National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (8)
- Behavioral Health (2)
- Cardiovascular Conditions (1)
- Case Study (1)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (2)
- Chronic Conditions (1)
- Community Partnerships (1)
- Dental and Oral Health (1)
- Disabilities (1)
- Healthcare Costs (3)
- Health Insurance (11)
- Low-Income (3)
- Maternal Care (2)
- (-) Medicaid (19)
- Medical Expenditure Panel Survey (MEPS) (2)
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- Payment (1)
- (-) Policy (19)
- Pregnancy (2)
- Provider: Physician (1)
- Quality Measures (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (1)
- Sexual Health (1)
- Surgery (1)
- Uninsured (4)
- Women (2)
- Young Adults (1)
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 19 of 19 Research Studies DisplayedCreedon 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
Selden TM, Lipton BJ, Decker SL
AHRQ Author: Selden TM, Lipton BJ, Decker SL
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
The researchers found that as of 2015, adults with incomes of 100-138 percent of the federal poverty level had experienced large declines in uninsurance rates in both expansion and nonexpansion states. Adults in expansion and nonexpansion states also experienced similar increases in having a usual source of care and primary care visits, and similar reductions in delayed receipt of medical care due to cost.
AHRQ-authored.
Citation: Selden TM, Lipton BJ, Decker SL .
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
Health Aff 2017 Dec;36(12):2069-77. doi: 10.1377/hlthaff.2017.0830.
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Keywords: Access to Care, Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Charles EJ, Johnston LE, Herbert MA
Impact of Medicaid expansion on cardiac surgery volume and outcomes.
The objective of this study was to evaluate the effect of Medicaid expansion on cardiac surgery volume and outcomes comparing one state that expanded to one that did not. It concluded that Medicaid expansion was associated with fewer uninsured cardiac surgery patients and improved predicted risk scores and morbidity rates. In addition to improving health care financing, Medicaid expansion may positively affect patient care and outcomes.
AHRQ-funded; HS022535.
Citation: Charles EJ, Johnston LE, Herbert MA .
Impact of Medicaid expansion on cardiac surgery volume and outcomes.
Ann Thorac Surg 2017 Oct;104(4):1251-58. doi: 10.1016/j.athoracsur.2017.03.079.
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Keywords: Patient-Centered Outcomes Research, Medicaid, Surgery, Cardiovascular Conditions, Policy
Huguet N, Hoopes MJ, Angier H
Medicaid expansion produces long-term impact on insurance coverage rates in community health centers.
This study assesses changes in insurance status of patients visiting community health centers (CHCs) comparing states that expanded Medicaid to those that did not. Rates of uninsured visits decreased pre- to post- Affordable Care Act with greater drops in expansion (-57 percent) versus nonexpansion (-20 percent) states. Medicaid-insured visits increased 60 percent in expansion states while remaining unchanged in nonexpansion states.
AHRQ-funded; HS024270.
Citation: Huguet N, Hoopes MJ, Angier H .
Medicaid expansion produces long-term impact on insurance coverage rates in community health centers.
J Prim Care Community Health 2017 Oct;8(4):206-12. doi: 10.1177/2150131917709403.
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Keywords: Community Partnerships, Health Insurance, Policy, Medicaid, Uninsured
Gonzales G, Golberstein E, Hill SC
AHRQ Author: Hill, SC; Zuvekas, SH
Psychological distress and enrollment in Medicaid.
Adults with poor mental health may want and need insurance to obtain care, but symptoms may impede enrollment into public health insurance. The enrollment response to Medicaid expansions prior to the Affordable Care Act was stronger for adults symptomatic of psychological distress compared with adults without distress and compared to adults with chronic physical health problems.
AHRQ-authored.
Citation: Gonzales G, Golberstein E, Hill SC .
Psychological distress and enrollment in Medicaid.
J Behav Health Serv Res 2017 Oct;44(4):523-35. doi: 10.1007/s11414-016-9532-9.
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Keywords: Access to Care, Policy, Medicaid, Medical Expenditure Panel Survey (MEPS), Behavioral Health
Hatch B, Marino M, Killerby M
Medicaid's impact on chronic disease biomarkers: a cohort study of community health center patients.
This study assessed changes in biomarkers of chronic disease among community health center (CHC) patients who gained Medicaid coverage with the Oregon Medicaid expansion (2008-2011). It found that patients with uncontrolled chronic conditions experienced objective health improvements over time. In two of three chronic disease cohorts, those who gained Medicaid coverage were more likely to achieve a controlled measurement than those who remained uninsured.
AHRQ-funded; HS024270.
Citation: Hatch B, Marino M, Killerby M .
Medicaid's impact on chronic disease biomarkers: a cohort study of community health center patients.
J Gen Intern Med 2017 Aug;32(8):940-47. doi: 10.1007/s11606-017-4051-9.
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Keywords: Medicaid, Chronic Conditions, Access to Care, Policy
Decker SL, Lipton BJ, Sommers BD
AHRQ Author: Decker SL, Lipton BJ
Medicaid expansion coverage effects grew in 2015 with continued improvements in coverage quality.
The researchers used detailed federal survey data through 2015 to analyze recent changes in coverage for low-income adults after the expansion associated with the Affordable Care Act's (ACA's) Medicaid expansion in 2014. They found that the uninsurance rate fell in both expansion and nonexpansion states but that it fell significantly more in expansion states.
AHRQ-authored; AHRQ-funded; HS021291.
Citation: Decker SL, Lipton BJ, Sommers BD .
Medicaid expansion coverage effects grew in 2015 with continued improvements in coverage quality.
Health Aff 2017 May;36(5):819-25. doi: 10.1377/hlthaff.2016.1462.
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Keywords: Medicaid, Low-Income, Health Insurance, Uninsured, Policy
Frean M, Gruber J, Sommers BD
Premium subsidies, the mandate, and Medicaid expansion: coverage effects of the Affordable Care Act.
Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. Win this study, the investigators provide the first comprehensive assessment of these provisions' effects, using the 2012-2015 American Community Survey and a triple-difference estimation strategy that exploits variation by income, geography, and time.
AHRQ-funded; HS021291.
Citation: Frean M, Gruber J, Sommers BD .
Premium subsidies, the mandate, and Medicaid expansion: coverage effects of the Affordable Care Act.
J Health Econ 2017 May;53:72-86. doi: 10.1016/j.jhealeco.2017.02.004..
Keywords: Healthcare Costs, Health Insurance, Policy, Medicaid
Jacobs PD, Hill SC, Abdus S
AHRQ Author: Jacobs PD, Hill SC, Abdus S
Adults are more likely to become eligible for Medicaid during future recessions if their state expanded Medicaid.
The researchers simulated eligibility for Medicaid for the period 2005-14 in two scenarios: assuming that each state's eligibility rules in 2009, the year before passage of the Affordable Care Act (ACA), were in place during the entire study period; and assuming that the ACA's expanded eligibility rules were in place during the entire period for all states. Their simulations showed that the ACA expansion increased Medicaid's responsiveness to changes in unemployment.
AHRQ-authored.
Citation: Jacobs PD, Hill SC, Abdus S .
Adults are more likely to become eligible for Medicaid during future recessions if their state expanded Medicaid.
Health Aff 2017 Jan;36(1):32-39. doi: 10.1377/hlthaff.2016.1076.
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Keywords: Medicaid, Health Insurance, Policy, Healthcare Costs
Decker SL, Lipton BJ
AHRQ Author: Decker SL, Lipton BJ
Most newly insured people in 2014 were long-term uninsured.
This study found that in 2014-after the implementation of most of the Affordable Care Act provisions, including Medicaid expansions in some states and subsidies to purchase Marketplace coverage in all states-adults who had been uninsured for more than three years represented a larger share of the newly insured, compared to adults who had been insured for shorter periods of time.
AHRQ-authored.
Citation: Decker SL, Lipton BJ .
Most newly insured people in 2014 were long-term uninsured.
Health Aff 2017 Jan;36(1):16-20. doi: 10.1377/hlthaff.2016.0984.
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Keywords: Health Insurance, Uninsured, Medicaid, Policy
Sohn H, Timmermans S
Social effects of health care reform: Medicaid expansion under the Affordable Care Act and changes in volunteering.
This article examined whether public health policy interventions result in pro-social behaviors. Specifically, it examined the association between Medicaid and volunteer work. Volunteerism is implicated in individuals' health and well-being yet it is highly correlated with a person's existing socioeconomic resources. The investigators found that increased volunteer work associated with Medicaid was greater among minority groups and narrowed existing ethnic differences in volunteerism in states that expanded Medicaid eligibility.
AHRQ-funded; HS000046.
Citation: Sohn H, Timmermans S .
Social effects of health care reform: Medicaid expansion under the Affordable Care Act and changes in volunteering.
Socius 2017 Jan-Dec;3. doi: 10.1177/2378023117700903..
Keywords: Medicaid, Policy, Racial and Ethnic Minorities
Christensen AL, Petersen DM, Burton RA
What factors influence states' capacity to report children's health care quality measures? A multiple-case study.
The objective of this study was to describe factors that influence the ability of state Medicaid agencies to report the Centers for Medicare & Medicaid Services' (CMS) core set of children's health care quality measures . Reporting capacity was influenced by a state's Medicaid data availability, ability to link to other state data systems, past experience with quality measurement, staff time and technical expertise, and demand for the measures.
AHRQ-funded; 290200900019I; 29032004T.
Citation: Christensen AL, Petersen DM, Burton RA .
What factors influence states' capacity to report children's health care quality measures? A multiple-case study.
Matern Child Health J 2017 Jan;21(1):187-98. doi: 10.1007/s10995-016-2108-8.
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Keywords: Quality Measures, Quality of Care, Children's Health Insurance Program (CHIP), Children/Adolescents, Medicaid, Health Insurance, Policy, Case Study