Paying for Language Services in Medicare: Preliminary Options and Recommendations

Discusses how the federal government could design payment systems for language services in Medicare, and offers preliminary recommendations for implementing such programs

How Race/Ethnicity, Immigration Status, and Language Affect Health Insurance Coverage, Access to and Quality of Care Among the Low-Income Population

Uses data from the 1999 National Survey of America's Families to examine the roles of race/ethnicity, citizenship status, and language on insurance coverage, access to care, and quality of care, particularly focusing on the low-income Latino population

Restoring Medicaid and SCHIP Coverage to Legal Immigrant Children and Pregnant Women: Implications for Community Health and Health Care for Tomorrow\u27s Citizens

In the coming weeks, Congress will consider the reauthorization of the State Children\u27s Health Insurance Program (SCHIP), whose legislative authorization will expire on March 31, 2009. SCHIP\u27s overarching goal, in tandem with Medicaid, is to assure coverage of low-income children, regardless of race or national origin. As the proportion of uninsured immigrant children grows, a crucial question is whether the SCHIP reauthorization will address the need to restore eligibility for legal immigrant children and pregnant women. Although SCHIP and Medicaid have been successful in improving health insurance coverage for most low-income American children since the mid-1990s, the health coverage gaps for immigrant children have deepened and about half of all low-income immigrant children are now uninsured. SCHIP reauthorization represents a critical opportunity to restore access to Medicaid and SCHIP coverage for some of the most vulnerable children and pregnant women, those who are legally-admitted immigrants. (Undocumented immigrants would remain ineligible for Medicaid and SCHIP, as they always have been, except for coverage of emergency care under Medicaid.) Welfare reform legislation passed in 1996 requires that most legal immigrants wait for five years before qualifying for coverage under Medicaid, regardless of how poor or sick they are. While numerous Senators and Congressmen from both sides of the aisle have supported proposals to allow states to restore coverage for legal immigrant children and pregnant women, they have yet to come to a full vote before both chambers of Congress. The lack of coverage makes it harder for these children and pregnant women to get necessary health care, especially if they lack access to a health center or other safety net provider. Thus, they may fail to receive immunizations or prenatal care, which are needed to grow up healthy. The restoration of Medicaid and SCHIP would enhance health centers\u27 ability to furnish care for more needy patients in the community, by freeing up funds now used for uncompensated care. Barring coverage for legal immigrant children and pregnant women jeopardizes community health while discriminating against future citizens, workers and family members. Restoring Medicaid and SCHIP coverage to these vulnerable populations will improve their health and strengthen their ability to contribute to the nation and economy

Do Medicaid and CHIP Measure Errors Correctly?

Measuring and reducing errors in Medicaid and CHIP is important, but the current program and the proposed regulatory provisions are flawed and misleading. Reducing errors should involve not only reducing payments that are issued in error, but reducing the rate at which eligible applicants are erroneously denied Medicaid coverage. CMS should give develop a better, more valid approach to error determination when there are cases of missing or insufficient provider or eligibility data and issue a new proposed rule that offers a new approach or approaches

Strengthening Immigrants\u27 Health Access: Current Opportunities

This brief summarizes key opportunities helping the nation’s newcomers in gaining health insurance coverage and health access that are possible under the current law. Provisions of the Affordable Care Act (ACA) will help millions of legal immigrants gain access to affordable health insurance coverage. At the same time, however, immigrants will also face new responsibilities. Like citizens, lawfully present immigrants will be responsible for having health insurance coverage or paying a tax penalty, although some are exempt. Rules about immigrants’ access to health insurance benefits are often complicated because they depend on specific immigration categories, as well as eligibility for other insurance programs

A Multivariate Analysis of Nationwide Changes in Opioid Prescriptions from 2012-2016

Background Between 2012 and 2016, the opioid overdose mortality rate in the U.S. almost doubled from 7.4 to 13.3 per 100,000 population, leading to calls for a national opioid crisis. This crisis has generated interest in Medicaid’s dual role as a health insurance system that provides reimbursement for both prescription opioid analgesics like Oxycodone used to treat chronic pain, which could inadvertently fuel addiction, and prescription opioids used as treatment medication to help people survive and recover from drug abuse, such as Naloxone. Methods In this study, we conduct a multi-variate analysis of Medicaid prescription drug utilization data for the years 2012 through 2016 to examine overall and per-enrollee changes in the number of prescriptions for opioid analgesics and opioid treatment medications and examine the impact expansion, opioid mortality, unemployment, and the availability of drug abuse treatment facilities that accept Medicaid have on the number of prescriptions. Results Overall, we find that Medicaid expansion did not have a significant impact on the use of opioid analgesics or treatment medications per adult Medicaid enrollee. Based on our analyses, these changes in the use of opioid analgesics and treatment medications are driven largely by changes in opioid mortality rates, and somewhat by changes in unemployment rates. However, by significantly increasing Medicaid enrollment levels, the expansion did increase the total volume of both opioid analgesics and opioid treatment medications being covered by Medicaid. Upon conducting a simple analysis to evaluate gross changes in opioid prescriptions between states that expanded and did not expand Medicaid, we find that the average opioid analgesic prescriptions per adult enrollee have gone down by almost a fourth in both expansion (24.1% decrease) and non-expansion states (28.4% decrease) from 2012 to 2016, signaling a nation-wide effort to curb the opioid crisis. We also find that the average opioid treatment medication prescriptions per adult enrollee have increased sharply in expansion states (55.9% increase) as compared to non-expansion states (9.9% increase). Conclusions Our findings suggest that, contrary to arguments that suggest that expanding Medicaid worsened the opioid crisis, the expansion has had no significant impact on prescription opioid use. In fact, the expansion has greatly increased the scope of treatment for drug abuse by providing states that were already hard-hit by the crisis with the funding they needed to expand treatment to cover a greater number of low-income and at-risk adults