National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 134 Research Studies DisplayedRoberts ET, Xue L, Lovelace J
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
This study’s objective was to evaluate changes in care associated with integrating Medicare and Medicaid coverage in a fully integrated dual-eligible special needs plan (FIDE-SNP) in Pennsylvania. This cohort study used a difference-in-differences analysis compared changes in care between 2 cohorts of dual-eligible individuals: (1) an integration cohort composed of Medicare Dual Eligible Special Needs Plan enrollees who joined a companion Medicaid plan following a 2018 state reform mandating Medicaid managed care (leading to integration), and (2) a comparison cohort with nonintegrated coverage before and after the start of Medicaid managed care. Analyses were conducted of outcomes in 4 domains: use of home- and community-based services (HCBS), care management and coordination, hospital stays and postacute care, and long-term nursing home stays. The study included 7967 individuals in the integration cohort and 3832 individuals in the comparison cohort. HCBS use increased differentially in the integration vs comparison cohorts by 0.61 days/person-month. However, integration was not associated with changes in care management and coordination, including medication use for chronic conditions (-0.02 fills/person-month) or follow-up outpatient care after a hospital stay (-0.01 visits/hospital stay). There was no significant difference in hospital stays between the cohorts.
AHRQ-funded; HS026727.
Citation: Roberts ET, Xue L, Lovelace J .
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
JAMA Health Forum 2023 Dec; 4(12):e234583. doi: 10.1001/jamahealthforum.2023.4583..
Keywords: Medicare, Medicaid, Health Insurance, Surgery, Outcomes
Mellor JM, McInerney M, Garrow RC
The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries.
This study examined indirect spillover effects of Affordable Care Act (ACA) Medicaid expansions to working-age adults on health care coverage, spending, and utilization by older low-income Medicare beneficiaries. The authors used data from the 2010-2018 Health and Retirement Study survey linked to annual Medicare beneficiary summary files. They estimated individual-level difference-in-differences models of total spending for inpatient, institutional outpatient, physician/professional provider services; inpatient stays, outpatient visits, physician visits; and Medicaid and Part A and B Medicare coverage. They also compared changes in outcomes before and after Medicaid expansion in expansion versus nonexpansion states. The sample included low-income respondents aged 69 and older with linked Medicare data, enrolled in full-year traditional Medicare, and living in the community. ACA Medicaid expansion was associated with a 9.8 percentage point increase in Medicaid coverage, a 4.4 percentage point increase in having any institutional outpatient spending, and a positive but statistically insignificant 2.4 percentage point change in Part B enrollment.
AHRQ-funded; HS025422.
Citation: Mellor JM, McInerney M, Garrow RC .
The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries.
Health Serv Res 2023 Oct; 58(5):1024-34. doi: 10.1111/1475-6773.14155..
Keywords: Medicaid, Medicare, Low-Income, Healthcare Utilization, Healthcare Costs, Health Insurance
Decker 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
Eliason EL, Thoma ME, Steenland MW
Differences in use of fertility treatment between people with Medicaid and private health insurance coverage in the United States.
This study compared differences in receipt of any and specific types of fertility services between people with Medicaid and private insurance. The authors used National Survey of Family Growth (2002-2019) data and linear probability regression models to examine the association between insurance type (Medicaid or private) and fertility service use. Primary outcome was use of fertility services in the past 12 months with secondary outcomes use of specific types of fertility services at any time: 1) testing, 2) common medical treatment, and 3) use of any fertility treatment type (testing, medical treatment, or surgical treatment of infertility). In adjusted models, Medicaid coverage was associated with an 11.2% lower use of fertility services in the past 12 months compared with private coverage. Medicaid insurance was also associated with large and statistically significantly lower rates of ever having used infertility testing or any fertility services compared to private insurance coverage. There was no difference in time-to-pregnancy with insurance type.
AHRQ-funded; HS027464; HS000011.
Citation: Eliason EL, Thoma ME, Steenland MW .
Differences in use of fertility treatment between people with Medicaid and private health insurance coverage in the United States.
Womens Health Issues 2023 Jul-Aug; 33(4):367-73. doi: 10.1016/j.whi.2023.03.003..
Keywords: Access to Care, Medicaid, Health Insurance
Eliason E, Admon LK, Steenland MW
Late postpartum coverage loss before COVID-19: implications for Medicaid unwinding.
The purpose of this study was to explore the loss of Medicaid coverage in toward the end of the postpartum period prior to COVID-19 and describe the implications for Medicaid unwinding. The researchers utilized unique Pregnancy Risk Assessment Monitoring System follow-up data from prior to the COVID-19 pandemic. The study found that only 68% of enrollees in prenatal Medicaid maintained continuous Medicaid coverage through 9 or 10 months postpartum. Of the total prenatal Medicaid enrollees who lost their coverage in the early postpartum period, two-thirds continued to be uninsured 9 to 10 months postpartum. The researchers concluded that extensions to state postpartum Medicaid could prevent a return to postpartum coverage loss rates similar to the level in the prepandemic period.
AHRQ-funded; HS027464; HS000011.
Citation: Eliason E, Admon LK, Steenland MW .
Late postpartum coverage loss before COVID-19: implications for Medicaid unwinding.
Health Aff 2023 Jul; 42(7):966-72. doi: 10.1377/hlthaff.2022.01659..
Keywords: COVID-19, Maternal Care, Medicaid, Women, Access to Care, Uninsured, Health Insurance
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
Roberts ET, Mellor JM, McInerny MP
Effects of a Medicaid dental coverage "cliff" on dental care access among low-income Medicare beneficiaries.
Medicare beneficiaries with income levels slightly exceeding the thresholds of eligibility for Medicaid have few affordable options for dental coverage. This gap results in a dental coverage “cliff” above these thresholds. The purpose of this study was to assess how a sudden drop-off in dental coverage from Medicaid impacts access to dental care in low-income Medicare beneficiaries. The researchers studied low-income community resident Medicare recipients whose incomes were within approximately 75 percentage points of state-specific Medicaid income eligibility thresholds. The study found that Medicare beneficiaries whose income was higher than Medicaid eligibility thresholds were 5.0 percentage points more likely to report challenges accessing dental care because of cost concerns or a lack of insurance than beneficiaries below the thresholds.
AHRQ-funded; HS026727; HS025422.
Citation: Roberts ET, Mellor JM, McInerny MP .
Effects of a Medicaid dental coverage "cliff" on dental care access among low-income Medicare beneficiaries.
Health Serv Res 2023 Jun; 58(3):589-98. doi: 10.1111/1475-6773.13981..
Keywords: Dental and Oral Health, Medicaid, Medicare, Health Insurance, Access to Care
Saldanha IJ, Adam GP, Kanaan G
Health insurance coverage and postpartum outcomes in the US: a systematic review.
The objective of this evidence review was to assess whether extension of health insurance coverage or improvements in health care access are associated with postpartum health care utilization and maternal outcomes. Findings with moderate strength of evidence suggested that more comprehensive association was likely to be related to greater postpartum visit attendance; findings with low strength of evidence indicated a possible association between more comprehensive insurance, fewer preventable readmissions, and emergency department visits. The authors concluded that these findings suggested that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate strength of evidence. They recommended that future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.
AHRQ-funded; 75Q80120D00001.
Citation: Saldanha IJ, Adam GP, Kanaan G .
Health insurance coverage and postpartum outcomes in the US: a systematic review.
JAMA Netw Open 2023 Jun; 6(6):e2316536. doi: 10.1001/jamanetworkopen.2023.16536..
Keywords: Health Insurance, Maternal Care, Women, Outcomes, Medicaid, Patient-Centered Outcomes Research, Evidence-Based Practice
Hogg-Graham R, Mamaril CB, Benitez JA
Impact of state Medicaid expansion on cross-sector health and social service networks: evidence from a longitudinal cohort study.
This study’s objective was to examine the impact of state Medicaid expansion on the delivery of population health activities in cross-sector health and social services networks. The authors used data measuring the composition of cross-sector population health networks from the 2006-2018 National Longitudinal Survey of Public Health Systems (NALSYS) linked with the Area Health Resource File. They restricted their data to jurisdictions serving populations of 100,000 or more and states that had NALSYS observations across all time periods, resulting in a final sample size of 667. Results indicated that Medicaid expansion was associated with a 2.3 percentage point increase in the density of population health networks. Communities in states with expanded Medicaid experienced significant increases in the participation of local public health, local government, hospitals, nonprofits, insurers, and K-12 schools. Of the organizations with significant increases in expansion communities, nonprofits (7.7 percentage points,), local public health agencies (6.5 percentage points), hospitals (5.8 percentage points), and local government agencies (6.0 percentage points) had the largest gains.
AHRQ-funded; HS025494.
Citation: Hogg-Graham R, Mamaril CB, Benitez JA .
Impact of state Medicaid expansion on cross-sector health and social service networks: evidence from a longitudinal cohort study.
Health Serv Res 2023 Jun; 58(3):634-41. doi: 10.1111/1475-6773.14144..
Keywords: Medicaid, Health Insurance, Community-Based Practice, Access to Care
Roberts ET, Kwon Y, Hames AG
Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.
The purpose of this study was to examine whether exceeding the income threshold for Medicaid, which causes a sudden loss of Medicaid eligibility, is related with higher racial and ethnic disparities in access to and use of care. The researchers evaluated Medicare beneficiaries with incomes 0% to 200% of FPL from the 2008 to 2018 biennial waves of the Health and Retirement Study linked to Medicare administrative data. To identify racial and ethnic disparities related with the loss of Medicaid eligibility, the researchers compared discontinuities in outcomes among Black and Hispanic beneficiaries and White beneficiaries. Analyses were conducted between January 1, 2022, and October 1, 2022. The primary outcomes were patient-reported challenges accessing care due to cost and outpatient service use, medication fills, and hospitalizations measured from Medicare administrative data. The study included 8,144 participants representing 151,282, 957 weighted person-years in the community-dwelling population of Medicare beneficiaries aged 50 years and older and incomes less than 200% of the federal poverty level (FPL). Study findings indicate that exceeding the Medicaid eligibility threshold was related with a 43.8 percentage point (pp) lower probability of Medicaid enrollment among Black and Hispanic Medicare beneficiaries and a 31.0 pp lower probability of Medicaid enrollment among White beneficiaries. Among Black and Hispanic beneficiaries, exceeding the threshold was associated with increased cost-related barriers to care, lower outpatient use, and fewer medication fills, but it was not associated with a statistically significant discontinuity in hospitalizations. Discontinuities in these outcomes were smaller or nonsignificant among White beneficiaries. Consequently, exceeding the threshold was associated with widened disparities, including greater reductions in outpatient service use and medication fills among Black and Hispanic vs White beneficiaries.
AHRQ-funded; HS026727.
Citation: Roberts ET, Kwon Y, Hames AG .
Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.
JAMA Intern Med 2023 Jun; 183(6):534-43. doi: 10.1001/jamainternmed.2023.0512..
Keywords: Disparities, Racial and Ethnic Minorities, Medicaid, Access to Care, Health Insurance, Low-Income, Access to Care
Jacobs PD, Moriya AS
AHRQ Author: Jacobs PD, Moriya AS
Changes in health coverage during the COVID-19 pandemic.
This AHRQ-authored paper used data from MEPS to examine patterns of health insurance coverage during the COVID-19 pandemic. The authors compared the proportion of people whose source of coverage changed from 2019 to 2020 with the proportion of people whose source changed from 2018 to 2019. The sample was limited to those who were interviewed in both 2018 and 2019 or in both 2019 and 2020. The analysis looked at people aged 63 or younger in the first year of the sample. The authors found increased stability for children and nonelderly adults during the first year of the pandemic. Fewer people who had Medicaid in 2019 became uninsured in 2020 (4.3%) than in 2018-19 (7.8%). Residents of Medicaid expansion states who were enrolled in 2019 were less likely to become uninsured in 2020 (3.6%) than was the case in the 2018-2019 period (6.0%). This was also true in non-Medicaid expansion states (6.6% vs 12.4%). However, residents of expansion states were more likely to become enrolled in Medicaid in 2020 if they were previously uninsured in 2019 (21.5%) compared with 2018-2019 (15.3%). For nonexpansion states, there was no detectable change in the percentage transitioning from uninsured to Medicaid over the two time periods (8.5% compared with 6.9%).
AHRQ-authored.
Citation: Jacobs PD, Moriya AS .
Changes in health coverage during the COVID-19 pandemic.
Health Affairs 2023 May; 42(5):721-26. doi: 10.1377/hlthaff.2022.01469..
Keywords: Medical Expenditure Panel Survey (MEPS), COVID-19, Health Insurance, Medicaid, Access to Care
Frenier C, McIntyre A
Insurance coverage transitions after disenrollment from Medicaid in Minnesota.
The transition of health insurance following withdrawal from Medicaid is an under-explored area of study. This is particularly significant with the impending cessation of Medicaid's continuous coverage policy due to pandemic relief measures, a shift that is predicted to affect about 18 million individuals. The purpose of this study was to analyze the pattern of insurance transition post-Medicaid disenrollment, specifically in a state where Medicaid expansion was adopted and continuous coverage and eligibility policies were relatively liberal. The study cohort was derived from the Minnesota All Payer Claims Database (MN APCD), with a focus on residents aged 64 or less, who had experienced Medicaid enrollment cessation between January 2018 and February 2019. The final sample included 346,734 cases of Medicaid disenrollment. The study found that approximately 50% of individuals who disenrolled from Medicaid in Minnesota were without observable coverage six months later, with a significant percentage returning to Medicaid within a year. It was also observed that many enrollees didn't transition seamlessly to new coverage, indicating that a meaningful proportion of disenrollment may have occurred among those who were still eligible for Medicaid or experienced short-term changes in eligibility that didn't last for an entire year.
AHRQ-funded; HS017589.
Citation: Frenier C, McIntyre A .
Insurance coverage transitions after disenrollment from Medicaid in Minnesota.
JAMA Netw Open 2023 Apr 3; 6(4):e239379. doi: 10.1001/jamanetworkopen.2023.9379..
Keywords: Health Insurance, Medicaid, Uninsured
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
Ellison JE, Kumar S, Steingrimsson JA
Comparison of low-value care among commercial and Medicaid enrollees.
Inefficient healthcare practices, known as low-value care, can be expensive and negatively impact patient outcomes. Despite increased utilization of low-value services, little is understood about the variation in low-value care across different payment systems. The purpose of this retrospective observational study was to examine disparities in low-value care utilization between patients with commercial insurance and those covered by Medicaid. Using the 2017 Rhode Island All-payer Claims Database, this study estimated the likelihood of receiving one of 14 low-value services among commercial and Medicaid enrollees, while accounting for patient sociodemographic and clinical factors. Medicaid and commercial insurance enrollees aged 18-64 who had continuous coverage and an encounter where they could potentially receive a low-value service. The study found that of the 110,609 patients, those enrolled in Medicaid were younger, possessed more comorbidities, and were predominantly female compared to commercial insurance enrollees. Medicaid patients exhibited higher utilization rates for 7 low-value care measures, while commercial insurance patients had higher rates for 5 measures. Overall, commercial insurance patients received more low-value services than Medicaid patients. Furthermore, commercial insurance patients were more likely to receive low-value services typically conducted in emergency departments and less costly services.
AHRQ-funded; HS000011
Citation: Ellison JE, Kumar S, Steingrimsson JA .
Comparison of low-value care among commercial and Medicaid enrollees.
J Gen Intern Med 2023 Mar;38(4):954-60. doi: 10.1007/s11606-022-07823-8.
Keywords: Medicaid, Health Insurance
Maclean JC, McClellan C, Pesko MF
AHRQ Author: McClellan C
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
This AHRQ-authored research studied the effects of changing Medicaid reimbursement rates for primary care services on behavioral health outcomes-defined here as mental illness and substance use disorders. The authors applied two-way fixed-effects regressions to survey data specifically designed to measure behavioral health outcomes over the period 2010-2016. They found that higher primary care reimbursement rates reduce mental illness and substance use disorders among non-elderly adult Medicaid enrollees, although they interpreted findings for substance use disorders with some caution as they may be vulnerable to differential pre-trends. Overall, their findings suggest positive spillovers from a policy designed to target primary care services to behavioral health outcomes.
AHRQ-authored.
Citation: Maclean JC, McClellan C, Pesko MF .
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
Health Econ 2023 Jan 6;32(4):873-909. doi: 10.1002/hec.4646.
Keywords: Medicaid, Payment, Primary Care, Behavioral Health, Outcomes, Access to Care, Substance Abuse, Health Insurance
Steenland MW, Wherry LR
Medicaid expansion led to reductions in postpartum hospitalizations.
The purpose of this study was to assess whether the Medicaid expansions of the Affordable Care Act (ACA) affected rates of postpartum hospitalization. The researchers compared states that did and did not expand Medicaid under the ACA as they related to changes in hospitalizations among birthing people with a Medicaid-financed delivery. The study found a 17% reduction in hospitalizations during the first 60 days postpartum associated with the Medicaid expansions, and evidence of a lesser decrease in hospitalizations between 61 days and 6 months postpartum. The researchers concluded that Medicaid coverage expansion under the ACA resulted in improved postpartum health for low-income birthing people.
AHRQ-funded; HS027464.
Citation: Steenland MW, Wherry LR .
Medicaid expansion led to reductions in postpartum hospitalizations.
Health Aff 2023 Jan; 42(1):18-25. doi: 10.1377/hlthaff.2022.00819..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Hospitalization, Maternal Care, Women, Health Insurance, Access to Care
Moriya AS, Chakravarty S
AHRQ Author: Moriya AS
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
This AHRQ-authored paper examined whether the 2014 Affordable Care Act (ACA) Medicaid expansions mitigated existing racial or ethnic disparities in preventable hospitalizations and emergency department (ED) visits. The authors used inpatient data from twenty-nine states and ED data from twenty-six states for the period 2011 to 2018. They found that Medicaid expansions decreased disparities in preventable hospitalizations and ED visits between non-Hispanic Black and White nonelderly adults by 10 percent or more. There were no significant effects on disparities between Hispanic and non-Hispanic White nonelderly adults. Their findings highlight sustained improvements in community-level care for non-Hispanic Black populations, but also suggest access barriers experienced by Hispanic adults that need to be addressed beyond Medicaid eligibility expansion.
AHRQ-authored.
Citation: Moriya AS, Chakravarty S .
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
Health Aff 2023 Jan; 42(1):26-34. doi: 10.1377/hlthaff.2022.00460..
Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Emergency Department, Hospitalization, Disparities, Medicaid, Health Insurance, Access to Care
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
Roberts ET, Mellor JM
Differences in care between special needs plans and other Medicare coverage for dual eligibles.
This study compared access to, use of, and satisfaction with care among dual eligibles enrolled in Dual Eligible Special Needs Plans (D-SNPs) versus those enrolled in Medicare Advantage (MA) plans and traditional Medicare. Findings showed that, compared with those in traditional Medicare, dual eligibles generally reported greater access to care, preventive service use, and satisfaction with care in D-SNPs. There were, however, fewer differences in these outcomes among dual eligibles in D-SNPs versus other MA plans. Overall, these findings suggested that D-SNPs altogether have not provided consistently superior or more equitable care, and they highlight areas where federal and state policy could strengthen incentives for D-SNPs to improve care.
AHRQ-funded; HS026727; HS025422.
Citation: Roberts ET, Mellor JM .
Differences in care between special needs plans and other Medicare coverage for dual eligibles.
Health Aff 2022 Sep;41(9):1238-47. doi: 10.1377/hlthaff.2022.00463..
Keywords: Medicare, Medicaid, Health Insurance, Access to Care
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
Cha P, Escarce JJ
The Affordable Care Act Medicaid expansion: a difference-in-differences study of spillover participation in SNAP.
Medicaid expansion through the Affordable Care Act increased access to insurance coverage to adults under 138% of the federal poverty level and connected individuals to SNAP (the Supplemental Nutrition Assistance Food Program – formerly the Food Stamp Program). The purpose of this study was to estimate the effect of Medicaid expansion on SNAP participation among 414,000 individuals across the U.S. The study found that there was a 2.9% increase in SNAP participation produced by Medicaid expansion among individuals living under 138% of the federal poverty level. In subgroup analyses the researchers discovered a 5% increase in households without children below 75% of the federal poverty level, and an increase in SNAP households with zero dollars in income. The study concluded that the impact of the Medicaid expansion on access to SNAP participation was the greatest in very-low-income individuals, and that the impact of Medicaid expansion reaches beyond healthcare by increasing access to other supports like food which is a social determinant of health.
AHRQ-funded; HS000046.
Citation: Cha P, Escarce JJ .
The Affordable Care Act Medicaid expansion: a difference-in-differences study of spillover participation in SNAP.
PLoS One 2022 May 4;17(5):e0267244. doi: 10.1371/journal.pone.0267244..
Keywords: Medicaid, Nutrition, Low-Income, Health Insurance
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
Decker SL, Abdus S, Lipton BJ
AHRQ Author: Decker SL, Abdus S
Eligibility for and enrollment in Medicaid among nonelderly adults after implementation of the Affordable Care Act.
The authors used simulation modeling to examine Medicaid eligibility and participation during 2014 to 2017. They found that more than one in five adults were Medicaid-eligible in expansion states, while about one in 30 adults were Medicaid-eligible in non-expansion states. Further, while eligibility rates differed substantially by expansion status, participation rates among Medicaid-eligible adults were similar in both sets of states, indicating that differences in eligibility, rather than in participation rates, explained differences in enrollment between expansion and non-expansion states during the study period.
AHRQ-authored.
Citation: Decker SL, Abdus S, Lipton BJ .
Eligibility for and enrollment in Medicaid among nonelderly adults after implementation of the Affordable Care Act.
Med Care Res Rev 2022 Feb;79(1):125-32. doi: 10.1177/1077558721996851..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicaid, Health Insurance
Dennett JM, Baicker K
Medicaid, health, and the moderating role of neighborhood characteristics.
The purpose of this study was to evaluate whether the characteristics of different neighborhoods have an impact on the interaction between local environment and the effect of health insurance on health. The researchers utilized existing data from the Oregon Health Insurance Experiment and combined it with new, expanded data on neighborhood characteristics to assess whether those characteristics impacted the relationship between getting health insurance and health outcomes. The study found that the multiple domains of neighborhood characteristics did not affect the correlation between insurance and health outcomes, and concluded that Medicaid expansions do not differ greatly in effectiveness across neighborhoods.
AHRQ-funded; HS000055.
Citation: Dennett JM, Baicker K .
Medicaid, health, and the moderating role of neighborhood characteristics.
J Urban Health 2022 Feb;99(1):116-33. doi: 10.1007/s11524-021-00579-2..
Keywords: Medicaid, Social Determinants of Health, Health Insurance