-
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 -
JAMA Health Forum May 2024Medicaid beneficiaries must periodically redemonstrate their eligibility in a process that is called renewal, redetermination, or recertification. The number and...
IMPORTANCE
Medicaid beneficiaries must periodically redemonstrate their eligibility in a process that is called renewal, redetermination, or recertification. The number and characteristics of people who lose Medicaid coverage due to renewal requirements are not known.
OBJECTIVE
To measure the proportion of people who lose Medicaid coverage at the renewal deadline, overall and by enrollee characteristics, and time until regaining Medicaid coverage among those losing coverage at the deadline.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study tracked the duration of Medicaid enrollment among Wisconsin Medicaid enrollees with a 12-month renewal deadline. Data were collected for all nonelderly (aged <65 years) new enrollees from January 2016 through January 2018, except those enrolled due to disability or pregnancy. Individuals were followed through January 2020 to provide at least 24 months of data on each enrollment spell. Data were analyzed from August 2023 to February 2024.
MAIN OUTCOMES AND MEASURES
The primary outcome was coverage loss during the renewal process, defined as a loss in Medicaid coverage from month 12 to month 13 for people who were still enrolled at the start of month 12. Secondary outcomes included coverage loss prior to the renewal deadline and the duration of the gap in Medicaid coverage among those who lost coverage during the renewal process.
RESULTS
The study sample included 684 245 Medicaid enrollment spells across 586 044 people (51% female and 47% children 18 years or younger). Among enrollees, 20% lost Medicaid coverage at the renewal deadline. Of those who lost coverage, 37% regained Medicaid coverage within 6 months, and an additional 10% regained coverage within 12 months. Children younger than 12 years and people with more Medicaid-covered health care (top quartile of Medicaid-covered health care costs during the first 6 months of enrollment) were less likely than other groups to lose coverage during the renewal process (15% and 6% lost coverage at renewal, respectively) and more likely to regain Medicaid quickly. Personal characteristics such as gender and race and ethnicity remained associated with the risk of losing Medicaid at the renewal deadline after adjustment for baseline household income, enrollment group, and past use of Medicaid services.
CONCLUSIONS AND RELEVANCE
In this cohort study, the risk of coverage loss during the Medicaid renewal process was associated with age, past use of care, and other personal characteristics. These findings shed light on how renewal requirements shape access to Medicaid.
Topics: Humans; Medicaid; United States; Female; Male; Adult; Insurance Coverage; Eligibility Determination; Middle Aged; Wisconsin; Cohort Studies; Adolescent; Young Adult; Child
PubMed: 38700852
DOI: 10.1001/jamahealthforum.2024.0839 -
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 -
The American Journal of Nursing Nov 2021Opportunities for nurses to spearhead these initiatives.
Opportunities for nurses to spearhead these initiatives.
Topics: Community Networks; Health Status Disparities; Humans; Medicaid; Nurses, Community Health; Safety-net Providers; Social Determinants of Health; United States
PubMed: 34673686
DOI: 10.1097/01.NAJ.0000798976.84714.86 -
Health Services Research Aug 2021To estimate the incremental associations between the implementation of expanded Medicaid eligibility and prerelease Medicaid enrollment assistance on Medicaid enrollment...
OBJECTIVE
To estimate the incremental associations between the implementation of expanded Medicaid eligibility and prerelease Medicaid enrollment assistance on Medicaid enrollment for recently incarcerated adults.
DATA SOURCES/STUDY SETTING
Data include person-level merged, longitudinal data from the Wisconsin Department of Corrections and the Wisconsin Medicaid program from 2013 to 2015.
STUDY DESIGN
We use an interrupted time series design to estimate the association between each of two natural experiments and Medicaid enrollment for recently incarcerated adults. First, in April 2014 the Wisconsin Medicaid program expanded eligibility to include all adults with income at or below 100% of the federal poverty level. Second, in January 2015, the Wisconsin Department of Corrections implemented prerelease Medicaid enrollment assistance at all state correctional facilities.
DATA COLLECTION/EXTRACTION METHODS
We collected Medicaid enrollment, and state prison administrative and risk assessment data for all nonelderly adults incarcerated by the state who were released between January 2013 and December 2015. The full sample includes 24 235 individuals. Adults with a history of substance use comprise our secondary sample. This sample includes 12 877 individuals. The primary study outcome is Medicaid enrollment within the month of release.
PRINCIPAL FINDINGS
Medicaid enrollment in the month of release from state prison grew from 8 percent of adults at baseline to 36 percent after the eligibility expansion (P-value < .01) and to 61 percent (P-value < .01) after the introduction of enrollment assistance. Results were similar for adults with a history of substance use. Black adults were 3.5 percentage points more likely to be enrolled in Medicaid in the month of release than White adults (P-value < .01).
CONCLUSIONS
Medicaid eligibility and prerelease enrollment assistance are associated with increased Medicaid enrollment upon release from prison. States should consider these two policies as potential tools for improving access to timely health care as individuals transition from prison to community.
Topics: Eligibility Determination; Humans; Interrupted Time Series Analysis; Medicaid; Poverty; Prisoners; United States; Wisconsin
PubMed: 33565117
DOI: 10.1111/1475-6773.13634 -
Health Affairs (Project Hope) Jan 2020
Topics: Deductibles and Coinsurance; Eligibility Determination; Health Expenditures; Humans; Medicaid; Medicare; Patient Care Bundles; United States
PubMed: 31905057
DOI: 10.1377/hlthaff.2019.01727 -
Pediatric Radiology May 2023In terms of number of beneficiaries, Medicaid is the single largest health insurance program in the US. Along with the Children's Health Insurance Program (CHIP),... (Review)
Review
In terms of number of beneficiaries, Medicaid is the single largest health insurance program in the US. Along with the Children's Health Insurance Program (CHIP), Medicaid covers nearly half of all births and provides health insurance to nearly half of the children in the country. This article provides a broad introduction to Medicaid and CHIP for the pediatric radiologist with a special focus on topics relevant to pediatric imaging and population health. This includes an overview of Medicaid's structure and eligibility criteria and how it differs from Medicare. The paper examines the means-tested programs within the context of pediatric radiology, reviewing pertinent topics such as the rise of Medicaid managed care plans, Medicaid expansion, the effects of Medicaid on child health, and COVID-19. Beyond the basics of benefits coverage, pediatric radiologists should understand how Medicaid and CHIP financing and reimbursement affect the ability of pediatric practices, radiology groups, and hospitals to provide services for children in a sustainable manner. The paper concludes with an analysis of future opportunities for Medicaid and CHIP.
Topics: Aged; Child; Humans; United States; Medicaid; Child Health; Child Health Services; Medicare; COVID-19; Insurance, Health; Radiologists
PubMed: 36879048
DOI: 10.1007/s00247-023-05640-7 -
The New England Journal of Medicine Dec 2020
Topics: Adolescent; COVID-19; Child; Child Health Services; Children's Health Insurance Program; Health Equity; Humans; Insurance Coverage; Insurance, Health, Reimbursement; Medicaid; United States
PubMed: 33369365
DOI: 10.1056/NEJMp2030646 -
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 -
Health Affairs (Project Hope) Nov 2019
Topics: Cost of Illness; Family Characteristics; Food Supply; Global Health; Health Policy; Medicaid; Patient Protection and Affordable Care Act; United States
PubMed: 31682497
DOI: 10.1377/hlthaff.2019.01402