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Inquiry : a Journal of Medical Care... 2019Congress has repeatedly proposed changing Medicaid from an entitlement to a block grant. Each state would receive a fixed amount instead of a Federal payment influenced...
Congress has repeatedly proposed changing Medicaid from an entitlement to a block grant. Each state would receive a fixed amount instead of a Federal payment influenced by state decisions on eligibility, coverage, and pricing. This paper uses existing data series to simulate redistributing the annual $353 billion Federal payment among Medicaid's 56 state (and territorial) programs. Capitation by general population would shift $52 billion, mainly from large Northeastern and West Coast states to large Southern and Mountain states. Capitation by population below the Federal Poverty Line (FPL) would shift $60 billion in a similar pattern. Policymakers should understand likely state-to-state effects when considering Medicaid legislation. States could then prepare for possible changes in their Federal payment for Medicaid.
Topics: Eligibility Determination; Health Policy; Humans; Insurance Benefits; Medicaid; Poverty; Socioeconomic Factors; State Health Plans; United States
PubMed: 31823662
DOI: 10.1177/0046958019892882 -
North Carolina Medical Journal 2019As North Carolina's Medicaid program transitions from fee-for-service to managed care, the Department of Health and Human Services is committed to building an...
As North Carolina's Medicaid program transitions from fee-for-service to managed care, the Department of Health and Human Services is committed to building an innovative, whole-person-centered and well-coordinated system of care that addresses both medical and non-medical drivers of health. Delivering on that vision, and improving the health and well-being of North Carolinians, means shifting from thinking of payers as exclusively buying medical services to thinking of them as buying health for their beneficiaries. Operationalizing this complex work will require strong partnership from stakeholders across the state and will also provide North Carolina an opportunity to help drive a national agenda centered around how to buy good health.
Topics: Humans; Managed Care Programs; Medicaid; North Carolina; United States
PubMed: 31471508
DOI: 10.18043/ncm.80.5.277 -
Pediatric Blood & Cancer Nov 2017Children with cancer are a unique patient population with high resource, complex healthcare needs. Understanding their healthcare utilization could highlight areas for...
BACKGROUND
Children with cancer are a unique patient population with high resource, complex healthcare needs. Understanding their healthcare utilization could highlight areas for care optimization.
PROCEDURE
We performed a retrospective, cross-sectional analysis of the 2014 Truven Marketscan Medicaid Database to explore clinical attributes, utilization, and spending among children with cancer who were Medicaid enrollees. Eligible patients included children (ages 0-18 years) with cancer (Clinical Risk Group 8). Healthcare utilization and spending (per member per month, PMPM) were assessed overall and across specific healthcare services.
RESULTS
Children with cancer (n = 5,405) represent less than 1% of the 1,516,457 children with medical complexity in the dataset. Children with cancer had high services use: laboratory/radiographic testing (93.0%), outpatient specialty care (83.4%), outpatient therapy/treatment (53.4%), emergency department (43.7%), hospitalization (31.5%), home healthcare (9.5%). PMPM spending for children with cancer was $3,706 overall and $2,323 for hospital care.
CONCLUSION
Children with cancer have high healthcare resource use and spending. Differences in geographic distribution of services for children with cancer and the trajectory of spending over the course of therapy are areas for future investigation aimed at lowering costs of care without compromising on health outcomes.
Topics: Adolescent; Child; Child, Preschool; Cross-Sectional Studies; Female; Follow-Up Studies; Health Expenditures; Health Services; Hospitalization; Humans; Infant; Infant, Newborn; Male; Medicaid; Neoplasms; Patient Acceptance of Health Care; Prognosis; Retrospective Studies; United States
PubMed: 28417587
DOI: 10.1002/pbc.26569 -
Health Services Research Apr 2018Examine the ACA Medicaid expansion effects on Medicaid take-up and private coverage through 2015 and coverage disparities by age, race/ethnicity, and gender.
OBJECTIVE
Examine the ACA Medicaid expansion effects on Medicaid take-up and private coverage through 2015 and coverage disparities by age, race/ethnicity, and gender.
DATA SOURCES
2011-2015 American Community Survey for 3,137,989 low-educated adults aged 19-64 years.
STUDY DESIGN
Difference-in-differences regressions accounting for national coverage trends and state fixed effects.
PRINCIPAL FINDINGS
Expansion effects doubled in 2015 among low-educated adults, with a nearly 8 percentage-point increase in Medicaid take-up and 6 percentage-point decline in uninsured rate. Significant coverage gains were observed across virtually all examined groups by age, gender, and race/ethnicity. Take-up and insurance declines were strongest among younger adults and were generally close by gender and race/ethnicity. Despite the increased take-up however, coverage disparities remained sizeable, especially for young adults and Hispanics who had declining but still high uninsured rates in 2015. There was some evidence of private coverage crowd-out in certain subgroups, particularly among young adults aged 19-26 years and women, including in both individually purchased and employer-sponsored coverage.
CONCLUSIONS
The ACA Medicaid expansions have continued to increase coverage in 2015 across the entire population of low-educated adults and have reduced age disparities in coverage. However, there is still a need for interventions that target eligible young and Hispanic adults.
Topics: Adult; Age Factors; Ethnicity; Female; Humans; Insurance Coverage; Insurance, Health; Longitudinal Studies; Male; Medicaid; Medically Uninsured; Middle Aged; Patient Protection and Affordable Care Act; Racial Groups; Sex Factors; United States; Young Adult
PubMed: 28517042
DOI: 10.1111/1475-6773.12711 -
Journal of General Internal Medicine Oct 2019Changing Medicaid fees is a common approach for states to address budget fluctuations, and many currently set Medicaid physician fees at levels lower than Medicare and...
BACKGROUND
Changing Medicaid fees is a common approach for states to address budget fluctuations, and many currently set Medicaid physician fees at levels lower than Medicare and private insurers. The Affordable Care Act included a temporary Medicaid fee bump for primary care providers (PCPs) in 2013-2014 that recently led to both an increase and then subsequent decrease in PCP fees in many states.
OBJECTIVE
To conduct a systematic literature review on the effects of changing Medicaid fees on provider participation and enrollees' access to care and service use.
METHODS
We searched PubMed/Medline and JSTOR and identified 18 studies that assessed the longitudinal impact of provider fee changes in Medicaid on the outcomes of interest. We summarized information on study design, methods, and findings.
RESULTS
Seven studies examined the impact of fee changes on provider participation in Medicaid. Of these, three studies found that fee increases were associated with positive effects on providers' likelihood of accepting Medicaid patients or on their Medicaid caseloads. Five studies that examined the impact of fee changes on Medicaid enrollees' access to care found a positive association with one or more access measure, such as having a usual source of care or appointment availability. Lastly, eight of 14 studies that examined service use found positive associations between fee changes and at least one measure of use, such as changes in the probability of enrollees having any visit, the number of visits, and shifts in the site of care toward office-based care; others largely did not find significant associations.
CONCLUSIONS
There is mixed evidence on the impact of changing Medicaid fees on provider participation and enrollees' service use; however, increasing fees appears to have more consistent positive effects on access to care. Whether these improvements in access translate into better health outcomes or downstream cost savings are critical questions.
Topics: Fees and Charges; Health Services Accessibility; Humans; Medicaid; Patient Protection and Affordable Care Act; United States
PubMed: 31388912
DOI: 10.1007/s11606-019-05160-x -
Federal Register Sep 2011This final rule implements section 6411 of the Patient Protection and Affordable Care Act (the Affordable Care Act), and provides guidance to States related to...
This final rule implements section 6411 of the Patient Protection and Affordable Care Act (the Affordable Care Act), and provides guidance to States related to Federal/State funding of State start-up, operation and maintenance costs of Medicaid Recovery Audit Contractors (Medicaid RACs) and the payment methodology for State payments to Medicaid RACs. This rule also directs States to assure that adequate appeal processes are in place for providers to dispute adverse determinations made by Medicaid RACs. Lastly, the rule directs States to coordinate with other contractors and entities auditing Medicaid providers and with State and Federal law enforcement agencies.
Topics: Centers for Medicare and Medicaid Services, U.S.; Contract Services; Financial Audit; Humans; Medicaid; Patient Protection and Affordable Care Act; State Government; United States
PubMed: 21938888
DOI: No ID Found -
JAMA Network Open Dec 2019As the proportion of children with Medicaid coverage increases, many pediatric health systems are searching for effective strategies to improve management of this...
IMPORTANCE
As the proportion of children with Medicaid coverage increases, many pediatric health systems are searching for effective strategies to improve management of this high-risk population and reduce the need for inpatient resources.
OBJECTIVE
To estimate the association of a targeted population health management intervention for children eligible for Medicaid with changes in monthly hospital admissions and bed-days.
DESIGN, SETTING, AND PARTICIPANTS
This quality improvement study, using difference-in-differences analysis, deployed integrated team interventions in an academic pediatric health system with 31 in-network primary care practices among children enrolled in Medicaid who received care at the health system's hospital and primary care practices. Data were collected from January 2014 to June 2017. Data analysis took place from January 2018 to June 2019.
EXPOSURES
Targeted deployment of integrated team interventions, each including electronic medical record registry development and reporting alongside a common longitudinal quality improvement framework to distribute workflow among interdisciplinary clinicians and community health workers.
MAIN OUTCOMES AND MEASURES
Trends in monthly inpatient admissions and bed-days (per 1000 beneficiaries) during the preimplementation period (ie, January 1, 2014, to June 30, 2015) compared with the postimplementation period (ie, July 1, 2015, to June 30, 2017).
RESULTS
Of 25 460 children admitted to the hospital's health system during the study period, 8418 (33.1%) (3869 [46.0%] girls; 3308 [39.3%] aged ≤1 year; 5694 [67.6%] black) were from in-network practices, and 17 042 (67.9%) (7779 [45.7%] girls; 6031 [35.4%] aged ≤1 year; 7167 [41.2%] black) were from out-of-network practices. Compared with out-of-network patients, in-network patients experienced a decrease of 0.39 (95% CI, 0.10-0.68) monthly admissions per 1000 beneficiaries (P = .009) and 2.20 (95% CI, 0.90-3.49) monthly bed-days per 1000 beneficiaries (P = .001). Accounting for disproportionate growth in the number of children with medical complexity who were in-network to the health system, this group experienced a monthly decrease in admissions of 0.54 (95% CI, 0.13-0.95) per 1000 beneficiaries (P = .01) and in bed-days of 3.25 (95% CI, 1.46-5.04) per 1000 beneficiaries (P = .001) compared with out-of-network patients. Annualized, these differences could translate to a reduction of 3600 bed-days for a population of 93 000 children eligible for Medicaid.
CONCLUSIONS AND RELEVANCE
In this quality improvement study, a population health management approach providing targeted integrated care team interventions for children with medical and social complexity being cared for in a primary care network was associated with a reduction in service utilization compared with an out-of-network comparison group. Standardizing the work of care teams with quality improvement methods and integrated information technology tools may provide a scalable strategy for health systems to mitigate risk from a growing population of children who are eligible for Medicaid.
Topics: Child; Child, Hospitalized; Child, Preschool; Female; Health Services Accessibility; Humans; Male; Medicaid; Population Health Management; Quality Improvement; United States
PubMed: 31880799
DOI: 10.1001/jamanetworkopen.2019.18306 -
Women's Health Issues : Official... 2021We aimed to estimate the association between Medicaid unbundling of payment for long-acting reversible contraceptives (LARC) from the global delivery fee and immediate...
OBJECTIVES
We aimed to estimate the association between Medicaid unbundling of payment for long-acting reversible contraceptives (LARC) from the global delivery fee and immediate postpartum (IPP) LARC provision, in a state outside a select group of early-adopters. We also examine the potential moderating roles of hospital academic affiliation and Catholic status on the association between unbundling and IPP LARC provision.
METHODS
We used a pre-post design to examine the association between unbundling and IPP LARC provision. We observed Medicaid-covered childbirth deliveries in Wisconsin hospitals between January 2016 and December 2017 (n = 45,200) in the State Inpatient Database from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. We conducted multivariate regressions using generalized linear mixed models.
RESULTS
From 2016 to 2017, IPP LARC provision increased from 0.28% to 0.44% of deliveries (p = .003). In our adjusted model, IPP LARC provision was 1.55 times more likely in the post-period versus the pre-period (95% confidence interval, 1.12-2.13). Both before and after unbundling, IPP LARC provision was significantly more common in academic versus nonacademic settings and was exceedingly rare in Catholic institutions.
CONCLUSIONS
In contrast with many early adopting states, in this later adopting state, Wisconsin Medicaid's unbundling of LARC from the global fee did not meaningfully change the rates of IPP LARC provision. These results indicate that delivery hospital characteristics are strong correlates of access to IPP LARC and suggest the need for interventions-perhaps outside of the inpatient setting-to ensure that patients can access desired contraceptive methods promptly postpartum.
Topics: Contraceptive Agents; Female; Humans; Long-Acting Reversible Contraception; Medicaid; Postpartum Period; United States; Wisconsin
PubMed: 33849768
DOI: 10.1016/j.whi.2021.02.009 -
American Journal of Public Health Mar 2016To investigate the impact of an increase in Supplemental Nutrition Assistance Program (SNAP) benefits on Medicaid costs and use in Massachusetts.
OBJECTIVES
To investigate the impact of an increase in Supplemental Nutrition Assistance Program (SNAP) benefits on Medicaid costs and use in Massachusetts.
METHODS
Using single and multigroup interrupted time series models, I examined the effect of an April 2009 increase in SNAP benefits on inpatient Medicaid cost and use patterns. I analyzed monthly Medicaid discharge data from 2006 to 2012 collected by the Massachusetts Center for Health Information and Analysis.
RESULTS
Inpatient costs for the overall Massachusetts Medicaid population grew by 0.55 percentage points per month (P < .001) before the SNAP increase. After the increase, cost growth fell by 73% to 0.15 percentage points per month (-0.40; P = .003). Compared with the overall Medicaid population, cost growth for people with the selected chronic illnesses was significantly greater before the SNAP increase, as was the decline in growth afterward. Reduced hospital admissions after the SNAP increase drove the cost declines.
CONCLUSIONS
Medicaid cost growth fell in Massachusetts after SNAP benefits increased, especially for people with chronic illnesses with high sensitivity to food insecurity.
Topics: Chronic Disease; Female; Food Assistance; Food Supply; Hospital Charges; Humans; Inpatients; Length of Stay; Male; Massachusetts; Medicaid; Socioeconomic Factors; United States
PubMed: 26794167
DOI: 10.2105/AJPH.2015.302990 -
Academic Emergency Medicine : Official... Jan 2017While the Affordable Care Act seeks to reduce emergency department (ED) visits for outpatient-treatable conditions, it remains unclear whether Medicaid patients or the...
OBJECTIVES
While the Affordable Care Act seeks to reduce emergency department (ED) visits for outpatient-treatable conditions, it remains unclear whether Medicaid patients or the uninsured have adequate access to follow-up care. The goal of this study was to determine the availability of follow-up orthopedic care by insurance status.
METHODS
Using simulated patient methodology, all 102 eligible general orthopedic practices in Dallas-Fort Worth, Texas, were contacted twice by a caller requesting follow-up for an ankle fracture diagnosed in a local ED using a standardized script that differed by insurance status. Practices were randomly assigned to paired private and uninsured or Medicaid and uninsured scenarios.
RESULTS
We completed 204 calls: 59 private, 43 Medicaid, and 102 uninsured. Appointment success rate was 83.1% for privately insured (95% confidence interval [CI] = 73.2% to 92.9%), 81.4% for uninsured (95% CI = 73.7% to 89.1%), and 14.0% for Medicaid callers (95% CI = 3.2% to 24.7%). Controlling for paired calls to the same practice, an uninsured caller had 5.7 times higher odds (95% CI = 2.74 to 11.71) of receiving an appointment than a Medicaid caller (p < 0.001), but the same odds as a privately insured caller (odds ratio = 1.0, 95% CI = 0.19 to 5.37, p = 1.0). Uninsured patients had to bring a median of $350 (interquartile range = $250 to $400) to their appointment to be seen, and only two uninsured patients were able to obtain an appointment for $100 or less up front. In comparison, typical total payments collected for privately insured patients were $236 and for Medicaid patients $128. When asked where else they could go, 49 (48%) uninsured callers and one Medicaid caller (2%) were directed to local public hospital EDs as alternative sources of care. Of the practices that appeared on Medicaid's published list of orthopedic providers accepting new patients, 15 told callers that they did not accept Medicaid, 11 did not treat ankles, nine listed nonworking phone numbers, and only three actually scheduled an appointment for the Medicaid caller.
CONCLUSIONS
Less than one in seven Medicaid patients could obtain orthopedic follow-up after an ED visit for a fracture, and prices quoted to the uninsured were 30% higher than typical negotiated rates paid by the privately insured. High up-front costs for uninsured patients and low appointment availability for Medicaid patients may leave these patients with no other option than the ED for necessary care.
Topics: Aftercare; Appointments and Schedules; Fees and Charges; Health Services Accessibility; Humans; Insurance Coverage; Male; Medicaid; Medically Uninsured; Odds Ratio; Orthopedics; Patient Simulation; Refusal to Treat; Texas; United States
PubMed: 27442786
DOI: 10.1111/acem.13058