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JAMA Sep 2022Medicaid is the largest health insurance program by enrollment in the US and has an important role in financing care for eligible low-income adults, children, pregnant... (Review)
Review
IMPORTANCE
Medicaid is the largest health insurance program by enrollment in the US and has an important role in financing care for eligible low-income adults, children, pregnant persons, older adults, people with disabilities, and people from racial and ethnic minority groups. Medicaid has evolved with policy reform and expansion under the Affordable Care Act and is at a crossroads in balancing its role in addressing health disparities and health inequities against fiscal and political pressures to limit spending.
OBJECTIVE
To describe Medicaid eligibility, enrollment, and spending and to examine areas of Medicaid policy, including managed care, payment, and delivery system reforms; Medicaid expansion; racial and ethnic health disparities; and the potential to achieve health equity.
EVIDENCE REVIEW
Analyses of publicly available data reported from 2010 to 2022 on Medicaid enrollment and program expenditures were performed to describe the structure and financing of Medicaid and characteristics of Medicaid enrollees. A search of PubMed for peer-reviewed literature and online reports from nonprofit and government organizations was conducted between August 1, 2021, and February 1, 2022, to review evidence on Medicaid managed care, delivery system reforms, expansion, and health disparities. Peer-reviewed articles and reports published between January 2003 and February 2022 were included.
FINDINGS
Medicaid covered approximately 80.6 million people (mean per month) in 2022 (24.2% of the US population) and accounted for an estimated $671.2 billion in health spending in 2020, representing 16.3% of US health spending. Medicaid accounted for an estimated 27.2% of total state spending and 7.6% of total federal expenditures in 2021. States enrolled 69.5% of Medicaid beneficiaries in managed care plans in 2019 and adopted 139 delivery system reforms from 2003 to 2019. The 38 states (and Washington, DC) that expanded Medicaid under the Affordable Care Act experienced gains in coverage, increased federal revenues, and improvements in health care access and some health outcomes. Approximately 56.4% of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, and disparities in access, quality, and outcomes are common among these groups within Medicaid. Expanding Medicaid, addressing disparities within Medicaid, and having an explicit focus on equity in managed care and delivery system reforms may represent opportunities for Medicaid to advance health equity.
CONCLUSIONS AND RELEVANCE
Medicaid insures a substantial portion of the US population, accounts for a significant amount of total health spending and state expenditures, and has evolved with delivery system reforms, increased managed care enrollment, and state expansions. Additional Medicaid policy reforms are needed to reduce health disparities by race and ethnicity and to help achieve equity in access, quality, and outcomes.
Topics: Aged; Child; Ethnicity; Female; Health Care Reform; Health Equity; Humans; Insurance Coverage; Medicaid; Minority Groups; Patient Protection and Affordable Care Act; Pregnancy; United States
PubMed: 36125468
DOI: 10.1001/jama.2022.14791 -
Journal of Health Politics, Policy and... Feb 2020
Topics: Health Care Reform; Humans; Marijuana Use; Medicaid; Patient Protection and Affordable Care Act; Politics; Tissue Donors; United States
PubMed: 31675061
DOI: 10.1215/03616878-7893543 -
Journal of Health Politics, Policy and... Aug 2020Medicaid's experience one decade after the passage of the Affordable Care Act represents extreme divergence across the American states in health care access and...
Medicaid's experience one decade after the passage of the Affordable Care Act represents extreme divergence across the American states in health care access and utilization, policy designs that either expand or restrict eligibility, and delivery model reforms. The past decade has also witnessed a growing ideological divide about the very purpose and intent of the Medicaid program and its place within the US health care system. While liberal-leaning states have actively embraced the program and used it to expand health coverage to working adults and families as an effort to improve health and prevent poverty and the insecurity and instability that comes with high medical costs (evictions, bankruptcy), conservative states have actively rejected this expanded idea of Medicaid and argued instead that the program should revert back to its "original" purpose and be used only for the "truly" needy. This article highlights several paradoxes within Medicaid that have led to this growing bifurcation, and it concludes by shedding light on important targets for future reform.
Topics: Eligibility Determination; Insurance Coverage; Medicaid; Patient Protection and Affordable Care Act; Politics; Poverty; United States
PubMed: 32186342
DOI: 10.1215/03616878-8255541 -
Health Affairs (Project Hope) Sep 2020
Review
Topics: Female; Humans; Male; Medicaid; Medicare; Prospective Payment System; Reimbursement, Incentive; United States
PubMed: 32897789
DOI: 10.1377/hlthaff.2020.01540 -
Issue Brief (Health Policy Tracking... Dec 2018
Topics: Community Health Services; Dental Health Services; Fraud; Home Care Services; Humans; Insurance Benefits; Insurance, Dental; Insurance, Health, Reimbursement; Insurance, Long-Term Care; Insurance, Pharmaceutical Services; Long-Term Care; Medicaid; Mental Health Services; Opioid-Related Disorders; State Government; Telemedicine; Transportation of Patients; United States
PubMed: 30694031
DOI: No ID Found -
Plastic and Reconstructive Surgery Mar 2020Medicaid is a complex federally and state funded health insurance program in the United States that insures an estimated 76 million individuals, approximately 20 percent... (Review)
Review
Medicaid is a complex federally and state funded health insurance program in the United States that insures an estimated 76 million individuals, approximately 20 percent of the U.S. population. Many physicians may not receive formal training or education to help understand the complexities of Medicaid. Plastic surgeons, residents, and advanced practice practitioners benefit from a basic understanding of Medicaid, eligibility requirements, reimbursement methods, and upcoming healthcare trends. Medicaid is implemented by states with certain federal guidelines. Eligibility varies from state to state (in many states it's linked to the federal poverty level), and is based on financial and nonfinancial criteria. The passage of the Affordable Care Act in 2010 permitted states to increase the federal poverty level eligibility cutoff to expand coverage for low-income adults. The aim of this review is to provide a brief history of Medicaid, explain the basics of eligibility and changes invoked by the Affordable Care Act, and describe how federal insurance programs relate to plastic surgery, both at academic institutions and in community practice environments.
Topics: Eligibility Determination; Health Services Accessibility; History, 20th Century; History, 21st Century; Insurance Coverage; Medicaid; Patient Protection and Affordable Care Act; Poverty; Plastic Surgery Procedures; Surgeons; United States
PubMed: 32097335
DOI: 10.1097/PRS.0000000000006560 -
JAAPA : Official Journal of the... May 2015
Topics: Civil Disorders; Humans; Medicaid; North Carolina; United States
PubMed: 25853672
DOI: 10.1097/01.JAA.0000463875.65492.d1 -
Home-Based Primary and Palliative Care in the Medicaid Program: Systematic Review of the Literature.Journal of the American Geriatrics... Jan 2021To describe the use of home-based medical care (HBMC) among Medicaid beneficiaries.
BACKGROUND/OBJECTIVES
To describe the use of home-based medical care (HBMC) among Medicaid beneficiaries.
DESIGN
A systematic review of the peer-reviewed and gray literature of home-based primary care and palliative care programs among Medicaid beneficiaries including dual eligibles.
SETTING
HBMC including home-based primary care and palliative care programs.
PARTICIPANTS
Studies describing Medicaid beneficiaries receiving HBMC.
MEASUREMENTS
Three groups of studies were included: those focused on HBMC specifically for Medicaid beneficiaries, studies that described the proportion of Medicaid patients receiving HBMC, and those that used Medicaid status as a dependent variable in studying HBMC.
RESULTS
The peer-reviewed and gray literature searches revealed 574 unique studies of which only 16 met inclusion criteria. Few publications described HBMC as an integral care delivery model for Medicaid programs. Data from the programs described suggest the use of HBMC for Medicaid beneficiaries can reduce healthcare costs. The addition of social supports to HBMC appears to convey additional savings and benefits.
CONCLUSION
This systematic literature review highlights the relative dearth of literature regarding the use and impact of HBMC in the Medicaid population. HBMC has great potential to reduce Medicaid costs, and innovative programs combining HBMC with social support systems need to be tested.
Topics: Delivery of Health Care; Home Care Services; Humans; Medicaid; Palliative Care; Primary Health Care; United States
PubMed: 32959375
DOI: 10.1111/jgs.16837 -
American Journal of Public Health Aug 2021To identify the association between Medicaid eligibility expansion and medical debt. We used difference-in-differences design to compare changes in medical debt for...
To identify the association between Medicaid eligibility expansion and medical debt. We used difference-in-differences design to compare changes in medical debt for those gaining coverage through Louisiana's Medicaid expansion with those in nonexpansion states. We matched individuals gaining Medicaid coverage because of Louisiana's Medicaid expansion (n = 196 556) to credit report data on medical debt and compared them with randomly selected credit reports of those living in Southern nonexpansion state zip codes with high rates of uninsurance (n = 973 674). The study spanned July 2014 through July 2019. One year after Louisiana Medicaid expansion, medical collections briefly rose before declining by 8.1 percentage points (95% confidence interval [CI] = -0.107, -0.055; ≤ .001), or 13.5%, by the third postexpansion year. Balances also briefly rose before falling by 0.621 log points (95% CI = -0.817, -0.426; ≤ .001), or 46.3%. Louisiana's Medicaid expansion was associated with a reduction in the medical debt load for those gaining coverage. These results suggest that future Medicaid eligibility expansions may be associated with similar improvements in the financial well-being of enrollees.
Topics: Adult; Female; Health Care Costs; Health Services Accessibility; Humans; Louisiana; Male; Medicaid; Middle Aged; Poverty; United States
PubMed: 34213978
DOI: 10.2105/AJPH.2021.306316 -
JAMA Oct 2016The Affordable Care Act expanded Medicaid eligibility for millions of low-income adults. The choice for states to expand Medicaid could affect the financial health of... (Comparative Study)
Comparative Study Observational Study
IMPORTANCE
The Affordable Care Act expanded Medicaid eligibility for millions of low-income adults. The choice for states to expand Medicaid could affect the financial health of hospitals by decreasing the proportion of patient volume and unreimbursed expenses attributable to uninsured patients while increasing revenue from newly covered patients.
OBJECTIVE
To estimate the association between the Medicaid expansion in 2014 and hospital finances by assessing differences between hospitals in states that expanded Medicaid and in those states that did not expand Medicaid.
DESIGN AND SETTING
Observational study with analysis of data for nonfederal general medical or surgical hospitals in fiscal years 2011 through 2014, using data from the American Hospital Association Annual Survey and the Health Care Cost Report Information System from the US Centers for Medicare & Medicaid Services. Multivariable difference-in-difference regression analyses were used to compare states with Medicaid expansion with states without Medicaid expansion. Hospitals in states that expanded Medicaid eligibility before January 2014 were excluded.
EXPOSURES
Medicaid expansion in 2014, accounting for variation in fiscal year start dates.
MAIN OUTCOMES AND MEASURES
Hospital-reported information on uncompensated care, uncompensated care as a percentage of total hospital expenses, Medicaid revenue, Medicaid as a percentage of total revenue, operating margins, and excess margins.
RESULTS
The sample included between 1200 and 1400 hospitals per fiscal year in 19 states with Medicaid expansion and between 2200 and 2400 hospitals per fiscal year in 25 states without Medicaid expansion (with sample size varying depending on the outcome measured). Expansion of Medicaid was associated with a decline of $2.8 million (95% CI, -$4.1 to -$1.6 million; P < .001) in mean annual uncompensated care costs per hospital. Hospitals in states with Medicaid expansion experienced a $3.2 million increase (95% CI, $0.9 to $5.6 million; P = .008) in mean annual Medicaid revenue per hospital, relative to hospitals in states without Medicaid expansion. Medicaid expansion was also significantly associated with improved excess margins (1.1 percentage points [95% CI, 0.1 to 2.0 percentage points]; P = .04), but not improved operating margins (1.1 percentage points [95% CI, -0.1 to 2.3 percentage points]; P = .06).
CONCLUSIONS AND RELEVANCE
The hospitals located in the 19 states that implemented the Medicaid expansion had significantly increased Medicaid revenue, decreased uncompensated care costs, and improvements in profit margins compared with hospitals located in the 25 states that did not expand Medicaid. Further study is needed to assess longer-term implications of this policy change on hospitals' overall finances.
Topics: Adult; Economics, Hospital; Humans; Medicaid; Medically Uninsured; Patient Protection and Affordable Care Act; Regression Analysis; Uncompensated Care; United States
PubMed: 27727384
DOI: 10.1001/jama.2016.14765