Medicaid/CHIP

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.

Medicaid Expansion Increased Use of Medications for Opioid Use Among Individuals with Criminal Justice Involvement

Apr. 5, 2021

Individuals involved in the criminal justice system have high rates of opioid use disorder (OUD), but frequently have limited options for treatment. The Affordable Care Act’s Medicaid expansion gave states the opportunity to increase coverage for individuals with criminal justice involvement, but whether that translated into increased access to OUD treatment in this population is an open question.

The Future of Value-Based Payment: A Road Map to 2030

Feb. 18, 2021

The 2020s require a new strategy that moves from a short-term focus on testing new payment models to a long-term focus on expanding models that are most likely to generate substantial savings and improve quality. This white paper outlines a new direction for the federal government—primarily through the Centers for Medicare and Medicaid Services (CMS)—to chart over the next decade aimed at completing the transition to a health care system that pays for value and reduced health disparities, rather than high volumes of services.

The Future of Value-Based Payment

Feb. 18, 2021

A decade of innovation and experimentation has failed to transform the health care system to one that pays for value rather than volume. It is now time to reconsider how value-based payment models can generate substantial savings and improve quality and health equity. Experts from the University of Pennsylvania, with input from a national panel of experts, reviewed the effectiveness of past payment reforms implemented by the Centers for Medicare and Medicaid Services (CMS) and made recommendations about how to accelerate and complete the nation’s transformation to value-based payment. This brief summarizes recommendations that provide a path toward widespread adoption and success of alternative payment models, producing better health outcomes for all Americans, reducing wasteful spending, improving health equity, and more effectively stewarding taxpayer funds to support other national priorities.

Safety-Net Hospitals After Medicaid Expansion

Feb. 15, 2021

In states that expanded Medicaid after the Affordable Care Act (ACA), safety-net hospitals (SNHs) saw their operating margins improve and levels of uncompensated care decrease. But a new study finds that while SNHs were also able to scale up some safety-net services—such as inpatient psychiatric care—these changes did not translate into measurable improvements in quality.

Engaging Consumers in Medicaid Program Design: Strategies from the States

Dec. 15, 2020

Jane M. Zhu, Ruth Rowland, Rose Gunn, Sarah E. Gollust, David T. Grande

Abstract [from journal]

Context: Consumer engagement early in the process of health care policymaking may improve the effectiveness of program planning and implementation, promote patient-centric care, enhance beneficiary protections, and offer opportunities to improve service delivery. As Medicaid programs grow in scale and complexity, greater consumer input may guide successful program design, but little is known about the extent to which state agencies are currently engaging consumers in the design and implementation of programs and policies, and how
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Impact of Medicaid Expansion on Liver-Related Mortality

Dec. 3, 2020

Smriti Rajita Kumar, Sameed Ahmed M. Khatana, David Goldberg

Abstract [from journal]

Background & aims: The Affordable Care Act provided the opportunity for states to expand Medicaid for low-income individuals. Not all states adopted Medicaid expansion, and the timing of adoption among expansion states varied. Prior studies have shown that Medicaid expansion improved mortality rates for several chronic conditions. Although there are data on the association between Medicaid expansion on insurance type among patients waitlisted for a liver transplant, there are no data on its impact on liver

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Association Between Physician Practice Medicaid Acceptance and Employing Nurse Practitioners and Physician Assistants: A Longitudinal Analysis

Nov. 11, 2020

Hilary BarnesMichael R. Richards, Grant R. Martsolf, Sayeh S. Nikpay, Matthew D. McHugh

Abstract [from journal]

Background: Access to care is often a challenge for Medicaid beneficiaries due to low practice participation. As demand increases, practices will likely look for ways to see Medicaid patients while keeping costs low. Employing nurse practitioners (NPs) and physician assistants (PAs) is one low-cost and effective means to achieve this. However, there are no longitudinal studies examining the relationship between practice Medicaid acceptance and NP/PA employment.

Purpose: The purpose of this

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Improving Emergency Care for Children with Complex Conditions

Oct. 29, 2020

Only about 1% of children in the U.S. are considered medically complex, but when you work in a busy Children’s Hospital Emergency Department (ED) in a large urban area, the prevalence seems much higher. We see a range of children with complex conditions, such as severe asthma coupled with significant eczema, metabolic disorders, and illnesses requiring a ventilator or other life-sustaining equipment.

The Design Of A Randomized Controlled Trial To Evaluate Multi-dimensional Effects Of A Section 1115 Medicaid Demonstration Waiver With Community Engagement Requirements

Oct. 7, 2020

Kristin A. Linn, Kristen Underhill, Erica L. Dixon, Elizabeth F. Bair, William J. Ferrell, Margrethe E. Montgomery, Kevin G. VolppAtheendar S. Venkataramani

Abstract [from journal]

Section 1115 demonstration waivers provide a mechanism for states to implement changes to their Medicaid programs. While such waivers are mandated to include evaluations of their impact, randomization - the gold standard for assessing causality - has not typically been a consideration. In a critical departure, the Commonwealth of Kentucky opted to pursue a two-arm randomized controlled trial (RCT) for their controversial 2018 Medicaid Demonstration waiver, which included work requirements as a condition for the subset of

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