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Journal of the American Society of... Jun 2021Low-income individuals without health insurance have limited access to health care. Medicaid expansions may reduce kidney failure incidence by improving access to...
BACKGROUND
Low-income individuals without health insurance have limited access to health care. Medicaid expansions may reduce kidney failure incidence by improving access to chronic disease care.
METHODS
Using a difference-in-differences analysis, we examined the association between Medicaid expansion status under the Affordable Care Act (ACA) and the kidney failure incidence rate among all nonelderly adults, aged 19-64 years, in the United States, from 2012 through 2018. We compared changes in kidney failure incidence in states that implemented Medicaid expansions with concurrent changes in nonexpansion states during pre-expansion, early postexpansion (years 2 and 3 postexpansion), and later postexpansion (years 4 and 5 postexpansion).
RESULTS
The unadjusted kidney failure incidence rate increased in the early years of the study period in both expansion and nonexpansion states before stabilizing. After adjustment for population sociodemographic characteristics, Medicaid expansion status was associated with 2.20 fewer incident cases of kidney failure per million adults per quarter in the early postexpansion period (95% CI, -3.89 to -0.51) compared with nonexpansion status, a 3.07% relative reduction (95% CI, -5.43% to -0.72%). In the later postexpansion period, Medicaid expansion status was not associated with a statistically significant change in kidney failure incidence (-0.56 cases per million per quarter; 95% CI, -2.71 to 1.58) compared with nonexpansion status and the pre-expansion time period.
CONCLUSIONS
The ACA Medicaid expansion was associated with an initial reduction in kidney failure incidence among the entire, nonelderly, adult population in the United States; but the changes did not persist in the later postexpansion period. Further study is needed to determine the long-term association between Medicaid expansion and changes in kidney failure incidence.
Topics: Adult; Black or African American; Diabetes Complications; Female; Health Services Accessibility; Hispanic or Latino; Humans; Hypertension; Incidence; Male; Medicaid; Middle Aged; Patient Protection and Affordable Care Act; Poverty; Renal Insufficiency; United States; White People; Young Adult
PubMed: 33795426
DOI: 10.1681/ASN.2020101511 -
Ear, Nose, & Throat Journal Dec 2021The List of Excluded Individuals and Entities (LEIE) is a federally updated and available list of providers who have been excluded from participating from federal...
The List of Excluded Individuals and Entities (LEIE) is a federally updated and available list of providers who have been excluded from participating from federal healthcare programs. With over 40 year's worth of exclusion history, we were able to isolate and identify otolaryngologists who were excluded and the most common cause, albeit exceptionally rare, was revocation of their medical license due to negligence.
Topics: Humans; Malpractice; Medicaid; Medicare; Otolaryngologists; Professional Misconduct; United States
PubMed: 32520600
DOI: 10.1177/0145561320933040 -
Health Services Research Dec 2021To assess the use of Medicaid programs, including waivers, to address the needs of aging autistic individuals.
OBJECTIVE
To assess the use of Medicaid programs, including waivers, to address the needs of aging autistic individuals.
DATA SOURCES
We gathered data on Medicaid programs in place between 2004 and 2015 for 50 states and the District of Columbia from the Centers for Medicare and Medicaid Services website, by contacting state Medicaid administrators and advocacy groups, and by reviewing the Medicaid Analytic eXtract Waiver Crosswalk.
STUDY DESIGN
This retrospective analysis classified each Medicaid program and documented state changes over time in eligibility criteria: those serving autism spectrum disorder only, autism spectrum disorder or intellectual disability, and intellectual disability only.
DATA COLLECTION/EXTRACTION METHODS
We captured age and diagnosis eligibility criteria for Medicaid programs serving any of the three target groups.
PRINCIPAL FINDINGS
A total of 269 Medicaid programs met our criteria and most programs (51%) were 1915(c) waivers. The number of autism-specific 1915(c) waivers grew more than fivefold during the study period, outpacing increases in waivers serving individuals with intellectual disability.
CONCLUSIONS
States varied in their use of Medicaid to address the needs of the aging autism population. Further study of characteristics of states that changed their Medicaid programs, and of the health care use and outcomes associated with these changes, are needed to identify opportunities to replicate effective approaches to meeting the needs of this population.
Topics: Adult; Aged; Autism Spectrum Disorder; District of Columbia; Eligibility Determination; Health Policy; Humans; Intellectual Disability; Medicaid; Middle Aged; Program Evaluation; Retrospective Studies; State Government; United States
PubMed: 34251042
DOI: 10.1111/1475-6773.13671 -
Health Services Research Dec 2021To re-evaluate the effect of Medicaid on poverty using a poverty measure that accounts for health insurance needs and benefits and an evaluation approach that reflects...
OBJECTIVE
To re-evaluate the effect of Medicaid on poverty using a poverty measure that accounts for health insurance needs and benefits and an evaluation approach that reflects disparities in access to alternative coverage.
DATA SOURCES
The Current Population Survey (CPS) for calendar year 2015.
STUDY DESIGN
We estimate the effect of losing Medicaid on poverty, combining two previous approaches: (1) A propensity impact, which simulates a no-Medicaid counterfactual incorporating changes to health insurance and medical out-of-pocket spending, using the Supplemental Poverty Measure (SPM). This measure does not reflect a need for health care access nor how health benefits meet that need. (2) An accounting impact, which assumes that those losing Medicaid remain uninsured and does not incorporate any behavioral changes, using the health-inclusive poverty measure (HIPM). This measure includes a need for health insurance in the threshold and health insurance benefits in resources.
DATA COLLECTION/EXTRACTION METHODS
Not applicable.
PRINCIPAL FINDINGS
Using the propensity-matched approach, we attributed a 2.5 percentage point reduction in health-inclusive poverty among those younger than age 65 to the Medicaid program, between the 1.0-point SPM propensity-match impact and the 3.9-point HIPM accounting impact. Medicaid's antipoverty impact and HIPM-SPM differences are greater among those who would become uninsured. HIPM propensity-matched estimates reveal much larger impacts of Medicaid on poverty disparities linked to race/ethnicity and single parenthood than SPM-based propensity estimates.
CONCLUSIONS
Both the poverty measure and the method used to estimate the counterfactual make substantial, policy-relevant differences to estimates of Medicaid's impact on poverty. A poverty measure that fails to incorporate health insurance needs and benefits substantially underestimates Medicaid's effect. Failing to consider adjustments in insurance coverage and out-of-pocket spending substantially overestimates Medicaid's effect and underestimates its reduction of disparities.
Topics: Adolescent; Adult; Child; Child, Preschool; Female; Health Expenditures; Health Services; Humans; Infant; Infant, Newborn; Insurance Coverage; Insurance, Health; Male; Medicaid; Medically Uninsured; Middle Aged; Poverty; Surveys and Questionnaires; United States
PubMed: 34268740
DOI: 10.1111/1475-6773.13699 -
Cancer Reports (Hoboken, N.J.) Dec 2021Currently, little is known about the effect of the Patient Protection and Affordable Care Act's Medicaid expansion on care delivery and outcomes in cervical cancer.
BACKGROUND
Currently, little is known about the effect of the Patient Protection and Affordable Care Act's Medicaid expansion on care delivery and outcomes in cervical cancer.
AIM
We evaluated whether Medicaid expansion was associated with changes in insurance status, stage at diagnosis, timely treatment, and survival outcomes in cervical cancer.
METHODS AND RESULTS
Using the National Cancer Database, we performed a difference-in-differences (DID) cross-sectional analysis to compare insurance status, stage at diagnosis, timely treatment, and survival outcomes among cervical cancer patients residing in Medicaid expansion and nonexpansion states before (2011-2013) and after (2014-2015) Medicaid expansion. January 1, 2014 was used as the timepoint for Medicaid expansion. The primary outcomes of interest were insurance status, stage at diagnosis, treatment within 30 and 90 days of diagnosis, and overall survival. Fifteen thousand two hundred sixty-five patients (median age 50) were included: 42% from Medicaid expansion and 58% from nonexpansion states. Medicaid expansion was significantly associated with increased Medicaid coverage (adjusted DID = 11.0%, 95%CI = 8.2, 13.8, p < .01) and decreased rates of uninsured (adjusted DID = -3.0%, 95%CI = -5.2, -0.8, p < .01) among patients in expansion states compared with non-expansion states. However, Medicaid expansion was not associated with any significant changes in cancer stage at diagnosis or timely treatment. There was no significant change in survival from the pre- to post-expansion period in either expansion or nonexpansion states, and no significant differences between the two (DID-HR = 0.95, 95%CI = 0.83, 1.09, p = .48).
CONCLUSION
Although Medicaid expansion was associated with an increase in Medicaid coverage and decrease in uninsured among patients with cervical cancer, the effects of increased coverage on diagnosis and treatment outcomes may have yet to unfold. Future studies, including longer follow-up are necessary to understand the effects of Medicaid expansion.
Topics: Adult; Combined Modality Therapy; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Insurance Coverage; Medicaid; Medically Uninsured; Middle Aged; Neoplasm Staging; Patient Protection and Affordable Care Act; Survival Rate; United States; Uterine Cervical Neoplasms
PubMed: 33934574
DOI: 10.1002/cnr2.1407 -
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 -
Journal of Health Politics, Policy and... Jun 2021The United States is facing a maternal health crisis with rising rates of maternal mortality and morbidity and stark disparities in maternal outcomes by race and...
The United States is facing a maternal health crisis with rising rates of maternal mortality and morbidity and stark disparities in maternal outcomes by race and socioeconomic status. Among the efforts to address this issue, one policy proposal is gaining particular traction: extending the period of Medicaid eligibility for pregnant women beyond 60 days after childbirth. The authors examine the legislative and regulatory pathways most readily available for extending postpartum Medicaid, including their relative political, economic, and public health trade-offs. They also review the state and federal policy activity to date and discuss the impact of the COVID-19 pandemic on the prospects for policy change.
Topics: COVID-19; Female; Humans; Insurance Coverage; Maternal Health; Medicaid; Policy; Postpartum Period; Pregnancy; United States
PubMed: 33647969
DOI: 10.1215/03616878-8893585 -
Translational Behavioral Medicine Apr 2024Most early maternal deaths are preventable, with many occurring within the first year postpartum (we use the terms "maternal" and "mother" broadly to include all...
Most early maternal deaths are preventable, with many occurring within the first year postpartum (we use the terms "maternal" and "mother" broadly to include all individuals who experience pregnancy or postpartum and frame our recognition of need and policy recommendations in gender-neutral terms. To acknowledge limitations inherent in existing policy and the composition of samples in prior research, we use the term "women" when applicable). Black, Hispanic, and Native American individuals are at the most significant risk of pregnancy-related death. They are more commonly covered by Medicaid, highlighting likely contributions of structural racism and consequent social inequities. State-level length and eligibility requirements for postpartum Medicaid vary considerably. Federal policy requires 60 days of Medicaid continuation postpartum, risking healthcare coverage loss during a critical period of heightened morbidity and mortality risk. This policy position paper aims to outline urgent risks to maternal health, detail existing federal and state-level efforts, summarize proposed legislation addressing the issue, and offer policy recommendations for legislative consideration and future study. A team of maternal health researchers and clinicians reviewed and summarized recent research and current policy pertaining to postpartum Medicaid continuation coverage, proposing policy solutions to address this critical issue. Multiple legislative avenues currently exist to support and advance relevant policy to improve and sustain maternal health for those receiving Medicaid during pregnancy, including legislation aligned with the Biden-Harris Maternal Health Blueprint, state-focused options via the American Rescue Plan of 2021 (Public Law 117-2), and recently proposed acts (HR3407, S1542) which were last reintroduced in 2021. Recommendations include (i) reintroducing previously considered legislation requiring states to provide 12 months of continuous postpartum coverage, regardless of pregnancy outcome, and (ii) enacting a revised, permanent federal mandate equalizing Medicaid eligibility across states to ensure consistent access to postpartum healthcare offerings nationwide.
Topics: Humans; Medicaid; United States; Female; Postpartum Period; Pregnancy; Child Health; Maternal Health; Health Policy
PubMed: 38417096
DOI: 10.1093/tbm/ibae007 -
Lancet (London, England) Jan 2020
Topics: Insurance, Health; Medicaid; Patient Protection and Affordable Care Act; Politics; Preexisting Condition Coverage; United States
PubMed: 31954443
DOI: 10.1016/S0140-6736(20)30100-8 -
Health Affairs (Project Hope) Sep 2019
Topics: Medicaid; Population Health; Residence Characteristics; United States
PubMed: 31479365
DOI: 10.1377/hlthaff.2019.01015