SIRN: Medicaid (Health Care Delivery) (Topic)最新文献

{"title":"The ACA’s Medicaid Expansion: A Review of Ineligible Enrollees and Improper Payments","authors":"Brian Blase, Aaron Yelowitz","doi":"10.2139/ssrn.3515323","DOIUrl":"https://doi.org/10.2139/ssrn.3515323","url":null,"abstract":"Enrollment in state-optional Medicaid expansions has significantly exceeded even the most optimistic forecasts. The open-ended federal financing of new adult Medicaid enrollees at elevated match rates — in excess of 90 percent — creates incentives for states and healthcare providers to improperly enroll new beneficiaries and inadequately monitor costs and eligibility. Several sources find that many states have done a poor job ensuring Medicaid enrollment only of those who meet eligibility requirements. First, several federal audits find massive problems with both incomplete and incompetent reviews and large-scale improper eligibility determinations. We summarize recent work that estimates causal effects of Medicaid expansions on enrollment. Using the publicly available American Community Survey, we demonstrate large increases in potentially improper enrollment from 2012 to 2017 in many expansion states across the United States. The evidence points to egregious eligibility errors in many states, including Arkansas, California, Colorado, Kentucky, Louisiana, Montana, New Mexico, New York, Oregon, Rhode Island, Washington, and West Virginia. Other expansion states have had much lower rates of improper enrollment. We offer recommendations to Congress, the Centers for Medicare and Medicaid Services, and the Congressional Budget Office on ways to confront improper enrollment in Medicaid, including both fundamental reform of program financing and meaningful federal oversight.","PeriodicalId":196880,"journal":{"name":"SIRN: Medicaid (Health Care Delivery) (Topic)","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133346287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimbursement Rates for Primary Care Services: Evidence of Spillover Effects to Behavioral Health","authors":"C. MacLean, C. McClellan, M. Pesko, D. Polsky","doi":"10.3386/W24805","DOIUrl":"https://doi.org/10.3386/W24805","url":null,"abstract":"We study spillover effects from the largest increase in Medicaid reimbursement rates in the history of the program for primary care services to 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. 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 primary care Medicaid reimbursement rates improve behavioral health outcomes among enrollees. We find no evidence that behavioral healthcare service use is altered. Previous economic research shows that the mandated boost increased office visits. Thus our results suggest that primary care providers are efficient in improving behavioral health outcomes among Medicaid enrollees. Given established shortages of behavioral health providers, these findings are important from a healthcare workforce and policy perspective.","PeriodicalId":196880,"journal":{"name":"SIRN: Medicaid (Health Care Delivery) (Topic)","volume":"326 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123148504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Expanding Medicaid Eligibility on Supplemental Security Income Program Participation","authors":"M. Burns, Laura Dague","doi":"10.2139/SSRN.2753784","DOIUrl":"https://doi.org/10.2139/SSRN.2753784","url":null,"abstract":"Low-income adults without dependent children have historically had few paths to obtain public health insurance unless they qualified for Supplemental Security Income (SSI) cash benefits because of a disability. However, in states that expand their Medicaid programs, childless adults may obtain Medicaid without undergoing an intensive SSI disability review process and with substantially higher income and assets than the SSI program allows. This expanded availability of Medicaid coverage, independent of SSI participation, creates an opportunity to increase earnings and savings without jeopardizing health insurance coverage. In this paper, we use the natural experiments created by state decisions to expand Medicaid to nondisabled, nonelderly adults without dependent children to study the effect of decoupling Medicaid eligibility and cash assistance using a difference-in-differences study design. We collected data on the income eligibility limits, enrollment caps, and coverage characteristics of state Medicaid expansions to childless adults from 2001 to 2013. We combine these data with the nationally representative American Community Survey to estimate the effects of state expansion on SSI participation. We find relative declines in SSI participation of 0.17 percentage points on average after the introduction of Medicaid coverage for childless adults, a 7% relative decrease. This finding suggests the potential for small but important efficiency gains from separating SSI and Medicaid eligibility.","PeriodicalId":196880,"journal":{"name":"SIRN: Medicaid (Health Care Delivery) (Topic)","volume":"253 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116472679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Costs of Caring for the Uninsured Under Well-Structured Safety Net Systems","authors":"M. Hall","doi":"10.2139/ssrn.1623413","DOIUrl":"https://doi.org/10.2139/ssrn.1623413","url":null,"abstract":"Despite comprehensive health insurance reform, over 20 million people will remain uninsured in the United States, amounting to roughly eight percent of the nonelderly population. Therefore, access to affordable care for the uninsured remains a critical issue for states and communities, both leading up to and following federal reform. Federal reform entails or anticipates several substantial changes in support for programs and providers of healthcare for the uninsured. Most visibly, federal support will double for community health centers (CHCs) at the same time that “disproportionate share hospital” (DSH) payments are cut and reallocated. In addition, the reform law requires clearer documentation of the charity care that tax-exempt hospitals provide. Reform also allows funding for several types of demonstration or waiver projects geared to low-income or uninsured populations. The changing landscape of the uninsured calls for renewed focus on model safety-net programs. If the best programs can be sustained and others improved, perhaps a form of nearly-universal coverage could be crafted by supplementing insurance expansions with decent safety-net access for those who unavoidably remain uninsured. Considering such possibilities, however, requires better understanding of the per-person costs of care under well-structured safety net systems. This is a study of model safety net programs for uninsured people in four communities, selected after a thorough national review based on consensus among experts that they are better structured than most. Each program covers a fairly full range of medical services, similar to what conventional insurance covers, and each program assigns members a place to receive primary care and provides an identification card that demonstrates eligibility to receive a range of services.The per person value of care was measured by its institutional costs. Purchased services were valued at paid costs and program costs were valued based on annual financial statements. In each location, a comparison insurance group was selected based on available data, from either a Medicaid program or a private insurance plan in the same city that used the same set of providers. The goal was to determine what would be the estimated cost to that insurer of covering the studied safety net population during the same year (2008). For each insurer, the actual mean cost for covering its nonelderly adults for a similar range of services was adjusted to reflect the demographic and health status mix of the uninsured program population in each location. The monthly cost-value of care per adult in 2008, net of patient copayments, was remarkably similar across three of the four safety net programs, at $141-147 per person. When adjusted for an area’s medical cost index (based on Medicare payments reported in the Dartmouth Atlas), per-person costs differed two-fold among programs with an overall monthly average of $161. The estimated monthly costs to have covere","PeriodicalId":196880,"journal":{"name":"SIRN: Medicaid (Health Care Delivery) (Topic)","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128246183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}