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Ethnicity & Disease 2021To identify ICD-10-CM diagnostic codes associated with the social determinants of health (SDOH), determine frequency of use of the code for homelessness across time, and...
OBJECTIVES
To identify ICD-10-CM diagnostic codes associated with the social determinants of health (SDOH), determine frequency of use of the code for homelessness across time, and examine the frequency of interrupted periods of Medicaid eligibility (ie, Medicaid churn) for beneficiaries with and without this code.
DESIGN
Retrospective data analyses of New York State (NYS) Medicaid claims data for years 2006-2017 to determine reliable indicators of SDOH hypothesized to affect Medicaid churn, and for years 2016-2017 to examine frequency of Medicaid churn among patients with and without an indicator for homelessness.
MAIN OUTCOME MEASURES
Any interruption in the eligibility for Medicaid insurance (Medicaid churn), assessed via client identification numbers (CIN) for continuity.
METHODS
Analyses were conducted to assess the frequency of use and pattern of New York State Medicaid claims submission for SDOH codes. Analyses were conducted for Medicaid claims submitted for years 2016-2017 for Medicaid patients with and without a homeless code (ie, ICD-10-CM Z59.0) in 2017.
RESULTS
ICD-9-CM / ICD-10-CM codes for lack of housing / homelessness demonstrated linear reliability over time (ie, for years 2006-2017) with increased usage. In 2016-2017, 22.9% of New York Medicaid patients with a homelessness code in 2017 experienced at least one interruption of Medicaid eligibility, while 18.8% of Medicaid patients without a homelessness code experienced Medicaid churn.
CONCLUSIONS
Medicaid policies would do well to take into consideration the barriers to continued enrollment for the Medicaid population. Measures ought to be enacted to reduce Medicaid churn, especially for individuals experiencing homelessness.
Topics: Ill-Housed Persons; Humans; Medicaid; Reproducibility of Results; Retrospective Studies; Social Problems; United States
PubMed: 33519159
DOI: 10.18865/ed.31.1.89 -
The Journal of Law, Medicine & Ethics :... 2022The proposed national PrEP program would serve people who are uninsured as well as those enrolled in Medicaid. In this article, the authors propose a set of... (Review)
Review
The proposed national PrEP program would serve people who are uninsured as well as those enrolled in Medicaid. In this article, the authors propose a set of recommendations for the proposed program's implementers as well as state Medicaid agencies and Medicaid managed care organizations to ensure PrEP access for people enrolled in Medicaid, addressing gaps without undermining the important role of the Medicaid program in covering and promoting PrEP.
Topics: Humans; Managed Care Programs; Medicaid; Medically Uninsured; State Government; United States
PubMed: 35902082
DOI: 10.1017/jme.2022.38 -
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 -
Health Services Research Dec 2021To examine the association between the generosity of Medicaid home- and community-based services (HCBS) and the likelihood of community discharge among Medicare-Medicaid...
OBJECTIVE
To examine the association between the generosity of Medicaid home- and community-based services (HCBS) and the likelihood of community discharge among Medicare-Medicaid dually enrolled older adults who were newly admitted to skilled nursing facilities (SNFs).
DATA SOURCES
National datasets, including Medicare Master Beneficiary Summary File (MBSF), Medicare Provider and Analysis Review (MedPAR), Medicaid Analytic eXtract (MAX), minimum data set (MDS), and publicly available data at the SNF or county level, were linked.
STUDY DESIGN
We measured Medicaid HCBS generosity by its breadth and intensity and described their variation at the county level. A set of linear probability models with SNF fixed effects were estimated to characterize the association between HCBS generosity and likelihood of community discharge from SNFs. We further stratified the analyses by the type of index hospitalizations (medical vs surgical events), age group, and the Medicaid cost-sharing policy for SNF services.
DATA EXTRACTION METHODS
The final analytical sample included 224 229 community-dwelling dually enrolled older duals who were newly admitted to SNFs after an acute inpatient event between October 1, 2010, and September 30, 2013.
PRINCIPAL FINDINGS
We observed substantial cross-sectional and over-time variations in HCBS breadth and intensity. Regression results indicate that on average, a 10 percentage-point increase in HCBS breadth was associated with a 0.7 percentage-point increase (P < 0.01) in the likelihood of community discharge. Such relationship could be modified by individual factors and state policies: significant effects of HCBS breadth were detected among medical patients (0.7 percentage-point, P < 0.05), individuals aged older than 85 (1.5 percentage-point, P < 0.01), and states with and without lesser-of policies (0.5 and 2.3 percentage-point, respectively, P < 0.05). No significant relationship between HCBS intensity and community discharge was detected.
CONCLUSIONS
Higher Medicaid HCBS breadth but not intensity was associated with a greater likelihood of community discharge, and such relationship could be modified by individual factors and state policies.
Topics: Aged; Aged, 80 and over; Community Health Services; Cross-Sectional Studies; Dual MEDICAID MEDICARE Eligibility; Female; Home Care Services; Hospitalization; Humans; Male; Medicaid; Medicare; Patient Discharge; Skilled Nursing Facilities; United States
PubMed: 34145567
DOI: 10.1111/1475-6773.13690 -
American Journal of Public Health Dec 2021
Topics: COVID-19; Child; Children's Health Insurance Program; Eligibility Determination; Humans; Insurance Coverage; Medicaid; SARS-CoV-2; United States
PubMed: 34878874
DOI: 10.2105/AJPH.2021.306550 -
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 -
Contraception Mar 2021Medicaid expansion increased access to care, but longitudinal patterns of contraception use after the Medicaid expansion have not been described.
INTRODUCTION
Medicaid expansion increased access to care, but longitudinal patterns of contraception use after the Medicaid expansion have not been described.
METHODS
We evaluated the effects of Medicaid expansion on the amount and type of contraceptive prescriptions using the Medicaid State Utilization Dataset.
RESULTS
Overall long-acting reversible contraception (LARC) use increased in both expansion and non-expansion states. In a difference-in-differences analysis, states that expanded Medicaid had no appreciable increase in per-capita prescription rates of LARC (p = 0.26) or short-acting hormonal contraception (p = 0.09) when compared to nonexpansion states.
DISCUSSION
The Medicaid expansion was not associated with a change in per-capita LARC or short-acting hormonal contraception use.
Topics: Contraception; Humans; Long-Acting Reversible Contraception; Medicaid; Prescriptions; United States
PubMed: 33212032
DOI: 10.1016/j.contraception.2020.11.005 -
American Journal of Public Health Apr 2021
Topics: COVID-19; Emergencies; Health Care Reform; Humans; Insurance Coverage; Insurance, Health; Medicaid; Patient Protection and Affordable Care Act; United States
PubMed: 33507804
DOI: 10.2105/AJPH.2020.306083 -
JAMA Jul 2021Medical debt is an increasing concern in the US, yet there is limited understanding of the amount and distribution of medical debt, and its association with health care...
IMPORTANCE
Medical debt is an increasing concern in the US, yet there is limited understanding of the amount and distribution of medical debt, and its association with health care policies.
OBJECTIVE
To measure the amount of medical debt nationally and by geographic region and income group and its association with Medicaid expansion under the Affordable Care Act.
DESIGN, SETTING, AND PARTICIPANTS
Data on medical debt in collections were obtained from a nationally representative 10% panel of consumer credit reports between January 2009 and June 2020 (reflecting care provided prior to the COVID-19 pandemic). Income data were obtained from the 2014-2018 American Community Survey. The sample consisted of 4.1 billion person-month observations (nearly 40 million unique individuals). These data were used to estimate the amount of medical debt (nationally and by geographic region and zip code income decile) and to examine the association between Medicaid expansion and medical debt (overall and by income group).
EXPOSURES
Geographic region (US Census region), income group (zip code income decile), and state Medicaid expansion status.
MAIN OUTCOMES AND MEASURES
The stock (all unpaid debt listed on credit reports) and flow (new debt listed on credit reports during the preceding 12 months) of medical debt in collections that can be collected on by debt collectors.
RESULTS
In June 2020, an estimated 17.8% of individuals had medical debt (13.0% accrued debt during the prior year), and the mean amount was $429 ($311 accrued during the prior year). The mean stock of medical debt was highest in the South and lowest in the Northeast ($616 vs $167; difference, $448 [95% CI, $435-$462]) and higher in poor than in rich zip code income deciles ($677 vs $126; difference, $551 [95% CI, $520-$581]). Between 2013 and 2020, the states that expanded Medicaid in 2014 experienced a decline in the mean flow of medical debt that was 34.0 percentage points (95% CI, 18.5-49.4 percentage points) greater (from $330 to $175) than the states that did not expand Medicaid (from $613 to $550). In the expansion states, the gap in the mean flow of medical debt between the lowest and highest zip code income deciles decreased by $145 (95% CI, $95-$194) while the gap increased by $218 (95% CI, $163-$273) in the nonexpansion states.
CONCLUSIONS AND RELEVANCE
This study provides an estimate of the amount of medical debt in collections in the US based on consumer credit reports from January 2009 to June 2020, reflecting care delivered prior to the COVID-19 pandemic, and suggests that the amount of medical debt was highest among individuals living in the South and in lower-income communities. However, further study is needed regarding debt related to COVID-19.
Topics: Financing, Personal; Health Expenditures; Healthcare Disparities; Humans; Income; Insurance, Health; Medicaid; Medically Uninsured; Social Determinants of Health; United States
PubMed: 34283184
DOI: 10.1001/jama.2021.8694 -
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