Health Status and Access to Care among Maine’s Low-Income Childless Adults: Implications for State Medicaid Expansion

The Affordable Care Act allows states to expand Medicaid coverage to low-income childless adults with income at or below 138 percent of the federal poverty level. Following a 2017 statewide referendum, Maine began enrolling eligible residents in expanded Medicaid in January 2019. While prior research suggests that Maine’s low-income childless adults may face health problems and barriers to accessing services, their health status has not been well documented. The rollout and ongoing implementation of Maine’s Medicaid expansion may be hampered by incomplete information on the characteristics and health status of the low-income childless adult population. This study examines demographic characteristics, health status, and access to care among Maine’s low-income childless adults and offers recommendations to policymakers, providers, and other stakeholders working to implement Medicaid expansion and address the health needs of this vulnerable population

Improving Hospital Patient Safety Through Teamwork: The Use of TeamSTEPPS in CAHs (Policy Brief #21)

This brief, one in a series identifying and assessing evidence-based patient safety and quality improvement interventions appropriate for use by state Flex Programs and CAHs, reviews teamwork and team training which have become a standard, evidence-based intervention in small and larger hospitals alike. The focus is on TeamSTEPPS, a training program developed and disseminated by the Department of Defense and the Agency for Healthcare Research and Quality. Key Findings: State Flex programs and CAHs have successfully adapted and used TeamSTEPPS to improve patient safety through team training. The evidence indicates that team training increases communications and reduces error. The success of TeamSTEPPS depends on having appropriate expectations and identifying and cultivating internal champions. Building a patient safety infrastructure helps sustain teamwork

Community Impact and Benefit Activities of Critical Access, Other Rural, and Urban Hospitals, 2017

Non-profit and publicly-owned hospitals, including Critical Access Hospitals (CAHs), have obligations to address the health needs of their communities. Non-profit hospitals are required to report their community benefit activities to the Internal Revenue Service using Form 990, Schedule H. Community benefit activities include programs and services that provide treatment and/or promote health in response to identified community needs. Publicly-owned hospitals are also held accountable to the needs of their communities through the oversight of their governing boards and local governments. To monitor the community impact and benefit activities of CAHs and to understand whether and how their community impact and benefit profiles differ from those of other hospitals, we compared CAHs to other rural and urban hospitals using a set of indicators developed by the FMT. This report enables State Flex Programs and CAH administrators to compare the community impact and benefit profiles of CAHs nationally (Tables 1 and 2) to the performance of CAHs in their state (see links to state-specific tables on page 5). Table 1 provides data for select measures of community impact and benefit, including the provision of essential health care services that are typically difficult to access in rural communities. Table 2 provides data on hospital charity care, bad debt, and uncompensated care activities. The Flex Monitoring Team also produces state-specific reports with more detailed results

Promoting a Culture of Safety: Use of the Hospital Survey on Patient Safety Culture in CAHs (Briefing Paper #30)

The Institute of Medicine has emphasized the importance of establishing a culture of safety to improve patient care, specifically: developing clear, highly visible patient safety programs that focus organizational attention on safety; using non-punitive systems for reporting and analyzing errors; incorporating well-established safety principles such as standardized and simplified equipment, supplies, and work processes; and establishing proven interdisciplinary team training programs for providers. We sought to investigate the degree to which these elements are present or absent in Critical Access Hospitals. This report presents the results of a literature review and a rural patient safety expert panel comprised of representatives from federal and state government and academia. There is another policy brief that summarizes these same findings

Community Impact and Benefit Activities of CAHs, Other Rural, and Urban Hospitals, 2014

Non-profit hospitals, including Critical Access Hospitals (CAHs), are required to report their community benefit activities (programs and services that provide treatment and/or promote health in response to identified community needs) to the Internal Revenue Service. Using a set of community benefit indicators developed by the Flex Monitoring Team (FMT), these reports compare CAHs to non-metropolitan non-CAHs (non-metro hospitals) and metropolitan (metro) hospitals in order to monitor the community benefit activities of CAHs and understand whether and how their community benefit profiles differ from the profiles of other hospitals. The Flex Monitoring Team also produces state-specific reports with more detailed results

CO-OP Health Plans: Can They Help Fix Rural America\u27s Health Insurance Markets?

Consumer-Operated and Oriented Plan (CO-OP) programs are intended to create nonprofit health insurance issuers that would offer health plans to individual and small group markets. Part of the Affordable Care Act, CO-OPs could have a substantial effect on rural healthcare delivery systems. In this Brief, authors Jean Talbot and Andy Coburn of the Maine Rural Health Research Center at the University of Southern Maine provide an overview of the CO-OP program legislation from the Affordable Care Act; identify the challenges to obtaining private health insurance in rural areas; and assess the opportunities and challenges of using the CO-OP program to address the limitations of the rural private health insurance market. Dr. Coburn participated in a webinar on this topic co-hosted by the Rural Assistance Center (RAC) with the State Health Access Reform Evaluation (SHARE)

Why Do Some CAHs Close Their Skilled Nursing Facility Services While Others Retain Them? (Briefing Paper #32)

Variations in reimbursement policies and swing bed use suggest that the incentives influencing the decisions of CAHs regarding their Skilled Nursing Facility (SNF) units may differ from those of urban hospitals. Based on a review of the literature and conversations with members of the Flex Monitoring Team’s Expert Work Group, we expected the financial decision regarding SNF unit operation to be more complex for CAHs than for PPS hospitals largely because the decision involves the profitability of a PPS-reimbursed SNF within a cost-based facility. In the case of the CAH, the indirect and facility costs associated with operating a PPS-reimbursed SNF unit must be subtracted from the cost base of the cost-reimbursed acute care services thereby reducing reimbursement for those services. We also expected that the availability of swing beds (which can be used effectively to manage acute care length of stay issues without compromising acute care reimbursement) would be a significant factor in decisions to close SNF units. We identified other factors that might influence a CAH’s decision to retain a SNF unit including: the need for an alternative to swing beds to manage length of stay issues for CAHs with consistently high acute care census levels; community need and preference (which might be particularly important for municipal and county-owned hospitals); and limitations on SNF unit closure imposed by state Certificate of Need regulations. Among the potential factors influencing a CAH’s decision to close or retains its SNF units, only the latter factor (i.e., the influence of Certificate of Need regulations) was not supported by our study. We interviewed 20 CAHs operating in eleven states, including 11 hospitals that had closed their SNF units and 9 that continued to operate their services. This report discusses our findings in detail; there is also a policy brief which highlights the same findings

Role and Early Impact of CO-OPs in the Rural Health Insurance Marketplace

This study will combine quantitative analysis with administrative health plan practice data with targeted case studies to examine the rural availability and pricing of CO-OP plans, and the early experiences of these plans

Health Status and Access to Care among Maine’s Low-Income Childless Adults: Implications for State Medicaid Expansion

The Affordable Care Act allows states to expand Medicaid coverage to low-income childless adults with income at or below 138 percent of the federal poverty level. Following a 2017 statewide referendum, Maine began enrolling eligible residents in expanded Medicaid in January 2019. While prior research suggests that Maine’s low-income childless adults may face health problems and barriers to accessing services, their health status has not been well documented. The rollout and ongoing implementation of Maine’s Medicaid expansion may be hampered by incomplete information on the characteristics and health status of the low-income childless adult population. This study examines demographic characteristics, health status, and access to care among Maine’s low-income childless adults and offers recommendations to policymakers, providers, and other stakeholders working to implement Medicaid expansion and address the health needs of this vulnerable population

Community Benefit Activities of CAHs, Non-Metropolitan Hospitals, and Metropolitan Hospitals, 2010

Non-profit hospitals, including Critical Access Hospitals (CAHs), are required to report their community benefit activities (programs and services that provide treatment and/or promote health in response to identified community needs) to the Internal Revenue Service. Using a set of community benefit indicators developed by the Flex Monitoring Team (FMT), these reports compare CAHs to non-metropolitan non-CAHs (non-metro hospitals) and metropolitan (metro) hospitals in order to monitor the community benefit activities of CAHs and understand whether and how their community benefit profiles differ from the profiles of other hospitals. The Flex Monitoring Team also produces state-specific reports with more detailed results