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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 -
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 -
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 -
American Journal of Preventive Medicine Dec 2017This review summarizes the current literature for the prevalence and medical costs of noncommunicable chronic diseases among adult Medicaid beneficiaries to inform... (Review)
Review
INTRODUCTION
This review summarizes the current literature for the prevalence and medical costs of noncommunicable chronic diseases among adult Medicaid beneficiaries to inform future program design.
METHODS
The databases MEDLINE and CINAHL were searched in August 2016 using keywords, including Medicaid, health status, and healthcare cost, to identify original studies that were published during 2000-2016, examined Medicaid as an independent population group, examined prevalence or medical costs of chronic conditions, and included adults within the age group 18-64 years. The review and data extraction was conducted in Fall 2016-Spring 2017. Disease-related costs (costs specifically to treat the disease) and total costs (all-cause medical costs for a patient with the disease) are presented separately.
RESULTS
Among the 29 studies selected, prevalence estimates for enrollees aged 18-64 years were 8.8%-11.8% for heart disease, 17.2%-27.4% for hypertension, 16.8%-23.2% for hyperlipidemia, 7.5%-12.7% for diabetes, 9.5% for cancer, 7.8%-19.3% for asthma, 5.0%-22.3% for depression, and 55.7%-62.1% for one or more chronic conditions. Estimated annual per patient disease-related costs (2015 U.S. dollars) were $3,219-$4,674 for diabetes, $3,968-$6,491 for chronic obstructive pulmonary disease, and $989-$3,069 for asthma. Estimated hypertension-related costs were $687, but total costs per hypertensive beneficiary ranged much higher. Estimated total annual healthcare costs were $29,271-$51,937 per beneficiary with heart failure and $11,446-$20,585 per beneficiary with schizophrenia. Costs among beneficiaries with cancer were $29,384-$46,194 for the 6 months following diagnosis.
CONCLUSIONS
These findings could help inform the evaluation of interventions to prevent and manage noncommunicable chronic diseases and their potential to control costs among the vulnerable Medicaid population.
Topics: Adult; Chronic Disease; Cost of Illness; Female; Health Care Costs; Health Expenditures; Health Status; Humans; Male; Medicaid; Middle Aged; Prevalence; United States; Young Adult
PubMed: 29153115
DOI: 10.1016/j.amepre.2017.07.019 -
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 -
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 Oct 2017
Topics: Federal Government; Health Care Reform; Humans; Medicaid; Politics; United States
PubMed: 28902546
DOI: 10.2105/AJPH.2017.304014 -
Health Services Research Jun 2020To determine the association between Medicaid expansion and infant mortality rate (IMR) in the United States.
OBJECTIVE
To determine the association between Medicaid expansion and infant mortality rate (IMR) in the United States.
DATA SOURCES
State-level aggregate data on US IMR, race, and sex were abstracted from the US Center for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research.
STUDY DESIGN
The association between Medicaid expansion and IMR adjusted for race and sex was assessed with multiple linear regression models using difference-in-differences estimation and Huber-White robust standard errors.
PRINCIPAL FINDINGS
Difference-in-differences regression found no association between Medicaid expansion status and change in national IMR from 2010 to 2017 (Coef. = 0.04; 95% CI: -0.39, 0.46). However, among Hispanics, the program was found to be associated with reduction in IMR (Diff-in-Diff Coef. = -0.53; 95% CI: -1.02, -0.03).
CONCLUSIONS
Overall, the Affordable Care Act-induced Medicaid expansion was not associated with IMR reduction in expansion states relative to nonexpansion states. However, the program was associated with a significant IMR decline among Hispanics.
Topics: Humans; Infant; Infant Mortality; Medicaid; Patient Protection and Affordable Care Act; Sex Distribution; United States
PubMed: 32196658
DOI: 10.1111/1475-6773.13286 -
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