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American Journal of Public Health Nov 2014We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled...
We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled (CAMOD) adults and younger adult admissions to nursing homes in the United States during 2001 through 2008, with control for facility and market characteristics and secular trends. We found that increased CAMOD Medicaid HCBS spending at the local level is associated with decreased admissions of younger adults to nursing homes. Our findings suggest that states' efforts to expand HCBS for this population should continue.
Topics: Age Factors; Community Health Services; Home Care Services; Humans; Medicaid; Middle Aged; Nursing Homes; United States
PubMed: 25211711
DOI: 10.2105/AJPH.2014.302144 -
Pediatrics Apr 2018To describe incidence, health care use, and cost trends for infants with neonatal abstinence syndrome (NAS) who are covered by Medicaid compared with other infants.
OBJECTIVES
To describe incidence, health care use, and cost trends for infants with neonatal abstinence syndrome (NAS) who are covered by Medicaid compared with other infants.
METHODS
We used 2004-2014 hospital birth data from the National Inpatient Sample, a nationally representative sample of hospital discharges in the United States ( = 13 102 793). Characteristics and trends among births impacted by NAS were examined by using univariate statistics and logistic regression.
RESULTS
Medicaid covered 73.7% of NAS-related births in 2004 (95% confidence interval [CI], 68.9%-77.9%) and 82.0% of NAS-related births in 2014 (95% CI, 80.5%-83.5%). Among infants covered by Medicaid, NAS incidence increased more than fivefold during our study period, from 2.8 per 1000 births (95% CI, 2.1-3.6) in 2004 to 14.4 per 1000 births (95% CI, 12.9-15.8) in 2014. Infants with NAS who were covered by Medicaid were significantly more likely to be transferred to another hospital and have a longer length of stay than infants without NAS who were enrolled in Medicaid or infants with NAS who were covered by private insurance. Adjusting for inflation, total hospital costs for NAS births that were covered by Medicaid increased from $65.4 million in 2004 to $462 million in 2014. The proportion of neonatal hospital costs due to NAS increased from 1.6% in 2004 to 6.7% in 2014 among births that were covered by Medicaid.
CONCLUSIONS
The number of Medicaid-financed births that are impacted by NAS has risen substantially and totaled $462 million in hospital costs in 2014. Improving affordable health insurance coverage for low-income women before pregnancy would expand access to substance use disorder treatment and could reduce NAS-related morbidity and costs.
Topics: Cross-Sectional Studies; Female; Hospital Costs; Humans; Incidence; Infant, Newborn; Male; Medicaid; Neonatal Abstinence Syndrome; United States
PubMed: 29572288
DOI: 10.1542/peds.2017-3520 -
Value in Health : the Journal of the... Jun 2018New direct-acting antivirals (DAAs) can cure chronic hepatitis C virus (HCV) infection. High DAA prices combined with a large number of patients needing treatment may...
BACKGROUND
New direct-acting antivirals (DAAs) can cure chronic hepatitis C virus (HCV) infection. High DAA prices combined with a large number of patients needing treatment may pose substantial economic burden on health systems.
OBJECTIVES
To examine Medicaid reimbursement for medications for HCV infection before and after the availability of new DAAs overall and by state and to also assess the impact of Medicaid expansion on reimbursement for DAAs.
METHODS
We calculated Medicaid reimbursements for medications for HCV infection between 2012 and 2015 in all 50 states and the District of Columbia. Outcomes included inflation-adjusted Medicaid reimbursement for medications for HCV infection, market share of individual DAAs, percentages of Medicaid outpatient pharmacy reimbursement for DAAs, and Medicaid reimbursement per Medicaid enrollee with HCV infection.
RESULTS
Medicaid reimbursement for medications for HCV infection increased from $723 million in 2012 to $2.35 billion in 2015. We found variations in Medicaid reimbursement for DAAs between states in 2014 (up to 7.4 times HCV infection prevalence) that widened in 2015 (0.1-11.4 times HCV infection prevalence). Expansion states had significantly higher increases in reimbursement for DAAs per enrollee with HCV infection compared with non- or late-expansion states ($2178.60; 95% confidence interval $1558.90-$2798.40), controlling for pre-expansion reimbursement.
CONCLUSIONS
Medicaid reimbursement for DAAs differs across states after controlling for HCV infection prevalence. A third of states contributed more than 5% to 15% of pharmacy reimbursements to DAAs. Medications for HCV infection are only one class of highly priced specialty drugs. Innovative policy strategies are needed for health systems to manage coverage for an increasing number of expensive specialty medications indicated for an increasing number of patients.
Topics: Ambulatory Care; Antiviral Agents; Hepatitis C, Chronic; Humans; Insurance, Health, Reimbursement; Medicaid; Sofosbuvir; United States
PubMed: 29909874
DOI: 10.1016/j.jval.2017.09.011 -
American Journal of Public Health May 2017To measure the impact of different outreach messages on health insurance enrollment among Medicaid-eligible adults. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To measure the impact of different outreach messages on health insurance enrollment among Medicaid-eligible adults.
METHODS
Between March 2015 and April 2016, we conducted a series of experiments using mail-based outreach that encouraged individuals to enroll in Pennsylvania's expanded Medicaid program. Recipients were randomized to receive 1 of 4 different messages describing the benefits of health insurance. The primary outcome was the response rate to each letter.
RESULTS
We mailed outreach letters to 32 993 adults in Philadelphia. Messages that emphasized the dental benefits of insurance were significantly more likely to result in a response than messages emphasizing the health benefits (odds ratio = 1.33; 95% confidence interval = 1.10, 1.61).
CONCLUSIONS
Medicaid enrollment outreach messages that emphasized the dental benefits of insurance were more effective than those that emphasized the health-related benefits. Public Health Implications. Although the structure and eligibility of the Medicaid program are likely to change, testing and identifying successful outreach and enrollment strategies remains important. Outreach messages that emphasize dental benefits may be more effective at motivating enrollment among individuals of low socioeconomic status.
Topics: Delivery of Health Care; Eligibility Determination; Humans; Insurance, Health; Medicaid; Motivation; Patient Selection; Philadelphia; Poverty; United States
PubMed: 28661816
DOI: 10.2105/AJPH.2017.303845 -
Health Services Research Jun 2017To assess the effects of Tennessee's 2005 Medicaid disenrollment on access to health care among low-income nonelderly adults.
OBJECTIVE
To assess the effects of Tennessee's 2005 Medicaid disenrollment on access to health care among low-income nonelderly adults.
DATA SOURCE/STUDY SETTING
We use data from the 2003-2008 Behavioral Risk Factor Surveillance System.
STUDY DESIGN
We examined the effects of Medicaid disenrollment on access to care among adults living in Tennessee compared with neighboring states, using difference-in-difference models.
PRINCIPAL FINDINGS
Evidence suggests that Medicaid disenrollment resulted in significant decreases in health insurance and increases in cost-related barriers to care for low-income adults living in Tennessee. Statistically significant changes were not observed for having a personal doctor.
CONCLUSIONS
Medicaid disenrollment is associated with reduced access to care. This finding is relevant for states considering expansions or contractions of Medicaid under the Affordable Care Act.
Topics: Behavioral Risk Factor Surveillance System; Female; Health Services Accessibility; Humans; Insurance Coverage; Insurance, Health; Male; Medicaid; Medically Uninsured; Patient Protection and Affordable Care Act; Poverty; Tennessee; United States
PubMed: 27256968
DOI: 10.1111/1475-6773.12515 -
American Journal of Public Health Feb 2016
Topics: Humans; Medicaid; Morals; Patient Protection and Affordable Care Act; Politics; Public Health; United States
PubMed: 26794374
DOI: 10.2105/AJPH.2015.302948 -
American Journal of Preventive Medicine Jul 2019Chlamydia and gonorrhea are the most commonly reported notifiable infections in the U.S., with direct medical costs for the treatment of these infections exceeding $700...
INTRODUCTION
Chlamydia and gonorrhea are the most commonly reported notifiable infections in the U.S., with direct medical costs for the treatment of these infections exceeding $700 million annually. Medicaid currently covers approximately 80 million low-income Americans, including a high percentage of racial and ethnic minorities. Studies have shown that racial and ethnic minority populations, particularly those with low SES, are at an increased risk of acquiring a sexually transmitted disease. Therefore, as Medicaid expands, there will likely be a greater demand for sexually transmitted disease services in community-based physician offices. To determine demand for these services among Medicaid enrollees, this study examined how often Medicaid was used to pay for sexually transmitted disease services received in this setting.
METHODS
This study combined 2014 and 2015 data from the National Ambulatory Medical Care Survey and tested for differences in the proportion of visits with an expected payment source of Medicaid when sexually transmitted disease services were and were not provided. All analyses were conducted in October 2018.
RESULTS
During 2014-2015, an estimated 25 million visits received a sexually transmitted disease service. Medicaid paid for a greater percentage of sexually transmitted disease visits (35.5%, 95% CI=22.5%, 51.1%) compared with non-sexually transmitted disease visits (12.1%, 95% CI=10.8%, 13.6%). Logistic regression modeling, controlling for age, sex, and race of the patient, showed that visits covered by Medicaid had increased odds of paying for a sexually transmitted disease service visit (OR=1.97, 95% CI=1.12, 3.46), compared with other expected payment sources.
CONCLUSIONS
Focusing sexually transmitted disease prevention in Medicaid populations could reduce sexually transmitted disease incidence and resulting morbidity and costs.
Topics: Adult; Aged; Female; Health Care Surveys; Humans; Male; Medicaid; Minority Groups; Poverty; Sexually Transmitted Diseases; United States
PubMed: 31128954
DOI: 10.1016/j.amepre.2019.02.019 -
Health Affairs (Project Hope) Jul 2015Over the past fifty years Medicaid has taken divergent paths in financing mental health and addiction treatment. In mental health, Medicaid became the dominant source of...
Over the past fifty years Medicaid has taken divergent paths in financing mental health and addiction treatment. In mental health, Medicaid became the dominant source of funding and had a profound impact on the organization and delivery of services. But it played a much more modest role in addiction treatment. This is poised to change, as the Affordable Care Act is expected to dramatically expand Medicaid's role in financing addiction services. In this article we consider the different paths these two treatment systems have taken since 1965 and identify strategic lessons that the addiction treatment system might take from mental health's experience under Medicaid. These lessons include leveraging optional coverage categories to tailor Medicaid to the unique needs of the addiction treatment system, providing incentives to addiction treatment programs to create and deliver high-quality alternatives to inpatient treatment, and using targeted Medicaid licensure standards to increase the quality of addiction services.
Topics: Delivery of Health Care; Health Care Reform; Humans; Medicaid; Mental Health; Substance-Related Disorders; United States
PubMed: 26153307
DOI: 10.1377/hlthaff.2015.0151 -
American Journal of Public Health Dec 2017
Topics: Cyclonic Storms; Delivery of Health Care; Disasters; Guidelines as Topic; Health Services; Humans; Medicaid; Puerto Rico; United States
PubMed: 29116848
DOI: 10.2105/AJPH.2017.304138 -
Health Services Research Oct 2020To develop the first longitudinal database of state Medicaid policies for paying the cost sharing in Medicare Part B for services provided to dual Medicare-Medicaid...
OBJECTIVE
To develop the first longitudinal database of state Medicaid policies for paying the cost sharing in Medicare Part B for services provided to dual Medicare-Medicaid enrollees ("duals") and an index summarizing the impact of these policies on payments for physician office services.
DATA SOURCES
Medicaid policy data collected from electronic sources and inquiries with states.
STUDY DESIGN
We constructed a national database of Medicaid payment policies for the period 2004-2018, consolidating information from online Medicaid policy documents, state laws, and policy data reported to us by state Medicaid programs. Using this database and state Medicaid fee schedules, we constructed a Medicaid payment index for duals. This index represented the proportion of the Medicare allowed amount that physicians would expect to be paid from Medicare and Medicaid for a subset of physician office services (evaluation and management services) based on annual state payment policies and Medicaid fee schedules.
PRINCIPAL FINDINGS
In 2018, 42 states had policies to limit Medicaid payments of Medicare cost sharing when Medicaid's fee schedule was lower than Medicare's-an increase from 36 such states in 2004. In the preponderance of states with these policies, combined Medicare and Medicaid payments for evaluation and management services provided to duals averaged 78 percent of the Medicare allowed amount for these services, reflecting relatively low Medicaid fee schedules in these states. In 2013 and 2014, physicians who qualified for the Affordable Care Act's Medicaid "fee bump" were paid 100 percent of the Medicare allowed amount for these services.
CONCLUSIONS
Medicaid programs vary across states and over time in their payments of cost sharing for physician office services provided to duals. Our database and index can facilitate monitoring of these policies and research on the consequences of policy changes for duals.
Topics: Humans; Insurance, Health, Reimbursement; Longitudinal Studies; Medicaid; Medicare Part B; United States
PubMed: 33460128
DOI: 10.1111/1475-6773.13545