of low-income patients. The resulting increase in demand for care was largely explored, but the effect of the 2014 Medicaid expansion on the physician and advanced practitioner labor market has not been well researched by economists. Using pooled cross-sectional data from the 2010 – 2018 American Community Surveys, this paper examines whether the Medicaid expansion has caused notable changes in physician, physician assistant, and nurse practitioner hours, compensation, and overall employment. The literature shows that practices that employ nurse practitioners are far more likely …

Universal Healthcare: Solution Or Delusion? Comparing Medicare For All, Public Option, And Business-As-Usual Models Among U.S. Democratic Presidential Candidates, Elizabeth Pinchman

Honors Theses

How much longer can the United States remain the only developed country without universal health insurance? While the U.S. leads the world in healthcare costs per capita, it trails behind in access and quality measures. Many Americans live in fear of medical bankruptcy, especially the twenty-six million people who remain uninsured. The Democratic presidential candidates vying for the nomination in 2020 have released plans to resolve these problems and bring the nation closer to universal coverage.

Through the analysis of proposed actions, plan feasibility, and expected impact, the candidates’ suggestions have been evaluated within the context of the United States. …

Stuck In Neutral? Federalism, Policy Instruments, And Counter-Cyclical Responses To Covid-19 In The United States, Philip Rocco, Daniel Beland, Alex Waddan

Political Science Faculty Research and Publications

Federalism plays a foundational role in structuring public expectations about how the United States will respond to the COVID-19 pandemic, as both an unprecedented public-health crisis and an economic recession. As in prior crises, state governments are expected to be primary sites of governing authority, especially when it comes to immediate public-health needs, while it is assumed that the federal government will supply critical counter-cyclical measures to stabilize the economy and make up for major revenue shortfalls in the states. Yet there are reasons to believe that these expectations will not be fulfilled, especially when it comes to the critical …

Who Pays For Gun Violence? You Do., Edda S. Fransdottir, Jeffrey A. Butts

Publications and Research

The total economic impact of gun violence is unknown. Studies focus on the direct and short-term expenses immediately following a shooting but often exclude the long-term and far-reaching effects of gun violence on the victim, their family, and their community. Available data vastly underestimate the full economic impact of firearm injuries in the United States, including the fact that taxpayers often get the bill.

An Examination Of The Association Between State Medicaid Perinatal Services And Birth Outcomes, Joy Morgan Myers

Honors Theses

This thesis investigated the connection between socioeconomic status, healthcare coverage, and birth outcomes. The research question that was posed specifically looked at twenty perinatal services that states covered under Medicaid to varying degrees to see their association, if any, with premature birth rates and low birthweight rates. State-level and Mississippi county-level data were compiled regarding preterm birth rates, low birthweight rates, presumptive eligibility adoption, and coverage of twenty different perinatal services. Using these data, the correlation between state Medicaid expansion status and birth outcomes was first calculated in order to determine if variation in birth outcomes was associated with expanded …

Health Care Access For Children In Latinx Immigrant Families In The Greater Philadelphia Area, Sophia King

Politics Honors Papers

This work examines the gap that exists in access to health care in the Greater Philadelphia Region for children of Latinx immigrant families in comparison to other children in the nation. It provides a critical analysis of the gap in access to coverage, noting that this exists despite wide support for a human right to health. This study draws on existing scholarly research as well as interviews with staff at two health clinics and one community outreach center that are located in Greater Philadelphia. It demonstrates that Latinx immigrant families are less likely to have health insurance and get primary …

The Hub And Spoke Solution: A Much-Needed Answer To Tennessee's Opioid Crisis, Ryne E. Tipton

Chancellor’s Honors Program Projects

No abstract provided.

Mhpaea & Marble Cake: Parity & The Forgotten Frame Of Federalism, Taleed El-Sabawi

Dickinson Law Review (2017-Present)

No abstract provided.

Organizational Change: The Experiences Of Practitioners Transitioning To A Fee-For-Service Model, Anthony Zazzarino, Zakia Clay, Ann Reilly

Journal of Human Services: Training, Research, and Practice

Many human service agencies are in the midst of a transition for a fee-for-service model. Through the midst of the transition, organizations must shift the culture of their agency and adapt to the new service delivery approach. Some organizational changes can create feelings of insecurity among staff, fewer resources, and greater potential for employee burnout. Though there is some research that provides valuable information, it often fails to highlight the individual experiences of the worker. This phenomenological study begins to explore the experiences and perceptions of practitioners working in supported housing agencies during the transition to a fee-for-service approach. The …

Trends In State Medicaid Programs' Eligibility, Enrollment Rules And Benefits, Ashley Fox, Wenhui Feng, Jennifer Zeitlin, Elizabeth Howell

Public Administration and Policy Faculty Scholarship

Recent literature has focused on the impact of the differential state adoption of the Affordable Care Act's Medicaid expansion. This DataWatch article highlights additional Medicaid policy dimensions where state-level trends in generosity have varied, including eligibility, benefits, and administrative burden, both before and after implementation of the Affordable Care Act.

Older Adults' Access To Medicaid's Home-And Community-Based Services, Joe Henry Horton

Walden Dissertations and Doctoral Studies

As the U.S. population ages, the need for public policies regarding long-term care increases, as the need is unequal to demand. The purpose of this qualitative study was to explore and describe the role of senior service providers (SSPs) who have dealt with health policies from being responsible for the decision-making processes of implementing federal and state guidelines in Michigan on access and wait-listing of older adults for home and community-based services (HCBS). The theoretical foundation for this study was the social construction and policy design theory. The central research question sought perceptions of SSPs as to their ability to …

Essays On Disability, Public Assistance Programs And Employment, Xiaoqi Zhu

Legacy Theses & Dissertations (2009 - 2024)

This dissertation explores the relationship between disability, public assistance programs and employment. The first chapter investigates the impact of chronic pain on the labor market participation decisions of people nearing retirement age. The results from estimating a random effect discrete-time hazard model suggest that chronic pain greatly enlarges the hazard of exiting labor market even after controlling for many diseases that contribute to pain, and this effect increases with the severity of pain level. I further estimate a discrete-time competing risks model to explore the association between chronic pain and labor market exits due to different reasons. The finding indicates …

Three Essays On Health Economics And Policy Evaluation, Shishir Shakya

Graduate Theses, Dissertations, and Problem Reports

This dissertation consists of three essays on the U.S. Health care policy. Each paragraph below refers to the three abstracts for the three chapters in this dissertation, respectively. I provide quantitative evidence on how much Prescription Drug Monitoring Programs (PDMPs) affects the retail opioid prescribing behaviors. Using the American Community Survey (ACS), I retrieve county-level high dimensional panel data set from 2010 to 2017. I employ three separate identification strategies: difference-in-difference, double selection post-LASSO, and spatial difference-in-difference. I compare how the retail opioid prescribing behaviors of counties, that are mandatory for prescribers to check the PDMP before prescribing controlled substances …

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 …

Three Essays On Property Tax Administration, Yusun Kim

Dissertations - ALL

This dissertation is comprised of three essays on real property tax administration and related state-local fiscal relations. All three essays exploit variation in state policies as natural experiments to study the various features of the property tax system.

The first essay examines how county governments respond to a state policy that reduced counties' share of state Medicaid costs, in a state where counties are mandated to financially contribute to the state program. The key motivation of this study is to understand the consequences of a change in the way a large public insurance program is co-financed by different levels of …

Three Essays On The Societal Impact Of Health Policies And Laws, Xuanhao He

Economics ETDs

This dissertation provides evidence to the two contentious debate over health policies and laws in the US, Medicaid expansion and sex offender registration and notification. In Chapter 2, I explore one key determinant of Medicaid take-up, the benefit of access to care proxied by the Medicaid-to-Medicare primary care physician payment ratio. Using a unique dataset of Medicaid physician reimbursement rates and the American Community Survey of 2010 – 14, I find that a 10-percentage-point increase in the payment ratio of a 30-minute new patient office visit will increase Medicaid enrollment among uninsured adults in poverty by more than 150,000. In …

Medicaid Coverage Across The Income Distribution Under The Affordable Care Act, Charles J. Courtemanche, James Marton, Aaron Yelowitz

Institute for the Study of Free Enterprise Working Papers

This chapter examines trends in Medicaid enrollment across the income distribution after the ACA’s Medicaid expansion.Using data from the American Community Survey between 2012and 2017, we compare Medicaid coverage over time in 9 states that expanded Medicaid in 2014 with no previous expansion for able-bodied, working-age adults with 12 states that had not expanded Medicaid by 2019 and also had no previous expansion for such adults. A difference-in-differences model is used to formalize this comparison. Similar to many previous studies, we find that Medicaid coverage increased dramatically for income-eligible adults under 138% of the federal poverty level (FPL). In addition, …