Browsing by Subject "Medicaid"

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Can This Marriage Be Saved? Federalism and the Future of U.S. Health Policy Under the Affordable Care Act
(Minnesota Journal of Law, Science and Technology, 2014-02-20) Rosenbaum, Sara
As with all transformational laws, the Patient Protection and Affordable Care Act, hereinafter referred to by its popular name, the Affordable Care Act (ACA or the Act), derives its power from the extent to which it realigns prior relationships and from adding new rights and duties: Between individuals and government through the creation of a right to accessible, affordable health insurance and a concomitant “personal responsibility” to secure it; between the insurance industry and the government through reforms aimed at assuring access to affordable coverage; between larger employers and workers through the Act’s “shared responsibility” requirements; and between health care providers and public and private insurers through provisions aimed at long-term restructuring in how health care is organized and paid for. But it is fair to say that no relationship within the health care system is more affected by the Act than that between the federal government and state governments. Indeed, the ACA establishes a legal approach to national health reform that, at its core, rests on the shoulders of this relationship. First, the Act expands the pre-existing federal-state partnership in the regulation of health insurance while establishing a new Marketplace for affordable coverage. Second, the Act expands the joint federal-state investment in health care for the poor (this time, with the lion’s share coming from the federal partner) through an expanded Medicaid program. As of May 2013, the Congressional Budget Office (CBO) has estimated that by 2022, twenty-five million Americans will gain coverage as a result of this recalibrated set of relationships. This Article takes a closer look at the two federalism relationships—one regulatory, the other investment—that lie at the heart of the Act. I surmise that even if sputtering and fragile, the regulatory partnership actually is built to weather current conditions and that ultimately, it will enable full implementation of the market reforms that the Act sets in motion. I also conclude, however, that at least where coverage of poor adults and their families is concerned, the Medicaid relationship is sufficiently under water to necessitate a federal fallback system, comparable in spirit to the federal fallback that has been designed for the regulatory side of the ledger. Creating such a fallback is essential if the nation is to avert the terrible spectacle of allowing any individual state to exclude its poorest residents from coverage.
Data and data analysis script supporting Is Fair Representation Good for Children? Effects of Electoral Partisan Bias in State Legislatures on Policies Affecting Children’s Health and Well-Being
(2023-10-26) Karatekin, Canan; Mason, Susan M.; Latner, Michael; Gresham, Bria; Corcoran, Frederique; Hing, Anna; Barnes, Andrew J.; karat00@umn.edu; Karatekin, Canan; University of Minnesota Child Wellbeing Research Group
Increasing evidence suggests that state policies impact constituents' health, but political determinants of health and health inequities remain understudied. Using state and year fixed-effects models, we determined the extent to which changes in electoral partisan bias in lower chambers of U.S. state legislatures (i.e., discrepancy between statewide vote share and seat share) were followed by changes in five state policies affecting children and families (1980-2019) and a composite of safety net programs (1999-2018). We examined effects on each policy and whether the effect was modified when bias was accompanied by unified party control. Next, we determined whether the effect differed depending on which party it favored. Less bias resulted only in higher AFDC/TANF benefits. Both pro-Democratic and pro-Republican bias was followed by decreased AFDC/TANF benefits and increased Medicaid benefits. AFDC/TANF recipients, unemployment benefits, minimum wage, and pre-K-12 education spending increased following pro-Democratic bias and decreased following pro-Republican bias. Estimated effects on the composite measure of safety net policies were all close to null. Some effects were modulated by unified party control. Results demonstrate that increasing fairness in elections is not a panacea by itself for increasing generosity of programs affecting children’s well-being. Indeed, bias can be somewhat beneficial for the expansiveness of some policies. Furthermore, with the exception of unemployment benefits and AFDC/TANF recipients, Democrats have not been using the additional power that comes with electoral bias to spend more on major programs that benefit children. Finally, after decades in which electoral bias was in Democrats’ favor, bias has started to shift toward Republicans in the last decade. This trend forecasts more cuts in almost all the policies in this study, especially education and AFDC/TANF recipients. There is a need for more research and advocacy emphasis on the political determinants of social determinants of health, especially at the state level.
The Effect of Minnesota's Value-baesd Reimbursement on Nursing Home Quality: An Impact Study Design Proposal with Preliminary Results
(2017) Monahan, Liam
Effective January 1, 2016, Minnesota implemented a new reimbursement system for nursing homes providing care to residents receiving Medical Assistance (MA), which is the name of Minnesota’s Medicaid program. At the time the Legislature passed the reform, the state estimated that the reforms would require over $124 million in additional funding during the first two fiscal years following enactment. One argument in favor of the design of the new reimbursement system was that it would reward quality care. The statewide implementation of the new system provides a natural experiment that could provide policy makers with the opportunity to test this argument and determine if the new reimbursement system is having an impact on nursing home quality. This paper proposes a method to begin to make this determination.
Essays on Disruptions in Medicaid Coverage
(2022-06) Frenier, Chris
This dissertation presents three empirical papers investigating how disruptions in Medicaid coverage affect enrollees. Medicaid is unique among public insurance programs in the United States because eligibility is means tested and, in most states, enrollment in private managed care plans is mandatory. Medicaid enrollees are low-income adults, children, and seniors, as well as people with disabilities, and these populations often face barriers to navigating the complexities of Medicaid enrollment, eligibility, and managed care. Changes in personal circumstance or state and federal policies can lead Medicaid enrollees to experience unanticipated changes to their health insurance coverage. Most Medicaid enrollees receive coverage through publicly financed, privately administered Medicaid managed care plans. States contract with Medicaid managed care organizations and offer most enrollees a choice of several plans. The high dollar amount of managed care contracts has led most states to select Medicaid plans using competitive bidding. When states conduct competitive bidding to select which plans to offer, enrollees may be forced to change managed care organizations if their plan's contract is not renewed. There is a sizable literature about plan switching in private insurance, but this type of disruption has not been extensively studied in Medicaid. Chapter 1 investigates how being forced to switch Medicaid managed care plans affects health care use and continuity of care for Medicaid enrollees. In 2016, Minnesota's state government used competitive bidding to contract with a new set of Medicaid managed care organizations. More than half of enrollees in the state were forced to change plans as a result of the bidding. I use data from the Minnesota All Payer Claims Database to show that enrollees who were forced to switch plans used fewer health care services after enrolling in their new plan. Plan switching also led to increased new provider visits, which is a sign of disrupted continuity of care. The effects on health care use were large, representing 30 percent reductions across a wide range of health care services, but were concentrated among enrollees who joined a specific managed care organization. These findings suggest that while states may be able to leverage competition between managed care plans to generate financial savings, being forced to switch insurers can be disruptive for Medicaid enrollees. Disenrollment from Medicaid is a second type of disruption. Some people lose Medicaid benefits because changes in their income or circumstances make them ineligible for the program, but others are disenrolled despite remaining eligible. This can occur when enrollees do not complete the necessary steps to renew or re-certify their Medicaid eligibility. Many people who are disenrolled later return to Medicaid. Losing Medicaid may result in uninsurance, even if benefits are restored in subsequent months. Transitioning in and out of Medicaid coverage may make it difficult for some people to receive regular medical care. Chapter 2 uses ten years of Medicaid enrollment data to measure the frequency of disenrollment and coverage disruption in Minnesota. I estimate the rate at which individuals disenroll from Medicaid, the share of disenrollments that result in uninsurance, and the share of enrollees who disenroll but return to the program within twelve months, which is called churn. I use medical and pharmacy claims data to show that the adults and children who experience disruptions in coverage are a lower spending population and leverage a unique feature of the Minnesota All Payer Claims Database to show that most enrollees do not have private insurance coverage during periods outside of Medicaid. This chapter demonstrates the role that All Payer Claims Databases can play in understanding coverage transitions in the fractured American health insurance system. I discuss state and federal policies that can help streamline Medicaid renewal and enrollment, with the goal of improving retention in the program and reducing the frequency of churn. Chapter 3 expands on Chapter 2 by examining how health care spending and use patterns differ between Medicaid enrollees who churn. I show that re-enrollment is highly correlated with short-term increases in medical spending and health care use and that enrollees who churn back into Medicaid coverage have higher spending throughout the re-enrollment period. This is the first paper to use administrative data to estimate the association between Medicaid churn and spending among non-elderly adults and shows how Medicaid enrollment policies like retroactive eligibility interact with disenrollment and churn.
Financing Long Term Care: Dilemmas and Decisions Facing the Elderly, Family Members, and Society.
(Center for Urban and Regional Affairs, University of Minnesota, 1996) Stum, Marlene; Brouwer, Estelle
Impact of Capitation on the Non-Institutionalized Aged: An Evaluation of the Hennepin County Medicaid Demonstration Project. Final Report - Part 1.
(1990) Moscovice, Ira; Lurie, Nicole; Finch, Michael; Christianson, Jon
Impact of pharmacy regulation and payment on generic drug use in the medicaid programs: 1991 to 2008
(2014-12) Sepulveda Adams, Daniel A.
The purpose of this study is to understand the effect of state generic substitution regulations on the generic prescribing and dispensing processes in the Medicaid program and describe the factors that influence dispensing and prescribing generic drugs. The primary research objective for this study is to calculate estimate the rates of generic substitution (i.e., "Generic Prescribing Rate", "Generic Dispensing Rate" and "Net Generic Rate") in the Medicaid program between 1991 and 2008 and to determine and understand how state regulations influence the process of prescribing and dispensing generic drugs in the state Medicaid programs. The research performs at the Substitutable Market level and explains the significant differences observed.The study design is a retrospective, cross-sectional time series study. Databases from the Centers for Medicare and Medicaid Service (CMS) and the "Medicaid State Drug Utilization Data" will be collected with four observations per year by state from 1991 to 2008. This data base was complemented with Medi-Span Master Drug Data Base ® (MDDB), Medi-Span Price-Check PC ®, National Association of Board of Pharmacy (NABP) publications and Medicaid Payment Data Base (MPDB).The data set for this study was the entire population of drugs reimbursed by therapeutic class in 48 states (excluding Arizona & Tennessee) since 1991 to 2008 in the Medicaid program. The descriptive analysis was performed nationwide and by state. However Fixed effects, two-stage least squares regression was utilized to analyze the regression models nationwide by therapeutic class.
The long-term effects of exposure to medicaid in early childhood
(2014-07) Boudreaux, Michel H.
This project investigates the long-term effects of exposure to Medicaid in early childhood on adult health and economic status by leveraging the program's gradual adoption across the states. The staggered timing of Medicaid's introduction created variation in cumulative exposure to Medicaid for birth cohorts that are now in adulthood. I use this natural experiment in a generalized difference-in-differences framework that is complemented by a rich set of state-by-year and county-by-year controls that measure changes in public spending on the poor and health care supply. I demonstrate further support for the study design by comparing Medicaid's impact in groups that were targeted by the program versus groups that had a low probability of being eligible for benefits. I first examine the impact of Medicaid's introduction on short-run measures of utilization and infant health to establish that the program had short-term effects that could have persisted over time. Using data from the National Health Interview Survey I find that Medicaid increased the probability of any annual hospital stay by approximately 3 percentages points among low-income children under 6. Data from the National Natality Survey suggests that the program reduced the incidence of low-birth weight in the low-income population by 4 percentage points. Both findings provide evidence that the introduction of Medicaid created meaningful short-run benefits that could have persisted over time. To examine the program's long-term impacts I use data from the Panel Study of Income Dynamics. Results suggest that in subgroups targeted by the program, exposure to Medicaid in childhood (age 0-5) is associated with statistically significant and meaningful improvements in adult health (age 18-54). I find no evidence for an economic effect, but the point estimates are imprecise and the findings are inconclusive. I discuss the significance of my results in the context of a dynamic model of child development that interacts with an evolving U.S. health system.
Long-term supports and services for persons with intellectual or developmental disabilities: Status and trends through 2020
(Institute on Community Integration, 2024-12-01) Larson, Sheryl; Neidorf, Jonathan; Begin, Brian; Pettingell, Sandra; Sowers, Mary
Medication Utilization of Dual Eligibles Before and After Medicare Part D: Cases of Antidepressants and Antipsychotics
(2014-05) Kim, Jee-Ae
Objectives: The study objective is to examine whether medication utilization among dual eligibles was different under Part D compared to Medicaid period by focusing on states which vary baseline state Medicaid policies and wrap-around programs for dual eligibles to access drugs under Part D. The transition of prescription drug benefits to federal Medicare Part D from state Medicaid has potential to affect medication utilization for dual eligibles, beneficiaries for both Medicaid and Medicare programs. Changes in prescription drug benefits under Part D will not equally affect the dual eligible and will differ by states with differences in baseline Medicaid policies and availability of wrap-around programs to access drugs under Part D. The study focuses on antidepressants and antipsychotics. Methods: This study is a pre-post study design with a longitudinal dataset by linking Medicaid data for 2004-2005 and 5% random sample of Medicare data for 2006-2007. The study population is dual eligibles, existing users of antidepressants and of antipsychotics in 2004 and with enrollment from 2004-2007 in eight states. I employ a state-fixed effect model to estimate medication utilization using proportion of days covered (PDC), adjusting for beneficiaries characteristics and health status. I adopt generalized estimation equation (GEE) model for estimating PDC and spline regression for investigating whether changes in PDCs were related to Part D. A stratified analysis is conducted for community based dual eligibles (n=4,703 for antidepressants, n=2,301 for antipsychotics) and nursing home dual eligibles (n=1,504 for antidepressants, n=1,011 for antipsychotics) separately. Results: For antidepressants, adjusted changes in PDC were not significant for most states, except Arkansas community based dual eligibles (p=0.00), Florida nursing home dual eligibles had a significant increase (p=0.03), New Mexico nursing home dual eligibles(p=0.01) under Part D. For antipsychotics, adjusted changes in PDC were not significant in all states except Arkansas community based dual eligibles (p=0.03) and Florida for both groups (p=0.00 for both community based dual eligibles and nursing home dual eligibles). A separate spline regression for states that had significant changes in PDC from the state-fixed effect model indicated that trends in PDC before and after Part D were not significantly different, suggesting that changes were not related to transition to Part D. Conclusions: I did not find empirical support for concerns regarding disruption of medication utilization of the dual eligible under Part D. Although states had different baseline Medicaid polices and wrap-around programs under Part D, lack of significant changes in utilization suggest that minor changes in copayments and refill/prescription limits etc. do not have large effect on medication utilization to antidepressants and antipsychotics.
Minnesota medicaid budget cutbacks 2010 and impact on dental service utilization in nursing home residents
(2013-11) Grover, Satbir S.
ABSTRACT Background and Objectives. Oral health is an integral part of maintaining the overall health of every individual and therefore an essential component of primary health care for older adults. Oral health service utilization is multifactorial and financial support plays an important part in determining the degree of oral care received. Past studies report a strong association between dental insurance coverage and dental service utilization by the elderly population. The purpose of this study was to examine the effects of a reduction in dental insurance for enrolled nursing home residents under Minnesota's Medicaid plan in 2010. As part of research hypothesis, it was theorized that Minnesota's Medicaid budget cuts, which took effect in January 2010, resulted in a reduced utilization of basic dental services among nursing home residents. Material and Methods.For this study, a retrospective cross sectional survey method was employed and data were collected from the dental practice software systems used in University of Minnesota's two community-based dental clinics for older adults. The Experimental Group included subjects above 55 years, who were nursing home residents and had dental visits between January 2009 and December 2010 and had any type of Medicaid dental coverage. The Comparison Group included subjects above 55 years of age who were nursing home residents and had dental visits and did not have any Medicaid dental insurance for the same time period. Outcome variables analyzed were dental services provided for MA and non-MA groups in three categories depending upon the changes that occurred after the 2010 Minnesota Medicaid cutbacks. These were: 1) non-impacted, services; 2) reduced services; or 3) eliminated services. Summary dental utilization measures such as overall visits, overall services, as well as visits per patient per year and services per patient per year were also analyzed. Results: For the Experimental (MA) group, no or marginally statistically significant differences were found from 2009 to 2010 in overall dental visits and overall services, although large and statistically significant increases were found in overall visits and services provided for the Comparison (non-MA) group in 2010 versus 2009. No statistically significant differences were found in both MA and non-MA groups for total visits per patient and total services per patient from 2009 to 2010. For those dental services unaffected by the 2010 Minnesota MA benefit changes, no statistically significant changes occurred from 2009 to 2010 for either the MA or non-MA groups. However, large and statistically significant reductions were found from 2009 to 2010 for dental services that were reduced in coverage in the 2010 Minnesota MA dental benefit cutbacks, and extremely large reductions were found for eliminated services in 2010. These reductions in reduced or eliminated dental services during 2010 occurred in both the Experimental (MA) and Comparison (non-MA) Groups. Conclusion. While the overall process of care in these two practices seemed unchanged based on overall visits and services per patient provided in 2009 and 2010, an expected increase in overall dental services and visits occurred among the non-MA patient group in 2010 perhaps to compensate for fewer covered MA services. While no statistically significant differences were found from 2009 to 2010 in utilization of services that were unaffected by the 2010 Minnesota MA service cutbacks as might have been expected, large and significantly different reductions in utilization were found in both the MA and non-MA groups for services that were either reduced or eliminated in 2010. While these results might be a reflection of the US economic downturn during the same time period, they also could suggest that the MA service cutbacks might have led to changes in dental providers' perceptions of all NH patients' ability to pay for these services in 2010. Future larger sample studies with a broader time frame are required to further investigate the effects of 2010 Medicaid benefit cutbacks on dental care utilization, as well as further analyses of changes in specific dental services provided.
Potentially preventable hospitalizations among elderly medicaid long-term care users
(2012-08) Wysocki, Andrea Jeanne
Over the last several decades, most states have increasingly shifted their Medicaid long-term care (LTC) expenditures away from primarily institutional services toward more home and community-based services (HCBS). Despite the increase in HCBS, the risk for potentially preventable hospitalizations among elderly Medicaid HCBS users is largely unknown. Given the health implications and the high cost of hospitalizations, it is important to better understand potentially preventable hospitalizations among these LTC users. This dissertation research empirically examined potentially preventable hospitalizations among elderly Medicaid LTC users in community and institutional settings. Specifically this research aimed to (1) identify the factors associated with potentially preventable hospitalizations among elderly Medicaid HCBS users, (2) compare the risk for a potentially preventable hospitalization between elderly Medicaid HCBS users and nursing home residents, and (3) compare the risk for a potentially preventable hospitalization between elderly Medicaid LTC users who transition from a nursing home to a home or community LTC setting and those who remain in a nursing home. Results from these analyses found that potentially preventable hospitalizations were frequent among elderly Medicaid HCBS recipients, and a few conditions accounted for the majority of these hospitalizations. Several characteristics were significantly associated with an increased risk for a potentially preventable hospitalization suggesting that there is variation in preventable hospitalizations among the elderly Medicaid HCBS population and improvements could be made in reducing this variation. After controlling for a number of characteristics and correcting for endogeneity, HCBS users had an increased risk for a preventable hospitalization compared to nursing home residents. More proactive medical care and policies focusing on reducing hospitalizations may be needed for the HCBS population, as well as better aligned incentives for providers to coordinate care. Elderly Medicaid LTC users who transitioned from a nursing home to using HCBS had an increased but non-significant risk for a preventable hospitalization compared with individuals who remained in the nursing home. The medical care and continuity of providers within the nursing home setting are likely important factors in keeping nursing home residents out of the hospital.
A Quest for Justice: A Historic Look at Comprehensive Health Care Reform Efforts in America 1945 - 2007
(Hubert H. Humphrey Institute of Public Affairs, 2009-05-05) Hoerle, Ellen
It is 2009 and health care reform is back, after a fifteen-year hiatus from the national political spotlight. A sixty-year history of various legislative initiatives has led to an expansion of the public sector of health insurance coverage, known as Medicare and Medicaid, but has continued to fall short of comprehensive reform. Comprehensive health care reform would provide universal health care insurance coverage for all Americans and include some type of system of cost controls so health care expenditures don't continue to increase at rates that threaten the budgets of other public programs such as K-12 and higher education.
Study of Public Policy and Availability of Nursing Home Beds in Minnesota.
(1984) Stryker-Gordon, Ruth

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