-
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 -
Health Affairs (Project Hope) Nov 2020
Topics: Health Expenditures; Humans; Medicaid; United States
PubMed: 33136499
DOI: 10.1377/hlthaff.2020.01945 -
Women's Health Issues : Official... 2020This study explores the effect of Medicaid expansion under the Affordable Care Act on the maternal mortality ratio in the United States.
OBJECTIVES
This study explores the effect of Medicaid expansion under the Affordable Care Act on the maternal mortality ratio in the United States.
METHODS
A difference-in-differences research design was used to analyze the effect of Medicaid expansion on maternal mortality. Maternal mortality was defined with and without late maternal deaths, to substantiate the contribution of increased preconception and postpartum insurance coverage. To examine whether there was a racial difference in the effects of Medicaid expansion, models were stratified by the woman's race/ethnicity for non-Hispanic Black women, non-Hispanic White women, and Hispanic women.
RESULTS
Medicaid expansion was significantly associated with lower maternal mortality by 7.01 maternal deaths per 100,000 live births (p = .002) relative to nonexpansion states. When maternal mortality definitions excluded late maternal deaths, Medicaid expansion was significantly associated with a decrease in maternal mortality per 100,000 live births by 6.65 (p = .004) relative to nonexpansion states. Medicaid expansion effects were concentrated among non-Hispanic Black mothers, suggesting that expansion could be contributing to decreasing racial disparities in maternal mortality.
CONCLUSIONS
Although maternal mortality overall continues to increase in the United States, the maternal mortality ratio among Medicaid expansion states has increased much less compared with nonexpansion states. These results suggest that Medicaid expansion could be contributing to a relative decrease in the maternal mortality ratio in the United States. The decrease in the maternal mortality ratio is greater when maternal mortality estimates include late maternal deaths, suggesting that sustained insurance coverage after childbirth as well as improved preconception coverage could be contributing to decreasing maternal mortality.
Topics: Black or African American; Female; Hispanic or Latino; Humans; Insurance Coverage; Maternal Mortality; Medicaid; Patient Protection and Affordable Care Act; United States; White People
PubMed: 32111417
DOI: 10.1016/j.whi.2020.01.005 -
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) Mar 2024
Topics: United States; Humans; Medicaid; Nursing Homes; Physicians
PubMed: 38437613
DOI: 10.1377/hlthaff.2024.00221 -
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 -
Journal of the American Podiatric... 2023Despite national and international guidelines supporting podiatric services as a means of prevention for lower-extremity complications, especially in at-risk... (Review)
Review
BACKGROUND
Despite national and international guidelines supporting podiatric services as a means of prevention for lower-extremity complications, especially in at-risk individuals, current coverage for these services under the US Medicaid program is not universal. The vast differences between state Medicaid programs regarding reimbursable foot care services is confusing and potentially serves as a barrier for the most vulnerable populations to receive preventative services. This article provides a brief discussion of "routine" podiatric services from a clinical perspective and provides a review of state Medicaid programs including optional services (eg, podiatric coverage).
METHODS
Using data from a national survey of state Medicaid programs, we present and discuss common Medicaid coverage schemes for routine foot care provided by podiatric physicians.
RESULTS
Analysis demonstrated that states vary dramatically in basic descriptions of preventive foot care, levels of coverage, eligibility, and methods of documenting coverage details.
CONCLUSIONS
The authors recommend bringing Medicaid in line with other federal health programs and including podiatric physicians in the definition of "physician" for coverage purposes. States should move away from describing preventative services as "routine" and choose language that more accurately reflects the true nature and purpose of the care.
Topics: United States; Humans; Medicaid; Insurance Coverage
PubMed: 37463184
DOI: 10.7547/22-050 -
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 -
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