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Medical Care Sep 2022Disparities in access to care between non-Hispanic White and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) patients are often attributed to higher...
BACKGROUND
Disparities in access to care between non-Hispanic White and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) patients are often attributed to higher uninsurance rates among AANHPI patients. Less is known about variation among individuals with Medicaid health insurance coverage and among AANHPI subgroups.
OBJECTIVE
The objective of this study was to examine differences in access to care between White and AANHPI adult Medicaid beneficiaries, both in the aggregate and disaggregated into 9 ethnic subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian, Native Hawaiian, and Pacific Islander).
RESEARCH DESIGN
Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems data (2014-2015), a cross-sectional survey representative of all Medicaid beneficiaries.
SUBJECTS
A total of 126,728 White and 10,089 AANHPI Medicaid beneficiaries were included.
MEASURES
The study outcomes were: (1) having a usual source of care; and (2) reporting a health center or clinic as the usual site of care. Multivariable linear probability models assessed the relationship between race/ethnic subgroup and our outcomes, adjusting for sociodemographic characteristics and health status.
RESULTS
Compared with White beneficiaries, Korean beneficiaries were significantly less likely to report having a usual source of care [difference=-8.9 percentage points (PP), P =0.01], and Chinese (difference=8.4 PP, P =0.001), Native Hawaiian (difference=25.8 PP, P <0.001), and Pacific Islander (difference=22.2 PP, P =0.001) beneficiaries were significantly more likely to report a health center or clinic as their usual site of care.
CONCLUSIONS
Despite similar health insurance coverage, significant differences in access to care remain between White and AANHPI Medicaid beneficiaries. Disaggregated AANHPI data may reveal important variation in access to care and inform more targeted public policies.
Topics: Adult; Humans; Cross-Sectional Studies; Medicaid; United States; Asian American Native Hawaiian and Pacific Islander
PubMed: 35293884
DOI: 10.1097/MLR.0000000000001709 -
Medical Care Jun 2020Medicaid beneficiaries with diabetes have complex care needs. The Accountable Care Communities (ACC) Program is a practice-level intervention implemented by...
BACKGROUND/OBJECTIVES
Medicaid beneficiaries with diabetes have complex care needs. The Accountable Care Communities (ACC) Program is a practice-level intervention implemented by UnitedHealthcare to improve care for Medicaid beneficiaries. We examined changes in costs and utilization for Medicaid beneficiaries with diabetes assigned to ACC versus usual care practices.
RESEARCH DESIGN
Interrupted time series with concurrent control group analysis, at the person-month level. The ACC was implemented in 14 states, and we selected comparison non-ACC practices from those states to control for state-level variation in Medicaid program. We adjusted the models for age, sex, race/ethnicity, comorbidities, seasonality, and state-by-year fixed effects. We examined the difference between ACC and non-ACC practices in changes in the time trends of expenditures and hospital and emergency room utilization, for the 4 largest categories of Medicaid eligibility [Temporary Assistance to Needy Families, Supplemental Security Income (without Medicare), Expansion, Dual-Eligible].
SUBJECTS/MEASURES
Eligibility and claims data from Medicaid adults with diabetes from 14 states between 2010 and 2016, before and after ACC implementation.
RESULTS
Analyses included 1,200,460 person-months from 66,450 Medicaid patients with diabetes. ACC implementation was not associated with significant changes in outcome time trends, relative to comparators, for all Medicaid categories.
CONCLUSIONS
Medicaid patients assigned to ACC practices had no changes in cost or utilization over 3 years of follow-up, compared with patients assigned to non-ACC practices. The ACC program may not reduce costs or utilization for Medicaid patients with diabetes.
Topics: Accountable Care Organizations; Adult; Aged; Diabetes Mellitus; Female; Health Care Costs; Humans; Male; Medicaid; Middle Aged; Patient Acceptance of Health Care; United States; Young Adult
PubMed: 32412952
DOI: 10.1097/MLR.0000000000001318 -
American Journal of Public Health Jun 2017To examine the health insurance coverage options for Medicaid expansion enrollees if the Affordable Care Act (ACA) is repealed, using evidence from Ohio, where more than...
OBJECTIVES
To examine the health insurance coverage options for Medicaid expansion enrollees if the Affordable Care Act (ACA) is repealed, using evidence from Ohio, where more than half a million adults have enrolled in the state's Medicaid program through the ACA expansion.
METHODS
The Ohio Medicaid Assessment Survey interviewed 42 000 households in 2015. We report data from a unique battery of questions designed to identify insurance coverage immediately prior to Medicaid enrollment.
RESULTS
Ninety-five percent of new Medicaid enrollees in Ohio did not have a private health insurance option immediately before enrollment. These new enrollees are predominantly older, low-income Whites with a high school education or less. Only 5% of new Medicaid enrollees were eligible for an employer-sponsored insurance plan to which they could potentially return in the case of repeal of the ACA.
CONCLUSIONS
The vast majority of Medicaid expansion enrollees would have no plausible pathway to obtaining private-sector insurance if the ACA were repealed. Demographic similarities between the expansion population and 2016 exit polls suggest that coverage losses would fall disproportionately on members of the winning Republican coalition.
Topics: Family Characteristics; Health Care Reform; Humans; Insurance Coverage; Insurance, Health; Medicaid; Ohio; Patient Protection and Affordable Care Act; Poverty; United States
PubMed: 28426315
DOI: 10.2105/AJPH.2017.303722 -
Health Care Financing ReviewThis article examines Medicaid's evolution over the last four decades in its role as a health insurer for low-income families, a source of health and long-term care...
This article examines Medicaid's evolution over the last four decades in its role as a health insurer for low-income families, a source of health and long-term care (LTC) coverage for people with disabilities, and as the supplement to Medicare for low-income aged and disabled Medicare beneficiaries. Medicaid's role and impact on each of these beneficiary groups is assessed.
Topics: Disabled Persons; History, 20th Century; Humans; Long-Term Care; Medicaid; Poverty; United States
PubMed: 17290638
DOI: No ID Found -
Journal of General Internal Medicine Apr 2021Medicaid, which provides health insurance to low-income Americans, is a joint federal-state partnership that manifests as 50 unique state programs. States have policy...
Medicaid, which provides health insurance to low-income Americans, is a joint federal-state partnership that manifests as 50 unique state programs. States have policy flexibility to design programs within federal parameters. However, Medicaid also requires funding flexibility to encourage states to maintain services during times of crisis when more people need Medicaid. Currently, Medicaid's funding formula, the Federal Medical Assistance Percentage (FMAP), adjusts federal spending by state levels of economic development but fails to adjust for nationwide recessions. During economic contractions, the federal government should use its ability to run budget deficits to reimburse states at higher rates in exchange for maintaining services. In turn, during economic expansions, states should shoulder relatively more costs of Medicaid. Although the current FMAP boost provided under the Families First Coronavirus Response Act has reduced strain on state Medicaid programs, it does not account for the severity of state-specific downturns and is limited to the current emergency. Instead of ad hoc, across-the-board FMAP boosts to respond to each crisis, Congress should pass legislation making automatic adjustments based on changes in state unemployment rates.
Topics: Budgets; COVID-19; Federal Government; Humans; Medicaid; SARS-CoV-2; United States
PubMed: 33483809
DOI: 10.1007/s11606-020-06457-y -
Journal of General Internal Medicine Feb 2019
Topics: Eligibility Determination; Health Personnel; Humans; Medicaid; Patient Advocacy; United States
PubMed: 30535749
DOI: 10.1007/s11606-018-4743-9 -
JAMA Network Open May 2020Medicaid expansion was widely expected to alleviate the financial stresses faced by hospitals by providing additional revenue in the form of Medicaid reimbursements from...
IMPORTANCE
Medicaid expansion was widely expected to alleviate the financial stresses faced by hospitals by providing additional revenue in the form of Medicaid reimbursements from patients previously receiving uncompensated care. Among nonprofit hospitals, which receive tax-exempt status in part because of their provision of uncompensated care, Medicaid expansion could have released hospital funds toward other community benefit activities.
OBJECTIVE
To examine changes in nonprofit hospital spending on community benefit activities after Medicaid expansion.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used difference-in-differences analysis of 1666 US nonprofit hospitals that filed Internal Revenue Service Form 990 Schedule H detailing their community benefit expenditures between 2011 and 2017. The analysis was conducted from February to September 2019.
EXPOSURES
State Medicaid expansion between 2011 and 2017.
MAIN OUTCOMES AND MEASURES
Percentage of hospital operating expenditures attributable to charity care and subsidized care, bad debt (ie, unreimbursed spending for care of patients who did not apply for charity care), unreimbursed Medicaid spending, noncare direct community spending, and total community benefit spending.
RESULTS
Of 1478 hospitals in the sample in 2011, nearly half (653 [44.2%]) were small hospitals with fewer than 100 beds, and nearly 70% of hospitals (1023 [69.2%]) were in urban areas. Among the 1666 nonprofit hospitals, Medicaid expansion was associated with a decrease in spending on charity care and subsidized care (-0.68 [95% CI, -0.99 to -0.37] percentage points from a baseline mean [SD] of 3.6% [4.0%] of total hospital expenditures; P < .001) and in bad debt (-0.17 [95% CI, -0.32 to -0.01] percentage points). There was an increase in unreimbursed spending attributable to caring for Medicaid patients (0.85 [95% CI, 0.60 to 1.10] percentage points; P = .04), which canceled out uncompensated care savings from the expansion. Noncare direct community expenditures decreased overall (-0.24 [95% CI, -0.48 to 0.00] percentage points; P = .049). Direct community expenditures remained more stable in small hospitals (-0.07 [95% CI, -0.20 to 0.05] percentage points; P =.26) compared with large hospitals (-0.37 [95% CI, -0.86 to 0.12] percentage points; P = .14) and in nonurban hospitals (0.02 [95% CI, -0.09 to 0.14] percentage points; P = .70) compared with urban hospitals (-0.36 [95% CI, -0.73 to 0.01] percentage points; P = .06).
CONCLUSIONS AND RELEVANCE
In this study, Medicaid expansion was associated with a decrease in nonprofit hospitals' burden of providing uncompensated care, but this financial relief was not redirected toward spending on other community benefits.
Topics: Economics, Hospital; Humans; Medicaid; Patient Protection and Affordable Care Act; State Government; Uncompensated Care; United States
PubMed: 32469411
DOI: 10.1001/jamanetworkopen.2020.5529 -
Health Care Financing Review 1995This overview summarizes issues addressed in this issue of the Health Care Financing Review, entitled "Medicaid and State Health Reform." Articles cover the following... (Review)
Review
This overview summarizes issues addressed in this issue of the Health Care Financing Review, entitled "Medicaid and State Health Reform." Articles cover the following topics: growth in the level of expenditures for Medicaid and creative financing strategies by States to manage these increases; section 1115 demonstration waivers; States' experiences with implementing approved section 1115 demonstrations; how section 1115 demonstration waivers fit into larger State health reform efforts; and other reform efforts in two States.
Topics: Centers for Medicare and Medicaid Services, U.S.; Eligibility Determination; Health Care Reform; Health Expenditures; Health Services Accessibility; Health Services Research; Medicaid; State Health Plans; United States
PubMed: 10142571
DOI: No ID Found -
Medical Care Research and Review : MCRR Oct 2019Using a novel data set from a major credit bureau, we examine the early effects of the Affordable Care Act Medicaid expansions on personal finance. We analyze less...
Using a novel data set from a major credit bureau, we examine the early effects of the Affordable Care Act Medicaid expansions on personal finance. We analyze less common events such as personal bankruptcy, and more common occurrences such as medical collection balances, and change in credit scores. We estimate triple-difference models that compare individual outcomes across counties that expanded Medicaid versus counties that did not, and across expansion counties that had more uninsured residents versus those with fewer. Results demonstrate financial improvements in states that expanded their Medicaid programs as measured by improved credit scores, reduced balances past due as a percent of total debt, reduced probability of a medical collection balance of $1,000 or more, reduced probability of having one or more recent medical bills go to collections, reduction in the probability of experiencing a new derogatory balance of any type, reduced probability of incurring a new derogatory balance equal to $1,000 or more, and a reduction in the probability of a new bankruptcy filing.
Topics: Financing, Personal; Health Policy; Humans; Insurance Coverage; Insurance, Health; Medicaid; Medically Uninsured; Models, Statistical; Patient Protection and Affordable Care Act; United States
PubMed: 28918678
DOI: 10.1177/1077558717725164 -
Health Services Research Jun 2018To design and test the validity of a method to identify homelessness among Medicaid enrollees using mailing address data.
OBJECTIVE
To design and test the validity of a method to identify homelessness among Medicaid enrollees using mailing address data.
DATA SOURCES/STUDY SETTING
Enrollment and claims data on Medicaid expansion enrollees in Hennepin and Ramsey counties who also provided self-reported information on their current housing situation in a psychosocial needs assessment.
STUDY DESIGN
Construction of address-based indicators and comparison with self-report data.
PRINCIPAL FINDINGS
Among 1,677 enrollees, 427 (25 percent) self-reported homelessness, of whom 328 (77 percent) had at least one positive address indicator. Depending on the type of addresses included in the indicator, sensitivity to detect self-reported homelessness ranged from 30 to 76 percent and specificity from 79 to 97 percent.
CONCLUSIONS
An address-based indicator can identify a large proportion of Medicaid enrollees who are experiencing homelessness. This approach may be of interest to researchers, states, and health systems attempting to identify homeless populations.
Topics: Ill-Housed Persons; Humans; Insurance Claim Review; Medicaid; Minnesota; Postal Service; United States; Urban Population
PubMed: 28670682
DOI: 10.1111/1475-6773.12738