Digital Commons Network^™

Medicaid Eligibility Loss Among Dual-Eligible Beneficiaries Before And During Covid-19 Public Health Emergency, Yanlei Ma, Eric T Roberts, Kenton J Johnston, E John Orav, Jose F Figueroa

2020-Current year OA Pubs

IMPORTANCE: Medicaid coverage loss can substantially compromise access to and affordability of health care for dual-eligible beneficiaries. The extent to which this population lost Medicaid coverage before and during the COVID-19 public health emergency (PHE) and the characteristics of beneficiaries more at risk for coverage loss are currently not well known.

OBJECTIVE: To assess the loss of Medicaid coverage among dual-eligible beneficiaries before and during the first year of the PHE, and to examine beneficiary-level and plan-level factors associated with heightened likelihood of losing Medicaid.

DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study used national Medicare data to estimate annual …

Identifying Rural Health Clinics Within The Transformed Medicaid Statistical Information System (T-Msis) Analytic Files, Katherine Ahrens Mph, Phd, Zachariah Croll, Yvonne Jonk Phd, John Gale Ms, Heidi O'Connor Ms

Rural Health Clinics

Researchers at the Maine Rural Health Research Center describe a methodology for identifying Rural Health Clinic encounters within the Medicaid claims data using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.

Background: There is limited information on the extent to which Rural Health Clinics (RHC) provide pediatric and pregnancy-related services to individuals enrolled in state Medicaid/CHIP programs. In part this is because methods to identify RHC encounters within Medicaid claims data are outdated.

Methods: We used a 100% sample of the 2018 Medicaid Demographic and Eligibility and Other Services Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files for 20 states …

Emergency Department And Dental Clinic Perceptions Of Appropriate, And Preventable, Use Of The Ed For Non-Traumatic Dental Conditions In Hot-Spot Counties: A Mixed Methods Study, Shawnda Schroeder, Judy Beck, Nick Medalen, Anastasia Stepanov

Indigenous Health Faculty Publications

Objectives:Frequency of emergency department (ED) use for nontraumatic dental conditions (NTDC) is a well-researched community health concern. However, research predominately relies on ambulatory ED discharge records. This explanatory sequential mixed methods study reviewed NTDC ED use in hot-spot counties and assessed perceptions around preventable and appropriate use among EDs and dental clinics.

Methods:Tooth pain data (2015-2021) were drawn from State Medicaid, and the Early Notification of Community-Based Epidemics (ESSENCE). NTDC data were compiled using International Classification of Disease, Ninth and Tenth Revisions. Employing extreme case sampling, providers in counties with the highest per-capita NTDC ED use were interviewed.

Results:North Dakota …

Affirmatively Furthering Health Equity, Mary Crossley

Articles

Pervasive health disparities in the United States undermine both public health and social cohesion. Because of the enormity of the health care sector, government action, standing alone, is limited in its power to remedy health disparities. This Article proposes a novel approach to distributing responsibility for promoting health equity broadly among public and private actors in the health care sector. Specifically, it recommends that the Department of Health and Human Services issue guidance articulating an obligation on the part of all recipients of federal health care funding to act affirmatively to advance health equity. The Fair Housing Act’s requirement that …

Assessment Of Ethno-Racial And Insurance-Based Disparities In Pediatric Forearm And Tibial Fracture Care In The United States, Andrew J Landau, Afolayan K Oladeji, Pooya Hosseinzadeh

2020-Current year OA Pubs

INTRODUCTION: Despite growing attention to healthcare disparities and interventions to improve inequalities, additional identification of disparities is needed, particularly in the pediatric population. We used state and nationwide databases to identify factors associated with the surgical treatment of pediatric forearm and tibial fractures.

METHODS: The Healthcare Cost and Utilization Project State Inpatient, Emergency Department, and Ambulatory Surgery and Services Databases from four US states and the Nationwide Emergency Department Sample database were quarried using International Classification of Diseases codes to identify patients from 2006 to 2015. Multivariable regression models were used to determine factors associated with surgical treatment.

RESULTS: State …

Association Of State Medicaid Expansion Status With Rates Of Suicide Among Us Adults, Hetal Patel, Justin Barnes, Nosayaba Osazuwa-Peters, Laura Jean Bierut

2020-Current year OA Pubs

Importance: In the US, suicide is the 10th leading cause of death and a serious mental health emergency. National programs that address suicide list access to mental health care as key in prevention, and more large-scale policies are needed to improve access to mental health care and address this crisis. The Patient Protection and Affordable Care Act (ACA) Medicaid Expansion Program was implemented in several states with the goal of increasing access to the health care system.

Objective: To compare changes in suicide rates in states that expanded Medicaid under the ACA vs states that did not.

Design, Setting, and …

Effectiveness Of Concurrent Care To Improve Pediatric And Family Outcomes At The End Of Life: An Analytic Codebook, Radion Svynarenko, Theresa L. Profant, Lisa C. Lindley

Faculty Publications and Other Works -- Nursing

Implementation of the section 2302 of the 2010 Patient Protection and Affordable Care Act (ACA) enabled children enrolled in Medicaid/Children's Health Insurance Program with a prognosis of 6 months to live to use hospice care while continuing treatment for their terminal illness. Although concurrent hospice care became available more than a decade ago, little is known about the socio-demographic and health characteristics of children who received concurrent care; health care services they received while enrolled in concurrent care, their continuity, management, intensity, fragmentation; and the costs of care. The purpose of this study was to answer these questions using national …

For Medicaid Beneficiaries, The Ability To Find A Dentist Is A Key Component Of Access To Care, Julie C. Reynolds, Shillpa Naavaal

Dental Public Health and Policy Publications

No abstract provided.

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 …

The Effect Of Medicaid On Dental Care Of Poor Adults: Evidence From The Oregon Health Insurance Experiment., Katherine Baicker, Heidi L Allen, Bill J. Wright, Sarah L Taubman, Amy N Finkelstein

Articles, Abstracts, and Reports

OBJECTIVE: To evaluate the effect of Medicaid coverage on dental care outcomes, a major health concern for low-income populations.

DATA SOURCES: Primary and secondary data on health care use and outcomes for participants in Oregon's 2008 Medicaid lottery.

STUDY DESIGN: We used the lottery's random selection to gauge the causal effects of Medicaid on dental care needs, medication, and emergency department visits for dental care.

DATA COLLECTION: Data were collected for lottery participants over 2 years, including mail surveys (N = 23,777) and in-person questionnaires (N = 12,229). Emergency department (ED) records were matched to lottery participants in Portland (N …

The Impacts Of Medicaid Expansion On Rural Low-Income Adults: Lessons From The Oregon Health Insurance Experiment., Heidi Allen, Bill J. Wright, Lauren Broffman

Articles, Abstracts, and Reports

Medicaid expansions through the Affordable Care Act began in January 2014, but we have little information about what is happening in rural areas where provider access and patient resources might be more limited. In 2008, Oregon held a lottery for restricted access to its Medicaid program for uninsured low-income adults not otherwise eligible for public coverage. The Oregon Health Insurance Experiment used this opportunity to conduct the first randomized controlled study of a public insurance expansion. This analysis builds off of previous work by comparing rural and urban survey outcomes and adds qualitative interviews with 86 rural study participants for …

Oregon Medicaid Expenditures After The 2014 Affordable Care Act Medicaid Expansion: Over-Time Differences Among New, Returning, And Continuously Insured Enrollees, Rachel Springer, Miguel Marino, Jean P. O'Malley, Stephan R. Lindner, Nathalie Huguet, Jennifer E. Devoe

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background—There is interest in assessing healthcare utilization and expenditures among new Medicaid enrollees after the 2014 Medicaid expansion. Recent studies have not differentiated between newly enrolled individuals and those returning after coverage gaps.

Objectives—To assess healthcare expenditures among Medicaid enrollees in the 24 months after Oregon’s 2014 Medicaid expansions and examine whether expenditure patterns were different among the newly, returning, and continuously insured.

Research Design—Retrospective cohort study using inverse-propensity weights to adjust for differences between groups.

Subjects—Oregon adult Medicaid beneficiaries insured continuously from 2014-2015 who were either newly, returning, or continuously insured.

Measures—Monthly expenditures for inpatient care, prescription drugs, total …

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

Journal Articles

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. …

Oral Health 2020: Recommendations To Help Ohio Meet Healthy People 2020 Goals Based On States’ Oral Health Plans, Mackenzie Hunter

Master of Public Health Program Student Publications

Dental caries remains one of the largest untreated diseases in children and is one of the leading causes of poor oral health in the United States. Many states have joined forces with the Centers for Disease Control and Prevention and Medicaid to formulate a state oral health action plan that targets the Healthy People 2020 Goals for Oral Health to improve the overall oral health of children in the state. Through this plan, in connection with state oral health plans many states are comprehensively addressing these Healthy People 2020 goals. Ohio, on the other hand, has not met a number …

Medicaid And Children With Special Health Care Needs, 2016-2017 Cohort Of New Hampshire-Maine Leadership Education In Neurodevelopmental And Related Disabilities (Nh-Me Lend) Program Trainees

Policy Analysis

Medicaid funds vital services for children and youth with special health care needs and disabilities (CYSHCN). Proposed changes to the structure of Medicaid would significantly reduce federal funding for this important program. The most concerning are the proposed structural changes including per capita caps and block grants, as well as threats to Early and Periodic Screening, Diagnostic and Treatment (EPSDT) and Medicaid Waiver services. Restructuring would have devastating effects on benefits for low-income children and individuals with disabilities, and their families, putting this very vulnerable population at additional risk.

Impact Of Wisconsin Medicaid Policy Change On Dental Sealant Utilization, Christopher Okunseri, Elaye Okunseri, Raul I. Garcia, Cesar Gonzales, Alexis Vistocky, Aniko Szabo

School of Dentistry Faculty Research and Publications

Background

In September 2006, Wisconsin Medicaid changed its policy to allow nondentists to become certified Medicaid providers and to bill for sealants in public health settings.

Objective

This study examined changes in patterns of dental sealant utilization in first molars of Wisconsin Medicaid enrollees associated with a policy change.

Data Source

The Electronic Data Systems of Medicaid Evaluation and Decision Support for Wisconsin from 2001 to 2009.

Study Design

Retrospective claims data analysis of Wisconsin Dental Medicaid for children aged 6-16 years.

Principal Findings

A total of 479,847 children followed up for 1,441,300 person-years with 64,546 visits were analyzed. The …

Differences In Utilization Of Dental Procedures By Children Enrolled In Wisconsin Medicaid And Delta Dental Insurance Plans, Pradeep Bhagavatula, Qun Xiang, Aniko Szabo, Fredrick Eichmiller, Christopher Okunseri

School of Dentistry Faculty Research and Publications

Background

Few studies have directly compared dental procedures provided in public and private insurance plans for enrollees living in dental health professional shortage areas (DHPSAs). We examined the rates for the different types of dental procedures received by 0–18-year-old children living in DHPSAs and non-DHPSAs who were enrolled in Medicaid and those enrolled under Delta Dental of Wisconsin (DDW) for years 2002 to 2008.

Methods

Medicaid and DDW dental claims data for 2002 to 2008 was analyzed. Enrollees were divided into DDW-DHPSA and non-DHPSA and Medicaid-DHPSA and non-DHPSA groups. Descriptive and multivariable analyses using over-dispersed Poisson regression were performed to …

Community Health Centers And Medicaid Payment Reform: Emerging Lessons From Medicaid Expansion States, Peter Shin, Jessica Sharac, Zoe Barber, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers represent a major source of primary health care for the nation’s Medicaid beneficiaries. Because the Federally Qualified Health Center (FQHC) payment system is encounter-based, health centers and Medicaid agencies in ACA expansion states are actively pursuing payment reforms that will enable health centers to adopt strategies that can more effectively respond to the considerable and complex health and social needs of people served by health centers, and more efficiently address the surging volume of patient care. In five expansion states whose alternative payment experiments are underway, health centers and Medicaid agencies are testing payment alternatives, such as …

Diabetes And The Uninsured In Montgomery County, Ohio: Effects Of A County-Funded Health Services Program On Hemoglobin A1c Values, Mark Feighery

Master of Public Health Program Student Publications

Montgomery County Care (MCC) was a county-funded, limited benefit health services program launched in 2010 as a bridge to expanded Medicaid and the health insurance marketplaces for the uninsured of Montgomery County, Ohio. A principal goal was to help manage chronic disease, particularly diabetes. Approximately 20% of the MCC members assigned to a community health center were diagnosed with diabetes. Paired sample t-tests of Hemoglobin A1c values were compared for diabetic members enrolled in the program for a minimum of one year. Among 188 members for whom initial and subsequent values were recorded, HA1c values declined (showed an improvement) from …

Crafting A Narrative For The Red State Option, Elizabeth Weeks Leonard

Scholarly Works

This Article examines the current state of play following the Supreme Court's decision in NFIB v. Sebelius to allow states the option of expanding their Medicaid programs in accordance with the Patient Protection and Affordable Care Act (ACA). Holding that mandatory expansion was unconstitutionally coercive, the Court created the Red State Option. Despite the enormously generous federal financial support for Medicaid expansion, close to half of the states have declined. At the same time, at least eight Republican-led states have crossed Tea Party lines to accept federal funding for expansion. Drawing lessons from these states, including Arkansas, Arizona, Michigan, and …

Cultural Collisions And The Limits Of The Affordable Care Act, Jasmine E. Harris

All Faculty Scholarship

National Federation of Independent Business v. Sebelius (“NFIB”) settled the central constitutional questions impeding the rollout of the Patient Protection and Affordable Care Act (“ACA”): whether the federal government’s “individual mandate” to purchase or hold health insurance and the federal government’s authority to retract existing federal dollars if states fail to expand Medicaid eligibility violate the Constitution. However, a number of residual questions persist in its wake. While most of the focus this year has been on related constitutional issues — such as religious exemptions from offering contraceptive coverage to employees — NFIB also clears the path for a discussion …

Patterns Of Dental Service Utilization Following Nontraumatic Dental Condition Visits To The Emergency Department In Wisconsin Medicaid, Nicholas M. Pajewski, Christopher Okunseri

School of Dentistry Faculty Research and Publications

Objectives: To examine patterns of dental service utilization for adult Medicaid enrollees in Wisconsin following nontraumatic dental condition (NTDC) visits to the emergency department (ED).

Methods: This is a retrospective, observational study of claims for NTDC visits to the ED and dental service encounters from the Wisconsin Medicaid Evaluation and Decision Support database (2001-2009). We used competing risk models to predict probabilities of returning to the ED versus obtaining follow-up care from a dentist.

Results: We observed a 43 percent increase in the rate of NTDC visits to the ED, with most of this increase occurring from 2001 to 2005. …

2013 Survey Of Children Served By Mainecare, Jean A. Talbot Phd, Deborah Thayer Mba, Zachariah T. Croll Mph, Kimberley Fox Mpa

Medicaid

These survey results help identify areas for improvement for future initiatives both for the MaineCare program and for providers serving this population. Key Findings: MaineCare higher than the national average on most patient experience measures. Significant improvements in MaineCare provider/family communication and care coordination. MaineCare lower than national average on customer service, availability of treatment choices, and care coordination among providers. Patient experience generally similar for Medicaid and CHIP enrollees. Many MaineCare children have special health care needs. 35% of children enrolled in MaineCare have special health care needs, according to the 2013 survey. Experience of children with special health …

Carter, Tim Lee, 1910-1987 (Mss 80), Manuscripts & Folklife Archives

MSS Finding Aids

Finding aid only for Manuscripts Collection 80. Correspondence, photographs, audiotapes, film, clippings, general office files, and records of legislative proceedings relating to the political career of Tim Lee Carter, U.S. Representative (Republican) for Kentucky's Fifth Congressional District, 1965-1981.

Government Provided Health Insurance, Kristina Lambert, Ryan O’Connor

Academic Symposium of Undergraduate Scholarship

No abstract provided.

Children Served By Mainecare, 2012: Survey Findings, Nathaniel J. Anderson Ms, Mph, Kimberley Fox Mpa, Deborah Thayer Mba, Zachariah T. Croll Mph

Medicaid

The purpose of the annual Survey of Children Served by MaineCare is to monitor the quality of services delivered by MaineCare, the State's Medicaid and CHIP program. The 2012 survey examines the experiences of families with children. ages 0-17, who are enrolled in MaineCare using a standardized survey instrument (Consumer Assessment of Healthcare Providers and Systems--CAHPS--4.0H Child Medicaid Health Plan Survey). MaineCare scores very favorably compared with national benchmarks on CAHPS measures of Getting Needed Care, Getting Care Quickly, and How Well the Child's Doctors Community, with ratings at or above the 75th percentile on all the composites and individual …

Managing A High-Performance Medicaid Program, Eileen Griffin Jd, Trish Riley, Vikki Wachino, Robin Rudowitz

Disability & Aging

Today, the Medicaid program is evolving more rapidly than at any other time in its fifty-year history. States and the federal government are working to maximize the value and efficiency of Medicaid by reforming payment to reward value over volume, integrating effective care coordination across payers, and streamlining key processes like eligibility determinations across coverage programs. Underpinning a state’s ability to implement these reforms is its capacity to manage its Medicaid program effectively and efficiently.

This paper discusses key responsibilities that the federal government and states hold for managing the Medicaid program and identifies the key issues and challenges states …

Funding Health-Related Vr Services: The Potential Impact Of The Affordable Care Act On The Use Of Private Health Insurance And Medicaid To Pay For Health-Related Vr Services, Robert Silverstein

All Institute for Community Inclusion Publications

One of the myriad of issues affecting the administration of the vocational rehabilitation (VR) program by State VR agencies under Title I of the Rehabilitation Act is how to maximize access to and use of all available funding sources to pay for VR services and supports for VR applicants and clients. In March 2010, Congress passed and the President signed into law the "Affordable Care Act" (ACA). 1 On June 28, 2012, the United States Supreme Court upheld all of the provisions of the ACA, with the exception of provisions mandating Medicaid expansion. The Supreme Court held that if a …

A Tale Of Two Cities? The Heterogeneous Impact Of Medicaid Managed Care In Kentucky, James Marton, Aaron Yelowitz, Jeffery C. Talbert

University of Kentucky Center for Poverty Research Discussion Paper Series

Does managed care produce lower health care utilization and costs through better aligned financial incentives and alternative delivery methods (the “pure” HMO effect) or by attracting more healthy enrollees (enrollee selection)? The purpose of this paper is to shed new light on this fundamental question using a quasi-experimental approach that exploits the timing and county specific implementation of Medicaid managed care plans in two distinct sub-sets of Kentucky counties in the late 1990s. We find large differences in the relative success of each region in reducing utilization that are likely driven by important differences in plan design. Asthmatic children enrolled …

On Why The Dental Therapists' "Movement" In The United States Should Focus On Children--Not Adults, David A. Nash

Oral Health Science Faculty Publications

No abstract provided.