Health Policy Commons^™

How The Supreme Court's Medicaid Decision May Affect Health Centers: An Early Estimate, Katherine J. Hayes, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The nation's federally funded health centers are the principal source of primary health care for medically underserved populations. In CY 2011, more than 1,200 health centers, operating in more than 8,500 urban and rural locations, served 20.2 million patients, 36 percent of whom were uninsured and 93 percent of whom had family incomes below twice the federal poverty level. Federal grants provide core support to health centers, but Medicaid represents the largest single health center financing mechanism, accounting for 39 percent of revenues. Medicaid revenue growth allows health centers to preserve their core grant funding to reach uninsured patients while …

Medicaid And Community Health Centers: The Relationship Between Coverage For Adults And Primary Care Capacity In Medically Underserved Communities, Peter Shin, Sara J. Rosenbaum, Brian K. Bruen, Alice (Xiao-Xiao) Lu, Rachel Arguello, Jennifer Tolbert

Health Policy and Management Faculty Publications

Community health centers play an important role in providing care to uninsured and low-income individuals living in medically underserved communities. They rely on many different revenue sources and, over time, Medicaid has become a central source of funding for most health centers. To better understand how Medicaid influences health center practice, this paper compares the strength of health centers in states that have expanded Medicaid coverage for adults to health centers in states with more limited Medicaid coverage for adults. Differences between the two groups of health centers help shed light on the implications of broader Medicaid coverage for low-income …

A New State Plan Option To Integrate Care And Financing For Persons Dually Eligible For Medicare And Medicaid, Jane H. Thorpe, Katherine J. Hayes

Health Policy and Management Faculty Publications

As health care costs continue to escalate, Congress, the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies, researchers, and policymakers are focusing on identifying new approaches to care delivery and reimbursement for individuals who are dually eligible for both Medicare and Medicaid. Although relatively few in number (9 million), dual eligible beneficiaries are more likely than others to experience poor health, including multiple chronic conditions, functional and cognitive impairments, and a need for continuous care. Sixty-six percent of dual eligibles have three or more chronic conditions; sixty-one percent are …

Medicaid And Access To Health Care--A Proposal For Continued Inaction?, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

Medicaid And Access To The Courts, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The Medicaid program is grounded in a statute that is one of the most complex of all federal laws. An insurer of more than 60 million people — and poised to begin serving 16 million more by 2019 — Medicaid will be reexamined this year, in all its legal complexities, by the U.S. Supreme Court, which has agreed to hear California's appeal in the case Maxwell-Jolly v. Independent Living Center of Southern California. The Court's ruling could fundamentally alter states' accountability to beneficiaries and providers when their official conduct allegedly violates Medicaid's essential federal requirements.

Medicaid Statistical Information System (Msis): A Data Source For Quality Reporting For Medicaid And The Children's Health Insurance Program (Chip), Patricia Mactaggart, Ashley Foster, Anne R. Markus

Health Policy and Management Faculty Publications

Section 401 of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) requires the Department of Health and Human Services (HHS) to identify and publish healthcare quality measures for children enrolled in the Children's Health Insurance Program (CHIP) or Medicaid. CHIPRA also requires core measures to identify disparities by race and ethnicity, among other factors. State Medicaid and CHIP programs are currently facing significant budgetary pressures that are likely to increase with eligibility expansions and programmatic changes resulting from the Patient Protection and Affordable Care Act (PPACA). To limit the burden on states and increase the likelihood of states' …

The States' Next Challenge--Securing Primary Care For Expanded Medicaid Populations, Leighton C. Ku, Karen Jones, Peter Shin, Brian K. Bruen, Katherine J. Hayes

Health Policy and Management Faculty Publications

In the coming years, the United States must address both an expansion of Medicaid coverage and an unexpected shortage of primary care physicians. Under the Patient Protection and Affordable Care Act (ACA), the Medicaid eligibility threshold for nonelderly adults will rise to 133% of the federal poverty level (about $30,000 for a family of four) in 2014. States with restrictive Medicaid eligibility requirements and high rates of uninsured residents will expand coverage substantially, while programs in states with higher current Medicaid eligibility thresholds and fewer uninsured residents will grow less. However, since many of the states with the largest anticipated …

Issues In Health Reform: How Changes In Eligibility May Move Millions Back And Forth Between Medicaid And Insurance Exchanges, Benjamin D. Sommers, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The Affordable Care Act will extend health insurance coverage by both expanding Medicaid eligibility and offering premium subsidies for the purchase of private health insurance through state health insurance exchanges. But by definition, eligibility for these programs is sensitive to income and can change over time with fluctuating income and changes in family composition. The law specifies no minimum enrollment period, and subsidy levels will also change as income rises and falls. Using national survey data, we estimate that within six months, more than 35 percent of all adults with family incomes below 200 percent of the federal poverty level …

Coverage Of Obesity Treatment: A State-By-State Analysis Of Medicaid And State Insurance Laws, Jennifer S. Lee, Jennifer L.O. Sheer, Nancy Lopez, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Objectives. We determined whether state Medicaid programs cover recommended treatments for adult and pediatric obesity and to what extent states regulate the treatment and coverage of obesity by private insurers.

Methods. We conducted a state-by-state document review of Medicaid manuals and private insurance laws and regulations.

Results. Eight state Medicaid programs appear to cover all recommended obesity treatment modalities for adults. Only 10 states appear to reimburse for obesity-related treatment in children. In the small-group insurance market, 35 states expressly allow obesity to be used for rate adjustments, while 10 states do so in the individual market. Two states expressly …

Accountable Care Organizations: Implications For Antitrust Policy, Taylor Burke, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This analysis examines accountable care organizations (ACOs) and assesses their implications for antitrust policy. Consideration of the antitrust implications of ACOs is timely. Both the House and Senate health reform measures contemplate the creation of ACOs as a new class of Medicare provider while providing parallel legal authority under Medicaid.

Changing Policy: The Elements For Improving Childhood Asthma Outcomes, Anne R. Markus, Meagan Lyon, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This report lays out the facts and offers specific policy recommendations for success that could change the face of childhood asthma in America. These recommendations aim to make better use of programs and policies already in place, such as Medicaid and the Children's Health Insurance Program (CHIP), as well as private sector insurance coverage and existing public health programs. The recommendations also underscore the importance of careful research -- scientific, practical, and community-based -- in order to continue to learn what works best and strengthen knowledge for future action. In a reformed health system, these initial efforts are not wasted …

The Economic Stimulus: Gauging The Early Effects Of Arra Funding On Health Centers And Medically Underserved Populations And Communities, Peter Shin, Brian K. Bruen, Emily Jones, Leighton C. Ku, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

During times of economic crisis, community health centers and other health care safety net providers become even more vital to the communities they serve. The current downturn, with its high levels of unemployment and enormous impact on family incomes, carries major implications for health insurance coverage. The American Recovery and Reinvestment Act (ARRA), signed into law on February 17, 2009, provided slightly more than two billion dollars to community health centers for capital improvements, expansion (or retention) of personnel and services, and adoption of health information technology. All of these uses not only support health centers' mission to serve populations …

Analysis Of State Medicaid Agency Performance In Relation To Incentivizing The Provision Of H1n1 Immunizations To Eligible Populations, Nancy Lopez, Ross Margulies, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This analysis examines the extent to which state Medicaid agencies have translated a recent CMS guidance on vaccine coverage into clear information for participating providers clarifying payment for costs associated with the administration of H1N1 vaccines. This clarification may be particularly important in states that do not otherwise cover and pay for recommended immunizations as part of treating adult patients.

An Analysis Of The Implications Of The Stupak/Pitts Amendment For Coverage Of Medically Indicated Abortions, Sara J. Rosenbaum, Lara Cartwright-Smith, Ross Margulies, Susan F. Wood, D. Richard Mauery

Health Policy and Management Faculty Publications

This analysis examines the implications for coverage of medically indicated abortions under the Stupak/Pitts Amendment (Stupak/Pitts) to H.R. 3962, the Affordable Health Care for America Act. In this analysis we focus on the Amendment's implications for the health benefit services industry as a whole. We also consider the Amendment's implications for the growth of a market for public or private supplemental coverage of medically indicated abortions. Finally, we examine the issues that may arise as insurers attempt to implement coverage determinations in which abortion may be a consequence of a condition, rather than the primary basis of treatment.

Using Primary Care To Bend The Cost Curve: The Potential Impact Of Health Center Expansion In Senate Reforms, Leighton C. Ku, Sara J. Rosenbaum, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This analysis of reforms being considered in the United States Senate reaches conclusions similar to those of our prior analyses of reforms being considered in the House of Representatives. The combination of expanded health insurance coverage and investments in the expansion of community health centers can produce substantial long-term savings both for the overall health care system and for the federal government. Our analysis of the Senate provisions from the HELP and Finance Committees estimates $369 billion in total medical savings, including $105 billion in federal Medicaid savings. The Senate provisions produce larger savings because they authorize larger funding increases …

Estimating The Economic Gains For States As A Result Of Medicaid Coverage Expansions For Adults, Peter Shin, Leighton C. Ku, D. Richard Mauery, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This policy research brief examines the Medicaid eligibility expansions under the pending legislative proposals, including the House Tri-Committee bill, the Senate Health, Education, Labor and Pensions Committee bill and the Senate Finance Committee bill. Using new Census Bureau data, the researchers find that under both the House and Senate Finance Committee proposals, about 9.6 million nonelderly adults would gain Medicaid eligibility by 2014. Furthermore, the federal and state expenditures are less than Medicaid's positive impact on the economy amounting in a return of three dollars in new business activities for every dollar of state Medicaid investment. Because Medicaid is designed …

Using Primary Care To Bend The Curve: Estimating The Impact Of A Health Center Expansion On Health Care Costs, Leighton C. Ku, Patrick Richard, Avi Dor, Ellen Tan, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This research brief, the third in a series examining the link between national health reform proposals and community health centers, estimates the cost savings that would be realized by making important investments in non-profit health centers as an element of national health reform. Key findings include:

Increasing health center capacity by another 20 million patients by 2019 (to 39 million patients) under health reform can be expected to generate an additional $35.6 billion savings in 2019 and $212 billion in additional savings over the 2010-2019 ten-year time period.

Were the Medicaid prospective payment rate system to be applied to exchange …

Community Health Centers In An Era Of Health System Reform And Economic Downturn: Prospects And Challenges, Sara J. Rosenbaum, Brad Finnegan, Peter Shin

Health Policy and Management Faculty Publications

This Policy Brief examines the role of health centers in the U.S. health care system, assessing their current and future roles in an era of both great promise and challenge. On one hand, government is poised perhaps more sharply than any time in nearly a generation to undertake a comprehensive effort at national health reform, addressing not only coverage but also access, quality, prevention, and the reinvigoration of primary health care, particularly for populations who face the highest health risks. On the other hand, the nation is facing the most severe economic recession in years, with lower income families and …

Restoring Medicaid And Schip Coverage To Legal Immigrant Children And Pregnant Women: Implications For Community Health And Health Care For Tomorrow's Citizens, Leighton C. Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In the coming weeks, Congress will consider the reauthorization of the State Children's Health Insurance Program (SCHIP), whose legislative authorization will expire on March 31, 2009. SCHIP's overarching goal, in tandem with Medicaid, is to assure coverage of low-income children, regardless of race or national origin. As the proportion of uninsured immigrant children grows, a crucial question is whether the SCHIP reauthorization will address the need to restore eligibility for legal immigrant children and pregnant women. Although SCHIP and Medicaid have been successful in improving health insurance coverage for most low-income American children since the mid-1990s, the health coverage gaps …

Uninsured And Medicaid Patients' Access To Preventive Care: Comparison Of Health Centers And Other Primary Care Providers, Avi Dor, Yuriy Pylypchuck, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This issue of Research Briefs examines health centers' role in reducing disparities in preventive health care access by medically vulnerable and high risk populations. The analysis uses information from several national data sources to examine differences in the provision of preventive health care to Medicaid and uninsured patients between health centers and other primary care providers.

Key Findings:

• Compared to those treated by other primary care providers, Medicaid and uninsured patients treated by health centers are significantly poorer, in significantly worse health, and in the case of uninsured patients, more likely to be members of racial and ethnic minority groups. …

Health Centers: An Overview And Analysis Of Their Experiences With Private Health Insurance, Peter Shin, Brad Finnegan, Jessica Sharac, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Steady growth in the number of uninsured and under-insured has sparked health reform proposals at the national and state levels. With many proposals emphasizing expanded access to private health insurance among the low-income population through the use of tax credits and an emphasis on stable and continuous primary care as a key to improving health care access, the interaction between health centers and private health insurance becomes an important aspect of national health policy. This policy brief provides an overview of health centers, with a special focus on the relationship between health centers and private health insurance.

Barriers To Serving The Vulnerable: Thoughts Of A Former Public Official, Christine Ferguson

Health Policy and Management Faculty Publications

In an environment of limited resources, the question of who is deserving and undeserving of assistance becomes critical. Policymakers’ biases about whether a health condition is self-inflicted, as well as their perceptions about whether treatments are truly effective, play a major role—often unstated—in the allocation of resources.

Parental Health Insurance Coverage As Child Health Policy: Evidence From The Literature, Sara J. Rosenbaum, Ramona Whittington

Health Policy and Management Faculty Publications

One of the policy questions expected to receive considerable attention during the State Children's Health Insurance Program (SCHIP) reauthorization process is whether — and if so, under what circumstances — to permit states to use SCHIP funds to cover parents. In 2006, the average Medicaid income eligibility level for coverage of working parents stood at 65% of the federal poverty level, and 15 states and the District of Columbia set income eligibility levels for this group at 100 percent of the federal poverty level or higher.1 In 2005, 8 states used some portion of their SCHIP allotment funding, in combination …

An Analysis Of Propsed Rules Restricting Federal Medicaid Payments For Publicly Supported Healthcare Services, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

During its 47-year existence, Medicaid has been the subject of countless analyses, articles, books, and studies, in view of its sheer size (federal expenditures standing at $190 billion in FY 2006),[1] its complexity (more than five dozen separate federal eligibility categories), and its importance in the American healthcare system. Medicaid funds nearly 40% of all births,[2] covers about one-third of all children,[3] and is the primary source of healthcare financing for persons with severe and chronic physical and mental disabilities.[4] Medicaid virtually enables the operation of public healthcare providers, such as school-based clinics, community health centers, and public hospitals, whose …

Strategies For Improving Access To Comprehensive Obesity Prevention And Treatment Services For Medicaid-Enrolled Children, Sara E. Wilensky, Ramona Whittington, Sara J. Rosenbaum

Health Policy and Management Issue Briefs

This policy brief builds on our prior work for the Robert Wood Johnson Foundation. In 2005, The George Washington University School of Public Health and Health Services (GW) evaluated the role of public and private insurance in financing preventive care and treatment for at-risk and obese children. One of the key findings from that report was that Medicaid's existing Early and Periodic Screening Diagnostic and Treatment (EPSDT) coverage standards provide for comprehensive, obesity-related pediatric health care interventions. Using data drawn from state Medicaid programs, this report examines the extent to which state programs use the Medicaid EPSDT benefit to address …

From Schip Benefit Design To Individual Coverage Decisions, Anne R. Markus, Sara J. Rosenbaum, Ruth E. K. Stein, Jill Joseph

Health Policy and Management Issue Briefs

The majority of states have implemented separate SCHIP (S-SCHIP) programs that significantly depart from Medicaid and resemble less comprehensive commercial products. This difference in program design may result in S-SCHIP potentially being less responsive to children with special needs (CSHCNs). This study explores how responsive insurers are to these higher than average needs. We found that, with one exception, insurers did not agree on the coverage of any specific service, but overall they provided coverage beyond state limits and exclusions. Second, the less acute the childhood condition, the more frequently insurers imposed exclusions. Finally, in the majority of states, some …

Reducing Obesity Risks During Childhood: The Role Of Public And Private Health Insurance, Sara J. Rosenbaum, Sara E. Wilensky, Marisa A. Cox, D. Brad Wright

Health Policy and Management Faculty Publications

In a widely publicized decision issued in 2004, the United States Department of Health and Human Services removed language from the Medicare Coverage Issues Manual which stated that obesity is not an illness, a pronouncement that paves the way for Medicare coverage of evidence-based obesity treatments. This determination by HHS also has important implications for public and private insurance coverage of health care services and interventions that have the potential to reduce the risk of lifelong obesity in children.

This Report assesses the implications of the 2004 HHS obesity ruling into the context of public and private health insurance for …

National Security And U.S. Child Health Policy: The Origins And Continuing Role Of Medicaid And Epsdt, Sara J. Rosenbaum, D. Richard Mauery, Peter Shin, Julia Hidalgo

Health Policy and Management Issue Briefs

Medicaid has touched the lives of half of all of the low income young adults of prime military service age. The roots of Medicaid's unique child health eligibility and coverage policies can be traced to a seminal, 1964 government study entitled One Third of a Nation: A Report on Young Men Found Unqualified for Military Service. This study analyzed the underlying causes of the astounding 50 percent rejection rate among the young men drafted into the military in 1962. It documented pervasive evidence of treatable and correctable physical, mental, and developmental conditions, and its findings influenced the course of Medicaid …

Act Now For Your Tomorrow: Final Report Of The National Commission On Nursing Workforce For Long-Term Care, Edward Howard, Brian Biles, Robyn Stone, Paul Wing, Kristin Mccloskey, Tim M. Henderson

Health Policy and Management Faculty Publications

The nursing workforce shortage faced by long-term care providers stems from factors both outside and inside the organization and operation of long-term care services. The nursing shortage diminishes quality of care and increases the costs of providing services. Resolution of the long-term care nursing workforce challenge will require improvement of the recruitment and retention of nurses. The leadership for the efforts to improve the long-term care workforce must come from the community itself. New and sustained leadership for action by long-term care leaders is the critical factor necessary to the development of the recommended initiatives and the achievement of the …

Teaching Medicaid: A Tool For Health Law Teachers (2004 Update), Sara J. Rosenbaum, David Rousseau

Health Policy and Management Faculty Posters and Presentations

A teaching guide examining: (1) Medicaid's role as a health insurer: major themes; (2) Eligibility and services; (3) Where do Medicaid expenditures go and how; (4) Important are they to the health care system?; (5) Medicaid as health care payer and its role in supporting the health care safety net; (6) Medicaid's role in state financing; (7) Medicaid's role as a legal entitlement; (8) Does Medicaid need reform and if so, what should reform accomplish?