Estimating the proportion of Medicaid-eligible pregnant women in Louisiana who do not get abortions when Medicaid does not cover abortion.

BackgroundTo estimate the proportion of pregnant women in Louisiana who do not obtain abortions because Medicaid does not cover abortion.MethodsTwo hundred sixty nine women presenting at first prenatal visits in Southern Louisiana, 2015-2017, completed self-administered iPad surveys and structured interviews. Women reporting having considered abortion were asked whether Medicaid not paying for abortion was a reason they had not had an abortion. Using study data and published estimates of births, abortions, and Medicaid-covered births in Louisiana, we projected the proportion of Medicaid births that would instead be abortions if Medicaid covered abortion in Louisiana.Results28% considered abortion. Among women with Medicaid, 7.2% [95% CI 4.1-12.3] reported Medicaid not paying as a reason they did not have an abortion. Existing estimates suggest 10% of Louisiana pregnancies end in abortion. If Medicaid covered abortion, this would increase to 14% [95% CI 12, 16]. 29% [95% CI 19, 41] of Medicaid eligible pregnant women who would have an abortion with Medicaid coverage, instead give birth.ConclusionsFor a substantial proportion of pregnant women in Louisiana, the lack of Medicaid funding remains an insurmountable barrier to obtaining an abortion. Forty years after the Hyde Amendment was passed, lack of Medicaid funding for abortion continues to have substantial impacts on women's ability to obtain abortions

Restoration of Adult Dental in the State's Medicaid Program

HB1516 SA2 Fact SheetTraditionally Illinois covered non-emergency adult dental services in Medicaid. However, Illinois eliminated these services as a Medicaid benefit for most adults in the Save Medicaid Access & Resources Together (SMART) Act, public act 097-0689 in 2012. HB1516 SA2 would fully restore preventive dental services (such as filling cavities and root canals) for adults under Medicaid

Transitioning From Medicaid Expansion Programs to Medicare: Making Sure Low-Income Medicare Beneficiaries Get Financial Help

The Affordable Care Act allows states to offer Medicaid coverage to low-income adults who would not have qualified under previous law. This population will face higher cost-sharing requirements when they transition to Medicare, although some may be eligible for traditional Medicaid benefits and/or Medicare Savings Programs (MSPs) that will reduce their costs. This report discusses how Medicare beneficiaries can qualify for traditional Medicaid and MSPs. It also provides new state data on the number and characteristics of eligible individuals and discusses the potential impact of expanding traditional Medicaid income and asset rules in the Medicaid expansion states. Finally, the report outlines policy options that would make it easier for Medicare beneficiaries to qualify for traditional Medicaid benefits and MSPs

Shaping Health Policy for Low-Income Populations: An Assessment of Public Comments in a New Medicaid Waiver Process

Since the Supreme Court decided that the Affordable Care Act\u27s (ACA) Medicaid expansion is optional for the states, several have obtained federal approval to use Section 1115 waivers to expand Medicaid while changing its coverage and benefits design. There has long been concern that policy making for Medicaid populations may lack meaningful engagement with low-income constituents, and therefore the ACA established a new process under which the public can submit comments on pending Medicaid waiver applications. We analyzed 291 comment letters submitted to federal regulators pertaining to Medicaid Section 1115 waiver applications in the first five states to seek such waivers: Arkansas, Indiana, Iowa, Michigan, and Pennsylvania. We found that individual citizens, including those who identified as Medicaid-eligible, submitted a sizable majority of the comment letters. Comment letters tended to mention controversial provisions of the waivers and reflected the competing political rhetoric of “personal responsibility” versus “vulnerable populations.” Despite the fact that the federal government seemed likely to approve the waiver applications, we found robust public engagement, reflecting the salience of the issue of Medicaid expansion under the ACA. Our findings are consistent with the argument that Medicaid is a program of growing centrality in US health politics

Dual Eligibles: Medicaid Enrollment and Spending for Medicare Beneficiaries in 2007

Provides an update on the share of total Medicaid enrollment and spending on those eligible for both Medicare and Medicaid through 2007, state-by-state estimates of Medicaid enrollment and expenditures for dual eligibles, and a breakdown of expenditures

Emerging Medicaid Accountable Care Organizations: The Role of Managed Care

Examines the Medicaid payment and care delivery systems in states working to develop accountable care organizations within Medicaid, how ACOs may be structured to fit into them, and how Medicaid ACOs differ from those in Medicare and the private market

Dental safety net capacity: An innovative use of existing data to measure dentists’ clinical engagement in state Medicaid programs

Background The demand for dentists available for state Medicaid populations has long outpaced the supply of such providers. To help understand the workforce dynamics, this study sought to develop a novel approach to measuring dentists’ relative contribution to the dental safety net and, using this new measurement, identify demographic and practice characteristics predictive of dentists’ willingness to participate in Indiana's Medicaid program. Methods We examined Medicaid claims data for 1,023 Indiana dentists. We fit generalized ordered logistic regression models to measure dentists’ level of clinical engagement with Medicaid. Using a partial proportional odds specification model, we estimated proportional adjusted odds ratios for covariates and separate estimates for each contrast of nonproportional covariates. Results Though 75% of Medicaid‐enrolled dentists were active providers, only 27% of them had 800 or more claims during fiscal year 2015. As has been shown in previous studies, our findings from the proportional odds model reinforced certain demographic and practice characteristics to be predictive of dentists’ participation in state Medicaid programs. Conclusions In addition to confirming predictive factors for Medicaid enrollment, this study validated the clinical engagement measure as a reliable method to assess the level of Medicaid participation. Prior studies have been limited by self‐reported data and variations in Medicaid claims reporting

Medicaid and Community Health Centers: The Relationship Between Coverage for Adults and Primary Care Capacity in Medically Underserved Communities

Compares the strength of health centers in states with expanded Medicaid coverage for adults and those in states with limited Medicaid coverage for adults, in terms of number of sites, patients, and staff; revenue; and proportion of revenue from Medicaid

A Decomposition of the Elasticity of Medicaid Nursing Home Expenditures Into Price, Quality, and Quantity Effects

Nursing home expenditures have become a public policy concern primarily because the Medicaid program payes for approximately 50 percent. Medicaid makes health care available to individuals who otherwise could not afford it, by directly reimbursing nursing homes for Medicaid patient care. Typically, Medicaid reimbursement rates are set by a cost plus method, where the reimbursement per patient is equal to average cost plus some return referred to as the Medicaid "plus" factor. This paper estimates the elasticity of Medicaid expenditures with respect to a change in the Medicaid "plus" factor,and decomposes that elasticity into price, quality, and quantity components. The decomposition is derived from a model of nursing home behavior, which shows that an increase in the Medicaid "plus" factor causes nursing homes to admit more Medicaid patients and reduce quality.Total expenditures are the Medicaid reimbursement rate times the number of Medicaid patients receiving care. An increase in the Medicaid "plus" factor affects the Medicaid reimbursement by directly raising the Medicaid "plus" factor, and by indirectly decreasing average cost through a reduction in quality. These are the price and quality effects, respectively. The quantity effect is change in the number of Medicaid patients. The elasticities are estimated separately for proprietary and "not for profit" nursing homes using a 1980 sample of New York nursing homes. Uniformly, the proprietary elasticities are approximately twice as large as the "not for profit" elasticities. As expected the price and quantity effects are positive, and the quality effects are negative. In the decomposition, the quality effect is quite important. In fact, ignoring it would lead to a fifty-three percent overestimate of the Medicaid expenditure elasticity.

Medicaid Expansions for the Working Age Disabled: Revisiting the Crowd-out of Private Health Insurance

Disabled individuals under 65 years old account for 15% of Medicaid recipients but half of all Medicaid spending. Despite their large cost, few studies have investigated the effects of Medicaid expansions for disabled individuals on insurance coverage and crowd-out of private insurance. Using an eligibility expansion that allowed states to provide Medicaid to disabled individuals with incomes less than 100% of the federal poverty level, I address these issues. Crowd-out estimates range from 49% using an ordinary least squares procedure to 100% using two-stage least-squares analysis. This potentially large degree of crowd-out could have fiscal implications for the Affordable Care Act which has greatly expanded Medicaid eligibility in 2014