Health Policy Commons^™

Medicaid Income Eligibility Transitions Among Rural Adults, Erika C. Ziller Phd, Deborah Thayer, Jennifer D. Lenardson Mhs

Access / Insurance

The Affordable Care Act (ACA) Medicaid Expansion allows coverage for all adults aged 18 to 64 with income below 138 percent of the federal poverty level (FPL), and as of 2018, 32 states had implemented expansion. Research prior to the ACA suggests people may transition in and out of Medicaid income eligibility, but little is known about how this may affect rural adults. Movement in and out of Medicaid may increase administrative costs, create benefit and provider discontinuity, or lead to patient difficulties in paying medical bills and accessing care. This brief uses data from the national Survey of Income …

Healthcare Utilization & Health Behaviors Among Older Adults: The Role Of Insurance, Jennifer Rose Geiger

LSU Doctoral Dissertations

As the population of older adults in the U.S. continues its exponential growth, so too will the need for high-quality health and preventive services. Despite the widely acknowledged need for proactive solutions to the coming public health challenges for this rapidly expanding age cohort, healthcare providers and social work practitioners continue to lack the proper education training to serve the needs of older adults. Furthermore, these allied health professionals also frequently engage in ageist behaviors across care settings that also often employ institutionally ageist policies and procedures. As a result, older adults may be particularly at risk of negative health …

Making Medicaid Work In The Mountain State? An Assessment Of The Effect Of Work Requirements For Medicaid Beneficiaries In West Virginia, Simon F. Haeder

Faculty & Staff Scholarship

West Virginia is one of the poorest states in the nation, and West Virginians face some of the highest rates of illness and disability. One of the few bright spots for the health of West Virginians have been government-funded programs like Medicaid and the Children’s Health Insurance Program (CHIP). The Affordable Care Act (ACA), including the expansion of Medicaid under Governor Tomblin in 2014, has brought health coverage and access to care to hundreds of thousands of West Virginians. Today, about a third of West Virginians rely on Medicaid, and the program has become the backbone of the state’s health …

Mental Hell, Jesenia De Moya, Hanaa' Tameez, Maritza Villela

Capstones

Mental Hell explores how difficult it is for low-income Latinos in New York City to access mental health care. Through explanations from experts and the personal stories of three Latinas New Yorkers who have gone through the process of trying to get the care they need, the story guides the reader through the many roadblocks this demographic encounters specifically under the insurance of Medicaid.

This is an extremely important topic that affects many New Yorkers, and we believe something needs to be done to make this type of healthcare more accessible for Latinos. New York City has a very high …

Maintaining Public Health Insurance Benefits: How Primary Care Clinics Help Keep Low-Income Patients Insured, Rose L. Harding, Jennifer D. Hall, Jennifer Devoe, Heather Angier, Rachel Gold, Christine Nelson, Sonja Likumahuwa-Ackman, John Heintzman, Aleksandra Sumic, Deborah J. Cohen

Patient Experience Journal

Low-income families struggle to obtain and maintain public health insurance. We identified strategies used by Community Health Centers (CHCs) to assist patients with insurance applications, and assessed patients’ receptivity to these efforts. Observational cross-case comparative study with four CHCs in Oregon. We observed insurance assistance processes, and interviewed 26 clinic staff and 18 patients/family members. Qualitative data were analyzed using a grounded theory approach. Patients’ understanding of eligibility status, reapplication schedules, and how to apply, were major barriers to insurance enrollment. Clinic staff addressed these barriers by reminding patients when applications were due, assisting with applications as needed, and tracking …

Healthcare: What Comes Next?, William H. Lane

English Faculty Publications

Where do we go from here on healthcare?

America has been talking about fixing its fragmented and overly expensive healthcare system for quite a while now. At times, it seems as though we simply keep having the same conversation (or argument, if you prefer) over and over again without making much progress in ensuring access to affordable care to all Americans. In fact, however, some significant gains have been made. Twenty million left without insurance (our situation now) has got to be better than forty million left without (our situation a decade ago).

Pregnancy Medicaid Expansions And Fertility: Differentiating Between The Intensive And Extensive Margins, Lincoln H. Groves, Sarah Hamersma, Leonard M. Lopoo

Center for Policy Research

The theoretical and empirical links between public health insurance access and fertility in the United States remain unclear. Utilizing a demographic cell-based estimation approach with panel data (1987-1997), we revisit the large-scale Medicaid expansions to pregnant women during the 1980s to estimate the heterogeneous impacts of public health insurance access on childbirth. While the decision to become a parent (i.e., the extensive margin) appears to be unaffected by increased access to Medicaid, we find that increased access to public health insurance positively influenced the number of high parity births (i.e., the intensive margin) for select groups of women. In particular, …

Covering The Care: Health Insurance Coverage In New Hampshire, Jo Porter, Lucy Hodder

Law Faculty Scholarship

the first in a series of data and policy briefs that seek to inform the current conversations about health reform happening across the state. The first brief uses data from the American Community Survey to provide information about the health insurance coverage landscape in NH.

The Role Of Public Versus Private Health Insurance In Ensuring Health Care Access & Affordability For Low-Income Rural Children, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Amanda Burgess Mppm

Access / Insurance

Medicaid and the Children’s Health Insurance Program (CHIP) have played a critical role in ensuring access to health insurance coverage among children and have been particularly important sources of coverage for rural children. More than 35.5 million children were enrolled in Medicaid or CHIP in September 2016—accounting for just over half of total Medicaid and CHIP enrollment. Given the large proportion of rural children covered by public insurance, it is critically important to understand the role of that coverage in ensuring access to affordable healthcare for rural children. Using data from the 2011-2012 National Survey of Children’s Health, this study …

Oregon's Medicaid Reform And Transition To Global Budgets Were Associated With Reductions In Expenditures, K. John Mcconnell, Stephanie Renfro, Neal T. Wallace, Deborah J. Cohen, Richard C. Lindrooth, Michael E. Chernew

OHSU-PSU School of Public Health Faculty Publications and Presentations

In 2012 Oregon initiated an ambitious delivery system reform, moving the majority of its Medicaid enrollees into sixteen coordinated care organizations, a type of Medicaid accountable care organization. Using claims data, we assessed measures of access, appropriateness of care, utilization, and expenditures for five service areas (evaluation and management, imaging, procedures, tests, and inpatient facility care), comparing Oregon to the neighboring state of Washington. Overall, the transformation into coordinated care organizations was associated with a 7 percent relative reduction in expenditures across the sum of these services, attributable primarily to reductions in inpatient utilization. The change to coordinated care organizations …

N.C. Medicaid Reform: A Bipartisan Path Forward, Barak D. Richman, Allison Rice

Faculty Scholarship

The North Carolina Medicaid program currently constitutes 32% of the state budget and provides insurance coverage to 18% of the state’s population. At the same time, 13% of North Carolinians remain uninsured, and even among the insured, significant health disparities persist across income, geography, education, and race.

The Duke University Bass Connections Medicaid Reform project gathered to consider how North Carolina could use its limited Medicaid dollars more effectively to reduce the incidence of poor health, improve access to healthcare, and reduce budgetary pressures on the state’s taxpayers.

This report is submitted to North Carolina’s policymakers and citizens. It assesses …

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 …

Balancing Coordinated Care With Tribal Sovereignty: Lesson’S From Oregon’S Medicaid Reform, Lydia E. Riley, R. Turner Goins, Stephanie Bernell

Journal of Health Disparities Research and Practice

The purpose of this case study is to examine the efforts made by the legislature and the Oregon Health Authority (OHA) to involve Oregon’s nine federally recognized tribes in the implementation of the revised Oregon Health Plan. We identified eight key informants, consisting of four tribal representatives and four state representatives, for interviews. Additionally, we identified the contact person from each newly-established Medicaid delivery network to determine if they had included the tribe(s) or planned to include the tribe(s) in their network. The OHA made some steps to ensure the inclusion of tribes in the planning and implementation process, but …

Implementation Of Self-Directed Supports For Individuals With Intellectual And Developmental Disabilities: A Political Economy Analysis, Matthew P. Decarlo

Theses and Dissertations

Self-directed supports, as a method of service delivery, have grown from small pilot programs in a handful of states to at least one program in every state. For individuals with intellectual and developmental disabilities (IDD), self-direction presents unique opportunities to engage in self-determined behavior and shape the services upon which they rely. Although the evidence base for self-direction is relatively robust, there is a significant lack of information on how implementation of self-direction is faring on the national level. The purpose of this study is to understand how the political and economic factors within and across states have impacted the …

Medicaid Crowd-Out Of Other Public Health Spending: Modeling Economic & Health Effects, Glen P. Mays

Health Management and Policy Presentations

MOTIVATION: Thirty states are expanding Medicaid eligibility under the Affordable Care Act (ACA) as of 2015, and while federal funds cover most costs for newly eligible recipients, states must share the additional costs of covering previously-eligible state residents who enroll in Medicaid. States, together with their local government counterparts, also provide the vast majority (87%) of public sector funds for public health programs designed to promote health and prevent disease and injury on a population-wide basis. Fiscal constraints and generous federal matching funds create strong budgetary incentives for states to channel their health-related spending to Medicaid rather than to other …

The Dynamics Of Medicaid & Public Health Spending: Implications For Aca Implementation, Glen P. Mays

Health Management and Policy Presentations

We estimate the dynamics and interactions of governmental spending on Medicaid and other public health services in all 50 states over a 15 year period. Using a quasi-experimental design with instrumental variables estimation, we find evidence that increased Medicaid spending leads to reduced governmental spending on other public health services, consistent with a crowd-out effect. Over 10 years, such crowd-out has the potential to diminish the health status improvements generated through health insurance coverage expansions.

Medicaid Expansions & Public Health Spending: Cross-Subsidies, Complementarities, And Crowd-Out, Glen P. Mays

Health Management and Policy Presentations

In this paper we estimate the causal impact of state Medicaid enrollment expansions and expenditures on state and local resources allocated to other public health programs and services. Using a quasi-experimental design with instrumental variables estimation, we find evidence that increased Medicaid spending leads to reduced governmental spending on other public health services, consistent with a crowd-out effect. Over 10 years, such crowd-out has the potential to diminish the health status improvements generated through health insurance coverage expansions.

An Analysis Of Political And Legal Debates Concerning Medicaid Expansion In Virginia, Rick Mayes, Benjamin Paul

Political Science Faculty Publications

The Supreme Court’s historic June 2012 ruling regarding the Affordable Care Act (ACA) in National Federation of Independent Business v. Sebelius set the stage for a massive federalism battle over Medicaid expansion in the United States. The original language of the Act was intended to nationalize Medicaid by having every state expand their program’s eligibility to all individuals up to 138% of the federal poverty level. This would have significantly reshaped Medicaid, a joint federal-state health insurance program, into a universal entitlement for all low-income citizens. Currently, Medicaid eligibility varies dramatically from state to state. The Court held that the …

A Study On Generic Prescription Substitution Policy As A Cost Containment Approach For Michigan’S Medicaid System, Khandaker Nayeemul Islam

Dissertations

Increasing health care costs have made management of Medicaid services to provide low-income families through Medicaid programs critical in the recent times. The number of Medicaid beneficiaries in Michigan has increased over the years mainly due to the downsizing of auto sectors. Currently, states spend almost 16% of their budget for Medicaid, making it the second largest item in the budget for most (Kaiser Foundation, 2010). Prescription drugs are a significant part of Michigan’s Medicaid costs. Higher costs caused a tremendous fiscal burden on Michigan in administering the program and providing prescription drugs for its patients. Michigan has implemented several …

Financial Security Scorecard: A State-By-State Analysis Of Economic Pressures Facing Future Retirees, Christian Weller, Nari Rhee, Carolyn Arcand

Public Policy and Public Affairs Faculty Publication Series

As Americans increasingly worry about their retirement prospects, states play an important and growing role in retirement security policy. States already manage long-term care programs for the elderly through Medicaid. Concerned about the impact of future elder poverty on state and local budgets and their local economies, a number of states are exploring the creation of low-cost and low-risk retirement savings plans for private sector workers who lack access to pensions or 401(k)s on the job. Some states have developed programs to help older workers find work.

This report presents the Financial Security Scorecard, designed to inform state-level stakeholders and …

Implications Of The Affordable Care Act's Medicaid Expansion On Low-Income Individuals On Probation, Marsha Regenstein, Lea Nolan

Health Policy and Management Faculty Publications

Every year, millions of Americans become involved in the local criminal justice system and are held in jails, placed on probation, or some combination of the two. This paper focuses on the probation population, a group of individuals who receive correctional supervision in communities, generally as an alternative to incarceration. Individuals on probation are disproportionately low-income and uninsured; many are likely to qualify for health coverage through state Medicaid expansions and private insurance Marketplaces that are part of the Patient Protection and Affordable Care Act. Opening up access to affordable health insurance coverage for this vulnerable group of individuals is …

Strategies For Health Care Cost Containment (1980s-Present), Rick Mayes

Political Science Faculty Publications

The U.S. health care system during the past three decades has been over two interrelated questions: first, who will control the manner in which medical care is paid for, and, second, how much will it cost? Many health care experts believe that Medicare's efforts at cost control, primarily in the form of the program's seminal transition to and continual modification of prospective payment of health care providers, has both triggered and repeatedly intensified the economic restructuring of the U.S. health care system. Medicare is an almost $600 billion public health insurance program for individuals sixty-five years of age and older; …

An Analysis Of Capacity Issues Within The Division Of Mental And Behavioral Health For The State Of Nevada, Jeffrey Buchwald, Tara Cooley, Enrique Mazon Jr., Jessica Sifuentes

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background

Nevada’s competitiveness in receiving federal funding has been a serious and contentious topic that has steered recent efforts to ascertain ways the state can increase and utilize federal dollars efficiently. Nevada is positioned 53rd out of 53 U.S. states and territories in bringing federal dollars to the state, missing out on $1.5 billion annually (Gustafson, 2012). Nevada spends far less on Medicaid (per capita) than any other state. Medicaid is a key factor in improving Nevada’s position; however, there are additional non-formula funding opportunities that are missed every year.

Purpose

The purpose of this evaluation project is to identify …

Quality Of Care In Community Health Centers And Factors Associated With Performance, Julia Paradise, Peter Shin, Jessica Sharac, Sara J. Rosenbaum, Kaiser Commission On Medicaid And The Uninsured

Health Policy and Management Issue Briefs

This study examines quality performance among community health centers (CHC) on three key measures of primary and preventive care — diabetes and blood pressure control and timely Pap tests — using quality in Medicaid managed care organizations (MCO) as a benchmark. The study also identifies factors that differ significantly between high- and lower-performing health centers. Most health centers perform better than 75% of all Medicaid MCOs on the two chronic care measures, and more than 1 in 10 exceed this benchmark on all three quality measures. Few health centers lag behind average Medicaid MCO performance on all three measures. Lower-performing …

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

Academic Symposium of Undergraduate Scholarship

No abstract provided.

Community Health Centers In An Era Of Health Reform: An Overview And Key Challenges To Health Center Growth, Peter Shin, Jessica Sharac, Carmen Alvarez, Sara J. Rosenbaum, Julia Paradise

Health Policy and Management Faculty Publications

Over 1,100 federally funded community health centers play a vital role in ensuring access to health care for a predominantly low-income population in medically underserved communities. Health centers’ ability to provide comprehensive primary care and improve access to high-quality care while holding down health care cost growth has been well-documented. As health reform spurs coverage expansion and efforts to improve quality, the nation’s reliance on health centers is likely to grow.

In the Affordable Care Act (ACA), Congress invested $11 billion over five years to expand the health center program, to broaden access to care in lower-income communities as coverage …

Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Rebalancing Long-Term Care Under The Affordable Care Act, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor

Gerontology Institute Publications

Federal approval of Rhode Island’s Global Consumer Choice Compact Global Waiver in 2009 provided Rhode Island with greater flexibility to modify its Medicaid program. Because 96% of long-term care expenditures in Rhode Island were directed toward institutional settings, a primary goal was to facilitate the state’s efforts to shift the locus of long-term care to non-institutional settings. This study draws lessons from Rhode Island’s experience with the Global Waiver for the long-term care rebalancing provisions of the Patient Protection and Affordable Care Act of 2010. Data derive from 325 archival sources and 26 semi-structured interviews. Results suggest that prospectively documenting …

Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Designing And Implementing State Health Reform, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor

Gerontology Institute Publications

Provisions in the Medicaid statute permit states to apply for waivers from traditional program requirements. On January 16, 2009, the federal government approved Rhode Island's Global Consumer Choice Compact Waiver. In exchange for a cap on combined federal and state spending of $12.075 billion through 2013, Rhode Island received greater flexibility to adopt certain Medicaid program changes. This study analyzes the design and implementation of the Global Waiver to draw general lessons for health reform at the state-level, a key concern given ongoing state discretion to improve their health care systems under the Patient Protection and Affordable Care Act. Data …

Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Block Granting Medicaid And Other Retrenchment, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor

Gerontology Institute Publications

On January 16, 2009, the Federal government approved Rhode Island’s application for a Global Consumer Choice Compact Medicaid Waiver whereby the state became the first granted permission to operate its entire Medicaid program under the state plan and a single 1115 “research and demonstration” waiver. The Global Waiver has been implemented in the context of Republican proposals to turn Medicaid into a block grant which would give states substantially more flexibility administering the program in exchange for receiving an upfront allotment from the Federal government. Proponents have held up the Global Waiver as a successful example of what might be …

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 …