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 102 Research Studies DisplayedEliason EL, Agostino J, Vivier P
Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic.
This cross-sectional study examined the impact that the COVID-19 pandemic had on infant health care, and broke it down by race and ethnicity, income, and insurance type. This study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations. The authors found that among 12,053 parental respondents with infants born from April to December 2020, 7.25% reported cancelations or delays in infant well visits/checkups, 5.49% reported changes to virtual infant care appointments, and 5.33% reported postponing immunizations, with significant differences by race and ethnicity, income, and insurance type. They found higher odds of canceling/delaying visits and postponing immunizations among non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid-paid deliveries. The odds of switching to virtual appointments was also significantly higher among Hispanic infants and infants whose parents had Medicaid-paid deliveries.
AHRQ-funded; HS000011.
Citation: Eliason EL, Agostino J, Vivier P .
Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic.
Acad Pediatr 2024 Jan-Feb; 24(1):105-10. doi: 10.1016/j.acap.2023.07.005..
Keywords: Newborns/Infants, Racial and Ethnic Minorities, COVID-19, Access to Care, Uninsured, Health Insurance, Healthcare Delivery
Bernard DM, Selden TM, Fang Z
AHRQ Author: Bernard
The joint distribution of high out-of-pocket burdens, medical debt, and financial barriers to needed care.
This AHRQ-authored paper examined the joint distribution of three financial problems related to healthcare: high out-of-pocket burdens, medical debt, and financial barriers to needed care. The authors applied relatively strict definitions of financial problems to data from the 2018-2019 MEPS and found that 27% of nonsenior adults lived in families with at least one of the three financial strains assessed. The percentage of participants who faced more broadly defined financial problems was 45.5%. This prevalence varied across sociodemographic characteristics, families' health care needs, insurance coverage, and financial resources.
AHRQ-authored.
Citation: Bernard DM, Selden TM, Fang Z .
The joint distribution of high out-of-pocket burdens, medical debt, and financial barriers to needed care.
Health Aff 2023 Nov; 42(11):1517-26. doi: 10.1377/hlthaff.2023.00604..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Access to Care, Health Insurance
Zachrison KS, Hsia RY, Schwamm LH
Insurance-based disparities in stroke center access in california: a network science approach.
The purpose of this study was to examine whether there is a relationship between ischemic stroke patient insurance and probability of transfer to a stroke center overall as well as whether hospital cluster modified the relationship between insurance and likelihood of stroke center transfer. The study included 332,995 total ischemic stroke encounters, with 3.5% transferred from the initial ED. The study found that of 52,316 participants presenting to a non-stroke center, 7.1% were transferred. Compared to privately insured patients, there were lower odds of transfer and of transfer to a stroke center among all groups. Within the 14 identified hospital clusters, there was variation in insurance-based disparities in transfer. The largest hospital was also the lowest performing cluster which fully explained the insurance-based disparity in odds of stroke center transfer. The study concluded that uninsured patients had lower stroke center access through transfer than patients with insurance, with the variation primarily explained by patterns in 1 specific hospital cluster.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Hsia RY, Schwamm LH .
Insurance-based disparities in stroke center access in california: a network science approach.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009868. doi: 10.1161/circoutcomes.122.009868..
Keywords: Access to Care, Stroke, Cardiovascular Conditions, Disparities, Health Insurance, Uninsured
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
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
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
Atherly A, Feldman R, van den Broek-Altenburg EM
Understanding factors associated with increases in Medicare Advantage enrollment, 2007-2018.
The purpose of this study was to explore the growth in the Medicare Advantage plan market share during a time period of dramatic increase. The authors investigated the factors behind the significant increase in market share of the Medicare Advantage (MA) program during a period where no structural changes were made. The study drew data from 2007-2018 and concluded that Medicare Advantage was becoming more preferred to more educated and nonminority beneficiaries compared to the past, with minority and lower-income beneficiaries also were more likely to choose the program.
AHRQ-funded; HS024281.
Citation: Atherly A, Feldman R, van den Broek-Altenburg EM .
Understanding factors associated with increases in Medicare Advantage enrollment, 2007-2018.
Am J Manag Care 2023 Apr; 29(4):e111-e16. doi: 10.37765/ajmc.2023.89351..
Keywords: Medicare, Access to Care, Health Insurance
Kirby JB, Nogueira LM, Zhao J
AHRQ Author: Kirby JB
Past disruptions in health insurance coverage and access to care among insured adults.
This AHRQ-authored study investigated whether disruptions in health insurance coverage continued to be associated with poor access even after coverage was regained. The study used a nationally representative cohort of insured adults aged 18-64 years (N=39,904). The authors estimated the association between past disruptions in coverage (occurring at least 1 year before) and the risks of lacking a usual source of care provider and having unmet medical need. Among insured nonelderly adults, the risk of being without a usual source of care provider was between 18% and 75% higher than for those with continuous coverage and the risk of having unmet medical needs was between 41% and 66% higher.
AHRQ-authored.
Citation: Kirby JB, Nogueira LM, Zhao J .
Past disruptions in health insurance coverage and access to care among insured adults.
Am J Prev Med 2023 Mar; 64(3):405-13. doi: 10.1016/j.amepre.2022.10.005..
Keywords: Health Insurance, Access to Care
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
Auty SG, Daw JR, Wallace J
State-level variation in supplemental maternity kick payments in Medicaid managed care.
The purpose of the cross-sectional study described in this research letter was to assesses the prevalence and magnitude of state-level delivery event–triggered kick payments to Medicaid managed care (MMC) plans for covering pregnant patients and the association of such payments with delivery costs. MMC kick payment rates were compared with average state Medicaid fee-for-service (FFS) payments for delivery hospitalizations and state kick payment rates compared with the Medicaid-Medicare fee index. The authors found “substantial and potentially unwarranted” state variation in delivery kick payment rates within MMC. They noted that if kick payment rates are set too low, plans may attempt to avoid pregnant enrollees by limiting coverage of certain services or restricting maternity care clinicians in their networks, with consequences for Black and Indigenous maternity patients.
AHRQ-funded; HS028754.
Citation: Auty SG, Daw JR, Wallace J .
State-level variation in supplemental maternity kick payments in Medicaid managed care.
JAMA Intern Med 2023 Jan; 183(1):80-82. doi: 10.1001/jamainternmed.2022.5146..
Keywords: Care Management, Health Insurance, Access to Care, Payment, Maternal 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
Chu J, Roby DH, Boudreaux MH
Effects of the Children's Health Insurance Reauthorization Act on immigrant children's healthcare access.
The purpose of this study was to estimate the effects of the Children's Health Insurance Reauthorization Act (CHIPRA) on insurance coverage, access, utilization, and health outcomes among immigrant children. The researchers utilized the restricted use 2000-2016 National Health Interview Survey (NHIS)with a sample which included immigrant children between the ages of 0 and 18 born outside the United States, with family income below 300% of the Federal Poverty Level (FPL). The study found that CHIPRA was related with a decrease in uninsured rates and an increase in public insurance enrollment for immigrant children. The effects of CHIPRA became small and statistically not significant 3 years after adoption. The researchers found no significant changes in health care access and utilization, and health outcomes, overall and across subgroups due to CHIPRA. The researchers concluded that the eligibility expansion of CHIPRA was related with increases in public insurance coverage for low-income children. However, no effect of CHIPRA on access to care and health was found.
AHRQ-funded; HS028532.
Citation: Chu J, Roby DH, Boudreaux MH .
Effects of the Children's Health Insurance Reauthorization Act on immigrant children's healthcare access.
Health Serv Res 2022 Dec;57(suppl 2):315-25. doi: 10.1111/1475-6773.14061..
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Health Insurance, Access to Care, Vulnerable Populations, Uninsured
Yabroff KR, Han X, Zhao J
AHRQ Author: Kirby J
Association of health insurance coverage disruptions with mortality risk among US working-age adults.
This cohort study assessed associations of a prior coverage disruption with mortality risk among large, nationally representative cohorts of working-age adults aged 18 to 64 with public or private health insurance coverage. Most research had previously been conducted among Medicaid enrollees, and little is known about insurance disruption among privately insured adults. The study used data from the 2000 to 2018 National Health Interview Survey (NIHS), specifically from the NHIS Linked Mortality files which contain data from the National Death Index. All data was deidentified and publicly available. The authors found that disruptions were associated with a higher mortality risk in either publicly or privately insured adults.
AHRQ-authored.
Citation: Yabroff KR, Han X, Zhao J .
Association of health insurance coverage disruptions with mortality risk among US working-age adults.
JAMA Health Forum 2022 Nov;3(11):e224258. doi: 10.1001/jamahealthforum.2022.4258..
Keywords: Health Insurance, Mortality, Risk, Access to Care
Eliason Gordon, Gordon SH
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
This study assessed the association between postpartum insurance instability and access to postpartum mental health services. The authors used data from the 2018-2019 Colorado Health eMoms survey, which sampled mothers from the 2018 birth certificate files at 3-6 months and 12-14 months postpartum. Respondents were classified at each time point as stably insured or unstable insured based on postpartum insurance status. Of respondents with public coverage at childbirth, 33.2% experienced postpartum insurance changes compared with 9.5% with private coverage. Respondents were more likely to experience unstable postpartum insurance if they were younger, had incomes of less than $50,000, and were of Hispanic ethnicity. Respondents who experienced postpartum insurance instability had lower odds of reporting that they discussed mental health at a postpartum check-up and received postpartum mental health services.
AHRQ-funded; HS000011.
Citation: Eliason Gordon, Gordon SH .
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
Womens Health Issues 2022 Nov-Dec;32(6):550-56. doi: 10.1016/j.whi.2022.06.010..
Keywords: Maternal Care, Access to Care, Women, Behavioral Health, 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
Kirby JB, Nogueira L, Zhao J
AHRQ Author: Kirby JB
Do disruptions in health insurance continue to affect access to care even after coverage is regained?
Researchers investigated the association between having a usual source of care provider (USCP) and past disruptions in insurance coverage among insured adults using a longitudinal, nationally representative sample. Using MEPS data, they found that, compared to people who were continuously insured, those with previous insurance coverage disruptions, even short ones, were less likely to have a USCP.
AHRQ-authored.
Citation: Kirby JB, Nogueira L, Zhao J .
Do disruptions in health insurance continue to affect access to care even after coverage is regained?
J Gen Intern Med 2022 Aug;37(10):2579-81. doi: 10.1007/s11606-021-07187-5..
Keywords: Medical Expenditure Panel Survey (MEPS), 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