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.

Strengthening Medicaid Waiver Evaluations

Dec. 3, 2018

States are considered “laboratories of democracy,” allowing experimentation with innovative reforms that could potentially be adopted at the national level. To test new approaches in their Medicaid programs, states have embraced Section 1115 waivers, which permit innovations that do not meet federal program rules, but still promote the program’s objectives.

Transportation and Medicaid: Breaking Through the Gridlock

Nov. 17, 2018

Lack of transportation has been an enduring barrier to care, especially for low-income and rural patients. Many of these patients are covered by Medicaid, which, since 1966, has provided non-emergency transportation (NEMT) to medical appointments for free or at a heavily subsidized rate. Although NEMT is built into the foundation of Medicaid, some state governments are seeking leeway to drop that benefit. The movement stems from persistent budget constraints and a view that NEMT is ineffective.

Supply of Primary Care Providers and Appointment Availability for Philadelphia's Medicaid Population

Issue Brief
Oct. 23, 2018

This brief analyzes the supply of primary care providers serving the Medicaid population in Philadelphia, and the geographic variability of this measure across the city. It also examines important measures of access – appointment availability and wait time for an initial appointment – that highlight challenges faced by Medicaid patients.

Primary Care Access for Philadelphia’s Medicaid Population

Oct. 23, 2018

Following Medicaid expansion in Pennsylvania in 2015, more than one in five non-elderly adults in Philadelphia are now covered by Medicaid. This population faces unique challenges with accessing primary care, including fewer providers accepting Medicaid patients. 

Debating Medicaid Rules for Mental Health Care

Aug. 10, 2018

In a recent Scattergood Foundation report, LDI Senior Fellow Dominic Sisti and I tackle the curious case of the “institutions for mental diseases” (IMD) exclusion in Medicaid. For non-elderly adults, the national IMD exclusion prevents Medicaid from paying for inpatient care in institutions with more than 16 beds that primarily provide care for persons with “mental diseases” other than dementia or intellectual disabilities.

Restricted Provider Choice in the ACA Marketplace

Aug. 8, 2018

On November 1st, the sixth year of open enrollment on the ACA Marketplace will start. While the basic rules that govern the Marketplace and the sliding-scale subsidies remain intact, gains in enrollment are unlikely given the end of penalties for the individual mandate, the emergence of association health plans, and new rules related to “short-term limited duration.”

Reimbursement Rates for Primary Care Services: Evidence of Spillover Effects to Behavioral Health

Jul. 30, 2018

Johanna Catherine Maclean, Chandler McClellan, Michael F. Pesko, Daniel Polsky

Abstract [from journal]

We study spillover effects of the largest ever increase in Medicaid primary care reimbursement rates on behavioral health and healthcare outcomes; mental illness, substance use disorders, and tobacco product use. Much of the variation in Medicaid reimbursement rates we leverage is attributable to a large federally mandated increase between 2013 and 2014 through the Affordable Care Act. We apply differences-in-differences models to survey data specifically designed to measure behavioral health outcomes over the period 2010 to 2016. We find that higher...

Narrow Networks Through A Pediatric Lens

Jul. 9, 2018

The adequacy of “narrow network” plans offered on the Affordable Care Act (ACA) Marketplaces continues to be a concern in the wake of exclusions of some high-cost providers and the incidence of “surprise medical bills” even in facilities that are in-network.

SUMR 2018 Attends AHRQ National Research Service Awards Conference

Jul. 2, 2018
The 24nd annual National Research Service Award (NRSA) Conference took place in tandem with the 2018 AcademyHealth Annual Research Meeting at the Sheraton Seattle Hotel and the adjacent Washington State Convention Center. NRSA is part of the Agency for Healthcare Research and Quality (AHRQ) program that provides training, grants and other supports to undergraduate, predoctoral and postdoctoral trainees and fellows in the health services research field. This year's event was attended by 23 Summer Undergraduate Minority Research (SUMR) scholars from the University of Pennsylvania program co-...

What State Legislators Say About Medicaid, and Why It Matters

May. 29, 2018

Medicaid’s federal-state partnership structure has long permitted states to adopt modifications to coverage design, including benefits and cost-sharing. That structure, combined with an Administration signaling its support for greater state flexibility and funding constraints, could produce substantial shifts in state Medicaid policy.

The Future of Medicaid: State Legislator Views on Policy Waivers

Research Brief
May. 23, 2018

A survey of state legislators revealed clear partisan differences in Medicaid reform priorities and policy preferences that states are pursuing in Section 1115 waiver applications. While there was some agreement across parties on broad goals for the Medicaid program, such as reducing health care spending and increasing affordability of health care, there was little consensus on specific policy changes needed to meet these goals.

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