National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (46)
- Ambulatory Care and Surgery (3)
- Behavioral Health (5)
- Cancer (6)
- Cancer: Breast Cancer (2)
- Cancer: Cervical Cancer (2)
- Cancer: Colorectal Cancer (4)
- Cancer: Lung Cancer (1)
- Cardiovascular Conditions (1)
- Case Study (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Children's Health Insurance Program (CHIP) (4)
- Children/Adolescents (9)
- Chronic Conditions (1)
- Community-Based Practice (1)
- Community Partnerships (1)
- Dental and Oral Health (2)
- Diabetes (2)
- Disabilities (1)
- Disparities (4)
- Domestic Violence (1)
- Elderly (2)
- Electronic Health Records (EHRs) (1)
- Emergency Department (2)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Cost and Utilization Project (HCUP) (7)
- Healthcare Costs (16)
- Healthcare Delivery (4)
- Healthcare Utilization (11)
- Health Information Technology (HIT) (1)
- Health Insurance (60)
- Health Services Research (HSR) (5)
- Health Status (3)
- Home Healthcare (1)
- Hospitalization (3)
- Hospital Readmissions (1)
- Hospitals (5)
- Human Immunodeficiency Virus (HIV) (4)
- Inpatient Care (1)
- Low-Income (15)
- Maternal Care (6)
- (-) Medicaid (105)
- Medical Expenditure Panel Survey (MEPS) (8)
- Medicare (10)
- Medication (5)
- Nutrition (1)
- Opioids (2)
- Patient-Centered Outcomes Research (1)
- Patient Experience (1)
- Payment (6)
- (-) Policy (105)
- Practice Patterns (2)
- Pregnancy (4)
- Prevention (5)
- Primary Care (1)
- Provider (1)
- Provider: Physician (1)
- Quality Measures (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (5)
- Rural Health (1)
- Screening (4)
- Sexual Health (4)
- Social Determinants of Health (3)
- Substance Abuse (4)
- Surgery (2)
- Tobacco Use (1)
- Tobacco Use: Smoking Cessation (1)
- Uninsured (23)
- Vulnerable Populations (5)
- Women (10)
- Young Adults (2)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 105 Research Studies DisplayedDecker S, Dworsky M, Gibson TB
AHRQ Author: Decker S
The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits.
The authors leveraged ACA coverage expansions, including Medicaid expansion and Marketplaces, to study the impact of health insurance on opioid-related emergency department (ED) visits. They used ZIP-code–level ED utilization data from HCUP’s State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) for 29 states. They found evidence of a dose-response relationship between pre-ACA uninsured and changes in ED visit rates in both expansion and non-expansion states: areas with higher uninsured rates prior to ACA saw larger reductions in opioid-related ED visits after the ACA took effect. The authors concluded that these findings suggest that increased insurance coverage may to help mitigate the opioid crisis.
AHRQ-authored.
Citation: Decker S, Dworsky M, Gibson TB .
The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits.
American Journal of Health Economics 2023 Sum; 9(3):405–34..
Keywords: Healthcare Cost and Utilization Project (HCUP), Opioids, Policy, Health Insurance, Emergency Department, Access to Care, Medicaid, Healthcare Utilization
Vasan A, Kenyon CC, Fiks AG
Continuous eligibility and coverage policies expanded children's Medicaid enrollment.
Researchers examined children's participation in Medicaid during 2019-21. Their findings found that states that had adopted continuous Medicaid coverage for children during the COVID-19 pandemic experienced a 4.62 percent relative increase in children's Medicaid participation when compared with states with existing continuous eligibility policies.
AHRQ-funded; HS028555.
Citation: Vasan A, Kenyon CC, Fiks AG .
Continuous eligibility and coverage policies expanded children's Medicaid enrollment.
Health Aff 2023 Jun; 42(6):753-58. doi: 10.1377/hlthaff.2022.01465..
Keywords: Children/Adolescents, Medicaid, Policy, Health Insurance, Access to Care
Quinlan TAG, Lindrooth RC, Guiahi M
Medicaid payment for postpartum long-acting reversible contraception prompts more equitable use.
In addition to providing a global payment for maternity care, an increasing number of state Medicaid programs pay for immediate postpartum long-acting reversible contraception (LARC). The purpose of this study was to examine postpartum LARC utilization by race and ethnicity and overall among respondents with Medicaid-paid births during 2012-2018 in eight states that implemented immediate postpartum LARC payment and eight states without immediate postpartum LARC payment. The study found that the policy resulted in a 2.1-percentage-point increase in postpartum LARC use overall. Further analysis found no significant change among White mothers and a 3.7-percentage-point increase in use among Black mothers compared with White mothers. The researchers concluded that additional research is required to determine whether the increase was related with patients' preferences and whether hospitals' immediate postpartum LARC policies and practices utilize a patient-centered approach that reinforces reproductive autonomy and equity.
AHRQ-funded; HS028762.
Citation: Quinlan TAG, Lindrooth RC, Guiahi M .
Medicaid payment for postpartum long-acting reversible contraception prompts more equitable use.
Health Aff 2023 May; 42(5):665-73. doi: 10.1377/hlthaff.2022.01178..
Keywords: Medicaid, Maternal Care, Women, Access to Care, Policy
Meille G, Post B
AHRQ Author: Meille G
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
This AHRQ-authored paper describes the effect of the Affordable Care Act Medicaid expansion on hospital utilization, employment, and capital. The authors conducted a difference-in-differences analysis that compared changes to hospital demand and supply in Medicaid expansion and nonexpansion states. They used 2010-2016 data from the American Hospital Association and the Healthcare Cost Report Information System to quantify changes to hospital utilization and characterize how hospitals adjusted labor and capital inputs. Medicaid expansion was associated with increases in emergency department visits and other outpatient hospital visits. They found strong evidence that hospitals met increases in demand by hiring nursing staff and weaker evidence that they increased hiring of technicians and investments in equipment. They found no evidence that hospitals adjusted hiring of physicians, support staff, or investments in other capital inputs.
AHRQ-authored.
Citation: Meille G, Post B .
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
Med Care Res Rev 2023 Apr;80(2):165-74. doi: 10.1177/10775587221133165.
Keywords: Medicaid, Hospitals, Healthcare Utilization, Health Insurance, Policy, Access to Care, Uninsured
Creedon TB, Zuvekas SH, Hill SC
AHRQ Author: Zuvekas SH, Hill SC, McClellan C
Effects of Medicaid expansion on insurance coverage and health services use among adults with disabilities newly eligible for Medicaid.
The purpose of this study was to explore the impact of Affordable Care Act (ACA) Medicaid expansion on insurance coverage and health services use for adults with disabilities newly eligible for Medicaid. The researchers utilized the 2008-2018 Medical Expenditure Panel Survey data and the Agency for Healthcare Research and Quality (AHRQ) PUBSIM model to identify adults between the ages of 26-64 years with disabilities who were newly Medicaid-eligible in expansion states or would have been eligible in non-expansion states if those states had opted in to ACA Medicaid expansion. The study found that among adults with disabilities who were newly eligible for Medicaid, Medicaid expansion was associated with significant increases in full-year Medicaid coverage, receipt of primary care, receipt of flu shots and a significant decrease in out-of-pocket spending. There were greater improvements for adults with disabilities compared to those without disabilities in full-year Medicaid coverage and receipt of flu shots. The researchers concluded that Medicaid expansion was associated with improvements in full-year insurance coverage, receipt of primary and preventive care, and out-of-pocket spending for adults with disabilities who were newly eligible for Medicaid, and there were greater improvements for adults with disabilities than for adults without disabilities.
AHRQ-authored.
Citation: Creedon TB, Zuvekas SH, Hill SC .
Effects of Medicaid expansion on insurance coverage and health services use among adults with disabilities newly eligible for Medicaid.
Health Serv Res 2022 Dec;57(suppl 2):183-94. doi: 10.1111/1475-6773.14034..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicaid, Health Insurance, Disabilities, Policy, Access to Care
Donohue JM, Cole ES, James CV
The US Medicaid program: coverage, financing, reforms, and implications for health equity.
This article is a literature review of the Medicaid program focusing on Medicaid eligibility, enrollment, and spending and examined areas of Medicaid policy, including managed care, payment, and delivery system reforms; Medicaid expansion; racial and ethnic health disparities; and the potential to achieve health equity. The authors included peer-reviewed articles and reports published between January 2003 and February 2022. Medicaid covered approximately 80.6 million people per month in 2022, representing 16.3% of US health spending. Managed care plans run by states enrolled 69.5% of Medicaid beneficiaries in 2019 and adopted 139 delivery system reforms from 2003 to 2019. Over half (56.4%) of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, and disparities in access, quality, and outcomes are common among these groups within Medicaid. The authors felt that additional Medicaid reforms are needed to reduce health disparities by race and ethnicity and to achieve equity in access, quality, and outcomes.
AHRQ-funded; HS026727.
Citation: Donohue JM, Cole ES, James CV .
The US Medicaid program: coverage, financing, reforms, and implications for health equity.
JAMA 2022 Sep 20;328(11):1085-99. doi: 10.1001/jama.2022.14791..
Keywords: Medicaid, Healthcare Costs, Policy, Health Insurance
Lipton BJ, Decker SL, Stitt B
AHRQ Author: Decker SL Manski RJ
Association between Medicaid dental payment policies and children's dental visits, oral health, and school absences.
The purpose of this cross-sectional study was to assess the relationship between the ratio of Medicaid payment rates to dentist charges and children's preventive dental visits, oral health, and school absences. The researchers conducted a difference-in-differences analysis of 15,738 Medicaid-enrolled children and a control group of 16 867 privately insured children aged 6 to 17 years who participated in the 2016-2019 National Survey of Children's Health. The study found that 87% and 48% of Medicaid-enrolled children had at least 1 and at least 2 past-year dental visits, respectively, and 29% had parent-reported excellent oral health. Increasing the fee ratio by was associated with increases in at least 1 and 2 visits and in excellent oral health. Increases in at least 2 visits were larger for Hispanic children than for White children. By weighted baseline estimates, 28% and 15% of Medicaid-enrolled children had at least 4 and at least 7 past-year school absences, respectively. The researchers concluded that Medicaid policies with higher payments were associated with modest increases in children's preventive dental visits and excellent oral health.
AHRQ-authored.
Citation: Lipton BJ, Decker SL, Stitt B .
Association between Medicaid dental payment policies and children's dental visits, oral health, and school absences.
JAMA Health Forum 2022 Sep 2;3(9):e223041. doi: 10.1001/jamahealthforum.2022.3041..
Keywords: Children/Adolescents, Dental and Oral Health, Medicaid, Payment, Policy
Eliason EL, A Spishak-Thomas, Steenland MW
Association of the Affordable Care Act Medicaid expansions with postpartum contraceptive use and early postpartum pregnancy.
The purpose of this study was to assess the relationship of the Affordable Care Act (ACA) Medicaid expansion with postpartum contraception use and pregnancy. The researchers found that Medicaid expansion was associated with a 7.0 percentage point increase in postpartum use of the contraceptive implant and intrauterine device LARC, a 3.1 percentage point decrease in short-acting contraception, and a 3.9 percentage point decrease in non-prescription contraceptive use overall. Increases in LARC use were concentrated among non-Hispanic, White, and Black respondents. Medicaid expansion was associated with a decrease in early postpartum pregnancy only among non-Hispanic Black respondents. The researchers concluded that the ACA Medicaid expansion improved postpartum contraceptive access and led to shifts from methods with a lower upfront out-of-pocket cost for people without insurance towards methods with the higher upfront out-of-pocket cost for people without insurance. These changes suggest that Medicaid expansions increased access to the full range of contraceptive methods.
AHRQ-funded; HS027464; HS000011
Citation: Eliason EL, A Spishak-Thomas, Steenland MW .
Association of the Affordable Care Act Medicaid expansions with postpartum contraceptive use and early postpartum pregnancy.
Contraception 2022 Sep;113:42-48. doi: 10.1016/j.contraception.2022.02.012..
Keywords: Sexual Health, Pregnancy, Maternal Care, Women, Medicaid, Access to Care, Policy
Newton H, Beetham T, Busch SH
Association of access to crisis intervention teams with county sociodemographic characteristics and state Medicaid policies and Its implications for a new mental health crisis lifeline.
This study’s objective was to assess county-level access to crisis intervention teams (CIS) for acute mental health issues in 2015 and 2020 and its association with area characteristics and state policies in 2020. This cross-sectional study included 10,430 facilities from the 2015 National Directory of Mental Health Treatment Facilities and 10,591 facilities from the 2020 National Directory of Mental Health Treatment Facilities, from 3142 US counties. Area measures included suicide, drug-related overdose mortality, rurality, and demographic characteristics. State-level policies included enactment of 5 Medicaid policies prior to 2020 and 2 recent policies intended to assist implementation of the 988 telephone lifeline. Most US residents (88%) lived in a county that had at least 1 facility offering CIT, although half of all US counties had no CIT facility. Counties without vs those with CIT access were less likely to be in states that expanded Medicare and in states that allow Medicaid to pay for short-term stays in psychiatric hospitals. Residents of counties without CIT access were more likely to be older (>55 years) and uninsured and were more likely to be rural.
AHRQ-funded; HS017589.
Citation: Newton H, Beetham T, Busch SH .
Association of access to crisis intervention teams with county sociodemographic characteristics and state Medicaid policies and Its implications for a new mental health crisis lifeline.
JAMA Netw Open 2022 Jul;5(7):e2224803. doi: 10.1001/jamanetworkopen.2022.24803..
Keywords: Medicaid, Behavioral Health, Access to Care, Policy
Fung V, Yang Z, Cook BL
Changes in insurance coverage continuity after Affordable Care Act expansion of Medicaid eligibility for young adults with low income in Massachusetts.
The purpose of this cohort study was to describe changes in insurance coverage continuity for Medicaid enrollees who turned age 19 years before and after eligibility policy changes from the 2014 Medicaid expansion of the Patient Protection and Affordable Care Act. Between November 1, 2020, and May 12, 2022 the researchers analyzed data from the Massachusetts All-Payer Claims Database (2012 to 2016) to compare coverage for Medicaid beneficiaries turning age 19 years before and after Medicaid expansion. A total of 41,247 young adults turning age 18 to 19 years in the baseline year were included in the study. The researchers found that enrollees who turned age 19 after vs before the Medicaid eligibility expansion were less likely to have 3 or more uninsured months at18 to 19 years of age and 19 to 20 years of age and more likely to have continuous insurance coverage for 12 or more months. Differences in the likelihood of having 3 or more uninsured months decreased at 20 to 21 years of age, when both groups had access to Medicaid. The study concluded that among Medicaid enrollees entering adulthood, the expansion of Medicaid to lower-income adults through the 2014 Patient Protection and Affordable Care Act was associated with a decreased possibility of becoming uninsured.
AHRQ-funded; HS024725.
Citation: Fung V, Yang Z, Cook BL .
Changes in insurance coverage continuity after Affordable Care Act expansion of Medicaid eligibility for young adults with low income in Massachusetts.
JAMA Health Forum 2022 Jul;3(7):e221996. doi: 10.1001/jamahealthforum.2022.1996..
Keywords: Young Adults, Health Insurance, Policy, Medicaid, Access to Care, Low-Income
Escarce JJ, Wozniak GD, Tsipas S
The Affordable Care Act Medicaid expansion, social disadvantage, and the practice location choices of new general internists.
This study’s objective was to examine the level of social disadvantage of the areas of Medicaid expansion states from the ACA that gained new physicians and the areas of nonexpansion states that lost them. The authors used American Community Survey data to classify commuting zones as high, medium, or low social disadvantage. The AMA Physician Masterfile data from 2009-2019 was used to compare where 32,102 new general internists located during the 6 years following the expansion to where they located during the 5 years preceding the expansion. They estimated that between 2014 and 2019 nonexpansion states lost 371 new general internists to expansion states. However, 62.5% of the physicians lost by nonexpansion states were lost from high disadvantage areas although those areas only account for 17.9% of the population of nonexpansion states. This potentially compromises access for all residents irrespective of insurance coverage.
AHRQ-funded; HS025750.
Citation: Escarce JJ, Wozniak GD, Tsipas S .
The Affordable Care Act Medicaid expansion, social disadvantage, and the practice location choices of new general internists.
Med Care 2022 May;60(5):342-50. doi: 10.1097/mlr.0000000000001703..
Keywords: Medicaid, Policy, Provider: Physician, Health Insurance
Gordon SH, Hoagland A, Admon LK
Extended postpartum Medicaid eligibility is associated with improved continuity of coverage in the postpartum year.
The purpose of this study was to explore whether states that adopt the American Rescue Plan Act 0f 2021 option to provide eligibility for pregnancy-related benefits for a full year after birth are likely to improve continuity of postpartum insurance coverage. The researchers utilized linked birth records, income, and all-payer claims data for Medicaid-paid births in Colorado during the period 2014-19. Continuity of coverage during one year postpartum among people eligible for low-income adult Medicaid as compared with those ineligible for Medicaid. The study found that retention of Medicaid coverage as a low-income adult was associated with 1.5 additional months of postpartum insurance enrollment and a 12-percentage-point increase in the probability of continuous insurance coverage during the first year after birth. The study concluded that states adopting the American Rescue Plan Act’s option to extend pregnancy-related benefits for a year after birth are likely to increase continuity of postpartum insurance coverage.
AHRQ-funded; HS027640.
Citation: Gordon SH, Hoagland A, Admon LK .
Extended postpartum Medicaid eligibility is associated with improved continuity of coverage in the postpartum year.
Health Aff 2022 Jan;41(1):69-78. doi: 10.1377/hlthaff.2021.00730..
Keywords: Maternal Care, Medicaid, Women, Pregnancy, Access to Care, Policy
Steenland MW, Wilson IB, Matteson KA
Association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities.
This study’s objective was to measure the association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities. A total of 60,990 childbirths were reviewed from January 1, 2014 on with a total of 72.3% paid for by Medicaid and 27.7% paid for by a commercial payer. The mean age of the birthing person was 27; with 67% White, 22% Black, and 7% Hispanic. Medicaid expansion in Arkansas was associated with a 27.8 percentage point increase in continuous insurance coverage and an increase in outpatient visits of 0.9 during the first 6 months postpartum, representing relative increases of 54.9% and 75.0%, respectively. Racial disparities in postpartum coverage decreased from 6.3 percentage points before expansion to -2.0 after. However, disparities in outpatient care after expansion persisted between Black and White individuals.
AHRQ-funded; HS027464.
Citation: Steenland MW, Wilson IB, Matteson KA .
Association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities.
JAMA Health Forum 2021 Dec;2(12):e214167. doi: 10.1001/jamahealthforum.2021.4167..
Keywords: Medicaid, Maternal Care, Pregnancy, Racial and Ethnic Minorities, Disparities, Policy, Women, Access to Care
McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM
Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid.
The authors examined whether Medicaid participation by low-income adults age 65 and up increased as a result of Medicaid expansions to working-age adults under the Affordable Care Act (ACA). Using American Community Survey data and state variation in ACA Medicaid expansions, they found that Medicaid expansions to working-age adults increased Medicaid participation among low-income older adults by 4.4 percent. They also found evidence of an “on-ramp” effect, which is an important mechanism behind welcome mat effects among some older adults.
AHRQ-funded; HS025422.
Citation: McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM .
Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid.
J Policy Anal Manage 2021 Win;40(1):12-41. doi: 10.1002/pam.22259..
Keywords: Elderly, Medicaid, Medicare, Low-Income, Health Insurance, Policy
Berdahl TA, Moriya AS
AHRQ Author: Berdahl TA, Moriya AS
Insurance coverage for non-standard workers: experiences of temporary workers, freelancers, and part-time workers in the USA, 2010-2017.
This AHRQ-authored paper estimates insurance disparities across non-standard employment categories and determines how coverage disparities shifted following health reform in 2014. Data on working-age adults was analyzed from the 2010-2012 and 2015-2017 MEPS. Uninsurance decreased after health reform for all groups of nonstandard workers with a 10-14% point decline. Uninsurance remained high for all freelance workers at 30.8%, full-time temporary workers (25.1%) and part-time workers (17.9%) compared to full-time workers (11.9%). Lower uninsurance in a Medicaid expansion state was found for all categories of workers.
AHRQ-authored.
Citation: Berdahl TA, Moriya AS .
Insurance coverage for non-standard workers: experiences of temporary workers, freelancers, and part-time workers in the USA, 2010-2017.
J Gen Intern Med 2021 Jul;36(7):1997-2003. doi: 10.1007/s11606-021-06700-0..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Policy, Uninsured, Medicaid, Low-Income
Chow JY, Nijhawan AE, Mathews WC
Hospitalization rates among persons with HIV who gained Medicaid or private insurance after the Affordable Care Act in 2014.
The purpose of this study was to investigate whether gaining inpatient healthcare coverage had an effect on hospitalization rates among persons with HIV following implementation of the Affordable Care Act in 2014. Hospitalization data from 2015 were obtained on adults receiving longitudinal care at HIV clinics; all patients were previously uninsured and supported by the Ryan White HIV/AIDS Program (RWHAP) in 2013. Findings showed that acquiring inpatient coverage was not associated with a change in hospitalization rates.
AHRQ-funded; 290201100007C.
Citation: Chow JY, Nijhawan AE, Mathews WC .
Hospitalization rates among persons with HIV who gained Medicaid or private insurance after the Affordable Care Act in 2014.
J Acquir Immune Defic Syndr 2021 Jun 1;87(2):776-80. doi: 10.1097/qai.0000000000002645..
Keywords: Human Immunodeficiency Virus (HIV), Hospitalization, Medicaid, Health Insurance, Access to Care, Policy
Roberts ET, James AE, Sabik LM
Modernizing Medicaid coverage for Medicare beneficiaries with low income.
Medicaid serves as a supplemental insurer for eleven million low-income Medicare beneficiaries, known as duals. For these beneficiaries, Medicaid pays for Medicare’s out-of-pocket costs, including premiums, deductibles and coinsurance. This paper examined opportunities to close these gaps in Medicaid coverage and discussed how these reforms could complement other efforts to modernize Medicaid for low-income Medicare beneficiaries.
AHRQ-funded; HS026727.
Citation: Roberts ET, James AE, Sabik LM .
Modernizing Medicaid coverage for Medicare beneficiaries with low income.
JAMA Health Forum 2021 Jun;2(6). doi: 10.1001/jamahealthforum.2021.0989..
Keywords: Medicaid, Medicare, Low-Income, Health Insurance, Policy
Malhotra NA, Nevar A, Yearby R
Medicaid's EPSDT benefit: an opportunity to improve pediatric screening for social determinants of health.
This paper discusses the Early and Periodic Screening, Diagnostic, and Treatment (EPDST) benefit which is a key component of Medicaid policy intended to define an essential set of services provided to patients age 21 and younger. This qualitative review examines the extent to which EPSDT might be used to implement structured screening to identify environmental and social factors affecting children’s health. Semistructured interviews conducted in 2017 were triangulated with a review of the recent literature to describe how states currently consider the EPSDT benefit with respect to social determinants of health (SDOH) screening. Findings suggest that with sufficient stakeholder advocacy given the evidence supporting social determinants of health as “medically necessary”, EPSDT benefits could be considered as a funding source to incentivize the incorporation of SDOH screening into the basic package of well-child care.
AHRQ-funded; 233201600221A.
Citation: Malhotra NA, Nevar A, Yearby R .
Medicaid's EPSDT benefit: an opportunity to improve pediatric screening for social determinants of health.
Med Care Res Rev 2021 Apr;78(2):87-102. doi: 10.1177/1077558719874211..
Keywords: Children/Adolescents, Medicaid, Social Determinants of Health, Screening, Disparities, Policy
Fung V, Price M, Hull P
Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries.
The purpose of this study was to examine the association between the Affordable Care Act (ACA) fee bump and primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Medicare claims data from 2012 to 2016 was used. Findings showed that the ACA fee bump was not associated with increases in primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Additionally, visits for dual-eligible beneficiaries with primary care physicians decreased after the ACA, a decrease that was partially offset by increases in visits with nonphysician clinicians.
AHRQ-funded; HS024725; HS025378.
Citation: Fung V, Price M, Hull P .
Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries.
JAMA Netw Open 2021 Jan;4(1):e2033424. doi: 10.1001/jamanetworkopen.2020.33424..
Keywords: Access to Care, Medicaid, Medicare, Health Insurance, Healthcare Costs, Policy
Hatch B, Hoopes M, Darney BG
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Researchers assessed whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers. Data was collected from electronic health records in 14 states. The researchers found that among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and non-expansion states, although the overall rates remained low. They recommended continued support to overcome barriers to preventive care in this population.
AHRQ-funded; HS025155.
Citation: Hatch B, Hoopes M, Darney BG .
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Womens Health Issues 2021 Jan-Feb;31(1):9-16. doi: 10.1016/j.whi.2020.08.011..
Keywords: Cancer, Medicaid, Health Insurance, Uninsured, Access to Care, Policy, Cancer: Cervical Cancer, Prevention, Women, Healthcare Utilization
Larson AE, Hoopes M, Angier H
Private/marketplace insurance in community health centers 5 years post-affordable care act in Medicaid expansion and non-expansion states.
This study compared differences in private/marketplace insurance in community health centers (CHCs) 5 years post-Affordable Care Act (ACA) in Medicaid expansion and non-expansion states. Electronic health record data from 702,663 patients in clinics across 20 states was used to explore trends in private/market insurance post-expansion and whether CHC patients retain private/marketplace insurance. The authors found that patients in non-expansion state CHCs relied more heavily on private/marketplace insurance than patients in expansive states and had increased visits from 2014 through 2018. There was a more pronounced seasonal variation in private/marketplace-insured visits too. A greater percentage of those who in non-expansion states did not retain private/marketplace insurance become uninsured, while those in expansion states gained other types of health insurance.
AHRQ-funded; HS024270.
Citation: Larson AE, Hoopes M, Angier H .
Private/marketplace insurance in community health centers 5 years post-affordable care act in Medicaid expansion and non-expansion states.
Prev Med 2020 Dec;141:106271. doi: 10.1016/j.ypmed.2020.106271..
Keywords: Medicaid, Health Insurance, Access to Care, Policy
Hudson JL, Moriya AS
AHRQ Author: Hudson JL
The role of marketplace policy on welcome mat effects for children eligible for Medicaid or the Children's Health Insurance Program.
This study examined the role of marketplace policy on “welcome mat” effects for children eligible for Medicaid or the Children’s Health Insurance Program (CHIP). Data from the American Community Survey from 2013-2018 was used to estimate the relationship between Marketplace policy and increases in Medicaid/CHIP coverage among pre-ACA eligible children after the implementation of the Affordable Care Act (ACA). The sample included non-disabled citizen children ages 0-18 at 139-250% federal poverty level who were Medicaid/CHIP-eligible before and after implementation of the ACA. Marketplace policies and enrollment were compared in expansion states versus non-expansion states. Public coverage did increase more in states that empowered their Marketplace to enroll publicly-eligible applicants directly into Medicaid/CHIP. This was driven by enrollment policy, not by choice of state-based versus federal-based Marketplaces. Welcome mats were largest in expansion states and increases ranged from 9 to 13 percentage points in enrollment.
AHRQ-authored.
Citation: Hudson JL, Moriya AS .
The role of marketplace policy on welcome mat effects for children eligible for Medicaid or the Children's Health Insurance Program.
Inquiry 2020 Jan-Dec;57:46958020952920. doi: 10.1177/0046958020952920..
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Medicaid, Health Insurance, Policy, Uninsured, Access to Care
Khouja T, Burgette JM, Donohue JM
Association between Medicaid expansion, dental coverage policies for adults, and children's receipt of preventive dental services.
Researchers examined whether low-income children's use of preventive dental services is linked to variation in state Medicaid policies that affect parents' access to dental care in Medicaid. Using MEPS data along with Area Health Resources File and Medicaid adult dental coverage policies, they found no change in children's receipt of preventive dental care associated with Medicaid expansions in states that covered vs did not cover preventive dental services for adults. They concluded that factors other than parental access to dental benefits through Medicaid may be more salient determinants of preventive dental care use among low-income children.
AHRQ-funded; HS026727.
Citation: Khouja T, Burgette JM, Donohue JM .
Association between Medicaid expansion, dental coverage policies for adults, and children's receipt of preventive dental services.
Health Serv Res 2020 Oct;55(5):642-50. doi: 10.1111/1475-6773.13324..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Dental and Oral Health, Medicaid, Health Insurance, Low-Income, Access to Care, Policy
Roberts ET, Nimgaonkar A, Aarons J
New evidence of state variation in Medicaid payment policies for dual Medicare-Medicaid enrollees.
The authors developed 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. Information from 2004-2018 was consolidated from online Medicaid policy documents, state laws, and policy data reported to them by state Medicaid programs. The database showed that in 2018 42 states had policies to limit Medicaid payments of Medicare cost sharing when Medicaid’s fee schedule was lower than Medicare’s. This was an increase from 36 such states in 2004. In most states, combined Medicare and Medicare payments for evaluation and management services provided to duals averaged 78% of the Medicare allowed amount for these services.
AHRQ-funded; HS026727.
Citation: Roberts ET, Nimgaonkar A, Aarons J .
New evidence of state variation in Medicaid payment policies for dual Medicare-Medicaid enrollees.
Health Serv Res 2020 Oct;55(5):701-09. doi: 10.1111/1475-6773.13545..
Keywords: Medicaid, Medicare, Payment, Policy, Healthcare Costs, Health Insurance
Cha P, Brindis CD
Early Affordable Care Act Medicaid: coverage effects for low- and moderate-income young adults.
This study examined the effects of early Medicaid expansions on low- and moderate-income young adults. They used the American Community Survey 2008-2013 to study three early expansion states: California, Connecticut and Minnesota. Results shows that Medicaid expansion reduced uninsurance in all three states and increased public insurance in California and Minnesota. Young men benefitted more than young women, who historically tend to be uninsured.
AHRQ-funded; HS022241.
Citation: Cha P, Brindis CD .
Early Affordable Care Act Medicaid: coverage effects for low- and moderate-income young adults.
J Adolesc Health 2020 Sep;67(3):425-31. doi: 10.1016/j.jadohealth.2020.05.029..
Keywords: Young Adults, Policy, Medicaid, Uninsured, Access to Care