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Pediatrics Aug 2019To describe the landscape of Medicaid and the Children's Health Insurance Program beneficiary incentive programs for child health and garner key stakeholder insights on... (Review)
Review
OBJECTIVES
To describe the landscape of Medicaid and the Children's Health Insurance Program beneficiary incentive programs for child health and garner key stakeholder insights on incentive program rationale, child and family engagement, and program evaluation.
METHODS
We identified beneficiary health incentive programs from 2005 to 2018 through a search of peer-reviewed and publicly available documents and through semistructured interviews with 80 key stakeholders (Medicaid and managed-care leadership, program evaluators, patient advocates, etc). This study highlights insights from 23 of these stakeholders with expertise on programs targeting child health (<18 years old) to understand program rationale, beneficiary engagement, and program evaluation.
RESULTS
We identified 82 child health-targeted beneficiary incentive programs in Medicaid and the Children's Health Insurance Program. Programs most commonly incentivized well-child checks ( = 77), preventive screenings ( = 30), and chronic disease management ( = 30). All programs included financial incentives (eg, gift cards, premium incentives); some also offered incentive material prizes ( = 12; eg, car seats). Loss-framed incentives were uncommon ( = 1; eg, lost benefits) and strongly discouraged by stakeholders. Stakeholders suggested family engagement strategies including multigenerational incentives or incentives addressing social determinants of health. Regarding evaluation, stakeholders suggested incentivizing evidence-based preventive services (eg, vaccinations) rather than well-child check attendance, and considering proximal measures of child well-being (eg, school functioning).
CONCLUSIONS
As the landscape of beneficiary incentive programs for child health evolves, policy makers have unique opportunities to leverage intergenerational and social approaches for family engagement and to more effectively increase and evaluate programs' impact.
Topics: Child; Children's Health Insurance Program; Humans; Medicaid; Peer Review; Program Evaluation; Stakeholder Participation; United States
PubMed: 31289193
DOI: 10.1542/peds.2018-3161 -
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 -
Health Services Research Aug 2018To assess the effect of the 2014 Medicaid expansion on Medicaid managed care plan quality.
OBJECTIVE
To assess the effect of the 2014 Medicaid expansion on Medicaid managed care plan quality.
DATA SOURCES
Three composite measures of plan-level quality constructed from the Health Care Effectiveness Data and Information Set.
STUDY SETTING
One hundred and sixty-three plans in 27 Medicaid expansion states and 100 plans in 14 nonexpansion states.
STUDY DESIGN
Quasi-experimental difference-in-differences (DID) analysis, comparing quality before (2011-13) and after (2014-15) Medicaid expansion in states that elected to expand Medicaid eligibility and those that did not.
PRINCIPAL FINDINGS
Mean plan enrollment increased from 130,533 to 274,259 in expansion states and from 105,449 to 148,194 in nonexpansion states. The proportion of enrollees receiving recommended preventive care increased from 62.6 to 65.2 percent in expansion states and from 59.3 to 62.5 percent in nonexpansion states (adjusted DID: -0.7 percentage points [95% CI -2.2, 0.7]). The proportion of enrollees receiving recommended chronic disease care management increased from 65.4 to 66.0 percent in expansion states and from 62.5 to 63.1 percent in nonexpansion states (adjusted DID: 1.1 percentage points [95% CI -0.5, 2.6]). We observed similar patterns for the receipt of recommended maternity care.
CONCLUSIONS
Medicaid expansion increased enrollment in managed care plans, but it did not result in erosion of quality.
Topics: Chronic Disease; Humans; Insurance, Health; Managed Care Programs; Maternal-Child Health Services; Medicaid; Mental Health Services; Patient Protection and Affordable Care Act; Preventive Health Services; Quality Indicators, Health Care; Quality of Health Care; United States
PubMed: 29230801
DOI: 10.1111/1475-6773.12814 -
AMA Journal of Ethics Aug 2019Medicaid covers approximately 1 in 5 Americans and accounts for one-sixth of US health care spending. Despite having to navigate increasing and variable spending on...
Medicaid covers approximately 1 in 5 Americans and accounts for one-sixth of US health care spending. Despite having to navigate increasing and variable spending on prescription drugs, Medicaid programs must balance their annual budgets, and they rely heavily on the Medicaid Drug Rebate Program (MDRP). The MDRP requires programs to maintain an open formulary covering all of a manufacturer's drugs in exchange for being given the lowest price in the market. Recent attempts by states to close their formularies signal that the benefit of this program might be attenuated by the lack of negotiating leverage in the rest of the market, exposing Medicaid to higher prices. Regardless of whether closed formularies would succeed in constraining Medicaid prescription drug spending, this trend raises important questions about the usefulness of a system that pegs Medicaid drug spending to net prices negotiated by others in the market.
Topics: Costs and Cost Analysis; Formularies as Topic; Insurance Coverage; Medicaid; Prescription Drugs; Program Evaluation; United States
PubMed: 31397659
DOI: 10.1001/amajethics.2019.645 -
Medical Care Mar 2019Opioid overdose deaths in the United States have climbed since 1999. In 2014, the Affordable Care Act prompted some states to expand Medicaid programs, providing...
BACKGROUND
Opioid overdose deaths in the United States have climbed since 1999. In 2014, the Affordable Care Act prompted some states to expand Medicaid programs, providing low-cost prescription access to millions of Americans. Some have questioned whether Medicaid expansion might worsen the opioid crisis.
OBJECTIVE
To test the association between the expansion of state Medicaid programs and Medicaid-paid prescriptions of opioid pain relievers and opioid addiction therapies.
RESEARCH DESIGN
We analyzed the 2010-2016 Medicaid State Drug Utilization Data using a difference-in-differences regression approach, comparing prescriptions per enrollee between states that expanded Medicaid in 2014 and states that did not. We compared opioid pain relievers and opioid addiction therapies to 5 other commonly prescribed drug types important to the Medicaid expansion population (antidepressants, antihypertensives, diabetes medications, cholesterol treatments, and contraceptives) and to overall prescription volume. A secondary analysis compared opioid pain relievers and opioid addiction therapies, between states with high and low overdose death rates.
RESULTS
We found overall prescription use per enrollee was higher after 2014. Relative growth in opioid pain reliever prescriptions was modest compared with growth in medications for depression, hypertension, diabetes, and high cholesterol. Growth in prescriptions used to treat opioid use disorder greatly outpaced other drugs, suggesting important gains in access to addiction treatments; growth was higher in states with higher pre-2014 overdose death rates.
CONCLUSIONS
Our results suggest Medicaid expansion benefited a population with unique needs, and that Medicaid expansion could be a valuable tool in addressing the opioid overdose epidemic.
Topics: Analgesics, Opioid; Drug Overdose; Humans; Medicaid; Opioid-Related Disorders; Patient Protection and Affordable Care Act; Prescription Drugs; United States
PubMed: 30629018
DOI: 10.1097/MLR.0000000000001054 -
American Journal of Public Health Dec 2020
Topics: Black or African American; Healthcare Disparities; Hispanic or Latino; Humans; Medicaid; Racism; United States
PubMed: 33058697
DOI: 10.2105/AJPH.2020.305946 -
Health Services Research Jun 2020To examine the associations between Medicaid expansion and nurse staffing ratios and hospital-wide readmission rates.
OBJECTIVE
To examine the associations between Medicaid expansion and nurse staffing ratios and hospital-wide readmission rates.
DATA SOURCES
Secondary data from the 2011-2016 Healthcare Cost Report Information System, the American Hospital Association Annual Survey, and the Hospital Compare data.
STUDY DESIGN
Difference-in-difference models are used to compare outcomes in hospitals located in states that expanded Medicaid with those located in nonexpansion states. The changes in nurse staffing ratios and hospital-wide readmission rates are calculated in each one of the postexpansion years (2014, 2015, and 2016), compared to pre-expansion.
PRINCIPAL FINDINGS
Results indicate that nurse staffing ratios increased, whereas hospital-wide readmission rates declined in expansion states relative to nonexpansion states. Nurse staffing ratios increased by 0.33, 0.42, and 0.46 registered nurses hours per adjusted patient days in 2014, 2015, and 2016 in hospitals located in expansion states, compared with hospitals in nonexpansion states after expansion. This increase was statistically significant (P < .001) in 2015 and 2016, but marginally significant (P = .016) in 2014. Hospital-wide readmission rates statistically significantly decreased by 9, 16, and 18 per 10 000 patients (P < .001) in 2014, 2015, and 2016, respectively, in expansion vs nonexpansion states hospitals after expansion.
CONCLUSIONS
Medicaid expansion was associated with gradually improved hospitals' nurse staffing ratios and hospital-wide readmission rates from 2014 through 2016. The continued monitoring of quality measures of hospitals can help assess the impact of Medicaid expansion over a longer period of time.
Topics: Hospital Administration; Hospital Bed Capacity; Humans; Medicaid; Nursing Staff, Hospital; Ownership; Patient Protection and Affordable Care Act; Patient Readmission; Personnel Staffing and Scheduling; Quality of Health Care; United States
PubMed: 32056212
DOI: 10.1111/1475-6773.13273 -
American Journal of Public Health Jun 2021To estimate the effect of Medicaid expansion on noncitizens' and citizens' participation in the Supplemental Security Income (SSI) program. The Affordable Care Act...
To estimate the effect of Medicaid expansion on noncitizens' and citizens' participation in the Supplemental Security Income (SSI) program. The Affordable Care Act (ACA) expanded Medicaid eligibility to cover low-income nonelderly adults without children, thus delinking their Medicaid participation from participation in the SSI program. Using data from the Social Security Administration for 2009 through 2018 (n = 1020 state-year observations) and the Current Population Survey for 2009 through 2019 (n = 78 776 respondents), we employed a difference-in-differences approach comparing SSI participation rates in US states that adopted Medicaid expansion with participation rates in nonexpansion states before and after ACA implementation. Medicaid expansion reduced the SSI (disability) participation of nonelderly noncitizens by 12% and of nonelderly citizens by 2%. Estimates remained robust with administrative and survey data. Medicaid expansion caused a substantially larger decline in the SSI participation of noncitizens, who face more restrictive SSI eligibility criteria, than of citizens. Our estimates suggest an annual savings of $619 million in the federal SSI cost because of the decline in SSI participation among noncitizens and citizens.
Topics: Adult; Emigrants and Immigrants; Humans; Medicaid; Middle Aged; Social Security; United States
PubMed: 33856886
DOI: 10.2105/AJPH.2021.306235 -
Journal of the American College of... Aug 2015
Topics: Anniversaries and Special Events; Humans; Medicaid; Medicare; United States
PubMed: 26271069
DOI: 10.1016/j.jacc.2015.06.1316 -
American Journal of Preventive Medicine Mar 2019In the U.S., youth enrolled in Medicaid experience more risk factors for suicide, such as mental illness, than youth not enrolled in Medicaid. To inform a national... (Comparative Study)
Comparative Study
INTRODUCTION
In the U.S., youth enrolled in Medicaid experience more risk factors for suicide, such as mental illness, than youth not enrolled in Medicaid. To inform a national suicide prevention strategy, this study presents suicide rates in a sample of youth enrolled in Medicaid and compares them with rates in the non-Medicaid population.
METHODS
Data sources were death certificate data matched with Medicaid data from 16 states, and the Web-based Injury Statistics Query and Reporting System. Deaths by suicide that occurred between 2009 and 2013 by youth aged 10 to 18 years were identified for Medicaid and non-Medicaid groups. Age-, gender-, and cause-specific mortality rates were calculated separately for both groups. Standardized mortality ratios were calculated to compare rates, and standardized mortality ratio 95% CIs were estimated with Poisson regressions. The data were analyzed in 2018.
RESULTS
A substantial proportion (39%) of the total number of deaths by suicide (N=4,045) in youth occurred among those enrolled in Medicaid. The overall suicide rate did not significantly differ between groups (standardized mortality ratio=0.96, 95% CI=0.90, 1.03). However, compared with the non-Medicaid group, the suicide rate in the Medicaid group was significantly higher among youth aged 10 to 14 years (standardized mortality ratio=1.28, 95% CI=1.11, 1.47), females (regardless of age; standardized mortality ratio=1.14, 95% CI=1.01, 1.29), and those who died by hanging (standardized mortality ratio=1.26, 95% CI=1.16, 1.38).
CONCLUSIONS
The population-based profile of suicide among youth enrolled in Medicaid differs from the profile of youth not enrolled in Medicaid, confirming the importance of Medicaid as a "boundaried" suicide prevention setting.
Topics: Adolescent; Age Distribution; Cause of Death; Child; Female; Humans; Male; Medicaid; Sex Distribution; Suicide; United States
PubMed: 30661887
DOI: 10.1016/j.amepre.2018.10.008