Publicly-funded programs that cover medical and long-term care for low-income adults, children, and people with disabilities. Medicaid expansion is one of the central tools to increase insurance coverage rates through the Affordable Care Act.

A Cautionary Tale About Medicaid Work Requirements

May. 14, 2020

In a new paper in JAMA Network Open, our team looked at the potential effects of Medicaid work requirements on Medicaid participation among those not actually subject to these requirements. We estimate that these “spillover effects” – which thus far have not been part of the conversation on work requirements – could be quite large. How we arrived at this answer is worth a bit of explanation.

Medicaid Expansion’s Effects on Patients with Newly Diagnosed, Common Screenable Cancers

Feb. 24, 2020

In our study of nearly a million patients with newly diagnosed breast, colon, or lung cancer, the Affordable Care Act’s Medicaid expansion was associated with a decreased rate of uninsurance and a shift toward earlier-stage cancer diagnosis. Despite concerns that coverage expansions would result in longer wait times for treatment, my colleagues and I found no evidence that Medicaid expansion worsened access to timely cancer-directed therapies.

Revisiting CHIP Buy-In Programs for Children

Issue Brief
Feb. 14, 2020

States have a long history of providing families with the option to purchase Medicaid or Children’s Health Insurance Program (CHIP) coverage for their children, but these programs have dwindled in recent years. In a February 2020 Health Affairs blog post, we review states’ experiences with buy-in programs for children, present updated information on the four remaining CHIP buy-in programs, and compare them to child-only coverage on the individual market. This document provides an overview of our findings.

Healthcare Utilization and Spending for Children with Mental Health Conditions in Medicaid

Stephanie Doupnik, MD
Feb. 1, 2020

Stephanie K. Doupnik, Jonathan Rodean, James Feinstein, James C. Gay, Julia Simmons, Jessica L. Bettenhausen, Jessica L. Markham, Matt Hall, Bonnie T. Zima, Jay G. Berry

Abstract [from journal]

Objective: To examine how characteristics vary between children with any mental health (MH) diagnosis who have typical spending and the highest spending; to identify independent predictors of highest spending; and to examine drivers of spending groups.

Methods: This retrospective analysis utilized 2016 Medicaid claims from 11 states and included 775,945 children ages 3-17 years with any MH diagnosis and at least 11 months of continuous coverage. We compared demographic characteristics and Medicaid expenditures


Association of a Targeted Population Health Management Intervention with Hospital Admissions and Bed-Days for Medicaid-Enrolled Children

David M. Rubin, MD, MSCE
Dec. 2, 2019

David M. Rubin, Chén C. Kenyon, Douglas Strane, Elizabeth Brooks, Genevieve P. Kanter,  Xianqun Luan, Tyra Bryant-Stephens, Roberto Rodriguez, Emily F. Gregory,  Leigh Wilson, Annique Hogan, Noelle Stack,...

Abstract [from journal]

Importance: As the proportion of children with Medicaid coverage increases, many pediatric health systems are searching for effective strategies to improve management of this high-risk population and reduce the need for inpatient resources.

Objective: To estimate the association of a targeted population health management intervention for children eligible for Medicaid with changes in monthly hospital admissions and bed-days.

Design, Setting, and Participants: This quality...

Are Medicaid Coverage Gaps Associated with Higher Health Care Resource Utilization and Costs in Patients with Schizophrenia?

Oct. 8, 2019

Dominic Pilon, Antoine C. El Khoury, Ameur M. Manceur, Maryia Zhdanava, Carmela Benson, Patrick Lefebvre, Jalpa A. Doshi

Abstract [from journal]

The objective was to assess the association of Medicaid coverage gaps with health care resource utilization (HRU) and costs of patients with schizophrenia. Patients with schizophrenia were identified from the Medicaid database. The beginning of the first eligible gap was defined as the index date. Per-patient per-month (PPPM) HRU and costs before versus after a gap were assessed, and the association between gap duration and PPPM HRU and costs was examined up to 12 months post index. Together with 95% confidence intervals, HRU differences were reported


Health Care Safety-Net Programs After The Affordable Care Act

Issue Brief
Oct. 1, 2019

Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.