Health Care Coverage and Access for Children in Low-Income Families: Stakeholder Perspectives from Texas

An important question to ask about any health care system is how well it serves children in low-income families. In Texas, the question raises optimism as well as serious concerns. On one hand, the proportion of eligible Texas children enrolled in Medicaid or the Children's Health Insurance Program (CHIP) has increased from 75 percent in 2008 to 84 percent in 2013. The passage of the Affordable Care Act (ACA) in 2010 and the reauthorization of CHIP in 2015 helped to protect these gains. But significant uncertainties persist. Texas has not expanded Medicaid as envisioned by the ACA; the introduction of the federal health insurance Marketplace was highly contentious in thestate; and the U.S. Congress has funded CHIP only until 2017. Moreover, there is concern in Texas that access to high quality health care services for low-income children is not keeping pace with access to insurance. This issue brief was prepared as part of a small-scale qualitative study funded by the David and Lucile Packard Foundation to convey recent positive developments, remaining unmet needs, and emerging issues in children's health care coverage and delivery, from the perspective of knowledgeable stakeholders. Companion issue briefs on children's health in California and Colorado and a cross-state analysis are also available

Rank and null space calculations using matrix decomposition without column interchanges

AbstractThe most widely used stable methods for numerical determination of the rank of a matrix A are the singular value decomposition and the QR algorithm with column interchanges. Here two algorithms are presented which determine rank and nullity in a numerically stable manner without using column interchanges. One algorithm makes use of the condition estimator of Cline, Moler, Stewart, and Wilkinson and relative to alternative stable algorithms is particularly efficient for sparse matrices. The second algorithm is important in the case that one wishes to test for rank and nullity while sequentially adding columns to a matrix

On Capturing the Ineffable: A Moment from Experimental Film 59.10

This artwork is a still from “59,” an experimental film installation I created with the following restrictions: I had to direct eleven 59-second films in eleven months with eleven collaborating artists, none of whom could be cis men.In the resulting project, we used film and those eleven short moments to capture our unique, fragile experiences. We explored everything from the way in which facets of personality drift in and out of the subconscious to the beautiful, mercurial nature of gender

The degradation of gel-spun poly(beta-hydroxybutyrate) fibrous matrix

Poly(β-hydroxybutyrate), (PHB), is a biologically produced, biodegradable thennoplastic with commercial potential. In this work the qualitative and quantitative investigations of the structure and degradation of a previously unstudied, novel, fibrous form of PHB, were completed. This gel-spun PHB fibrous matrix, PHB(FM), which has a similar appearance to cotton wool, possesses a relatively complex structure which combines a large volume with a low mass and has potential for use as a wound scaffolding device. As a result of the intrinsic problems presented by this novel structure, a new experimental procedure was developed to analyze the degradation of the PHB to its monomer hydroxybutyric acid, (HBA). This procedure was used in an accelerated degradation model which accurately monitored the degradation of the undegraded and degraded fractions of a fibrous matrix and the degradation of its PHB component. The in vitro degradation mechanism was also monitored using phase contrast and scanning electron microscopy, differential scanning calorimetry, fibre diameter distributions and Fourier infra-red photoacoustic spectroscopy. The accelerated degradation model was used to predict the degradation of the samples in the physiological model and this provided a clearer picture as to the samples potential biodegradation as medical implantation devices. The degradation of the matrices was characterized by an initial penetration of the degradative medium and weakening of the fibre integrity due to cleavage of the ester linkages, this then led to the physical collapse of the fibres which increased the surface area to volume ratio of the sample and facilitated its degradation. Degradation in the later stages was reduced due to the experimental kinetics, compaction and degradation resistant material, most probably the highly crystalline regions of the PHB. The in vitro degradation of the PHB(FM) was influenced by blending with various polysaccharides, copolymerizing with poly(~-hydroxyvalerate), (PHV), and changes to the manufacturing process. The degradation was also detennined to be faster than that of conventional melt processed PHB based samples. It was concluded that the material factors such as processing, sample size and shape affected the degradation of PHB based samples with the major factor of sample surface area to volume ratio being of paramount importance in determining the degradation of a sample

Evaluating Basic Science Investments: Toward a More Robust Practice

Our understanding of the world—even our well-being—is shaped by advances in basic science knowledge. Philanthropic organizations play a crucial role in supporting the research that leads to such advances. For example, they support scientists, build organizations' research capacity and help train new generations of scientists. Philanthropies making such investments in basic or discovery science share a common goal—to catalyze advances in knowledge that improve our lives by enhancing our understanding of ourselves, our world and our universe. They also share a common challenge: establishing that their investments in basic science indeed contribute to advancing knowledge. This brief summarizes learning from early efforts by a working group of philanthropies and other organizations that are tackling this challenge together

Findings from Health-e-App Public Access and Implications for ACA Implementation

California will implement the key enrollment expansions of the Patient Protection and Affordable Care Act (ACA) in January 2014, with preenrollment beginning in October 2013.The state will expand Medicaid, known as Medi-Cal in California, to include previously ineligible adults with incomes up to 138 percent of the federal poverty level. It will also launch a Health Insurance Marketplace, known as Covered California. Individuals, families,and small businesses can purchase insurance through Covered California, and those with low and moderate incomes may qualify for tax credits and cost-sharing subsidies. As many as 1.6 million Californians could gain health insurance coverage through the expansion of Medi-Cal. Approximately 2.6 million Californians are expected to qualify for credits or subsidies through Covered California, and another 2.7 million could enroll and benefit from guaranteed coverage.California is creating a new, statewide enrollment system to support this historic coverage expansion. The system, known as the California Healthcare Eligibility, Enrollment, and Retention System or CalHEERS, must accommodate consumer needs and preferences for ease, convenience, and assistance. The system must also enable the state to efficiently process an anticipated influx of applications and promptly notify consumers of their eligibility. Self-service online applications, required by the ACA, are one promising way to meet the dual goal of consumer friendliness and system efficiency. They could be an important source of applications for coverage.California has experience with self-service online enrollment, most notably through the statewide Health-e-App Public Access (HeA PA) system. HeA PA was introduced in December 2010 for Healthy Families, California's Children's Health Insurance Program (CHIP), and now is used for Medi-Cal for Families. Applicants can access HeA PA wherever and whenever they use the Internet. Available in English and Spanish, HeA PA automatically checks for errors and omissions and directs applicants only to questions that apply to them. The fully automated HeA PA eliminates most manual data entry and reduces the time that application processors spend pursuing complete or correct information from applicants.Mathematica Policy Research, Inc. has studied the first year of HeA PA implementation and presented findings in four research briefs. Although the circumstances surrounding the launch of HeA PA were quite different from the eligibility expansion, enrollment-system change, and mass outreach now under way in California, key findings from the HeA PA study have implications for ACA implementation in California and other states. HeA PA contributed to growth in program applications, was used and well received by a segment of Internet-connected applicants, and complemented the system of assisted-online applications that many applicants used. Each page of this final brief presents a key study finding and potential implications

Final Report from the Models for Change Evaluation

Note: This evaluation is accompanied by an evaluation of the National Campaign for this initiative as well as introduction to the evaluation effort by MacArthur's President, Julia Stasch, and a response to the evaluation from the program team. Access these related materials here (https://www.macfound.org/press/grantee-publications/evaluation-models-change-initiative).Models for Change is an initiative of The John D. and Catherine T. MacArthur Foundationto accelerate juvenile justice reforms and promote fairer, more effective, and more developmentally appropriate juvenile justice systems throughout the United States. Between 2004 and 2014, the Foundation invested more than $121 million in the initiative, intending to create sustainable and replicable models of systems reform.In June 2013, the Foundation partnered with Mathematica Policy Research and the University of Maryland to design and conduct a retrospective evaluation of Models for Change. The evaluation focused on the core state strategy, the action network strategy, and the national context in which Models for Change played out. This report is a digest and synthesis of several technical reports prepared as part of the evaluation

Lessons About Evaluating Health-Coverage Advocacy Across Multiple Campaigns and Foundations

This article draws on a dozen years’ experience in evaluating major consumerhealth advocacy initiatives to build the knowledge base about advocacy evaluation. The authors explain how their evaluations were strengthened by articulating a detailed theory of change and emphasizing assessment of interim outcomes from many perspectives and methods. Even with comprehensive data and integrated analysis, however, some ambiguity in the results is inevitable; there is no completely objective way to determine the effectiveness of an advocacy initiative. Moreover, sometimes solid or even exceptional advocacy efforts do not lead to desired policy outcomes. Advocacy initiatives that fail initially may be groundwork for future opportunities. Evaluators must tell a compelling story about what advocates hope to achieve, how they tried to achieve it, and the extent to which external factors helped or hindered progress. The narrative about why advocates did what they did must describe context and its influence on all aspects of advocacy campaigns, from goal setting to strategy development to implementation