Managing Medicaid Misclassification: Using Simulation Techniques to Identify Administrative Leverage Points in Policy Implementation

Poster Division: Arts, Humanities, and Social Sciences: 3rd Place (The Ohio State University Edward F. Hayes Graduate Research Forum)A fundamental challenge for state Medicaid programs is the ongoing task of implementing beneficiary enrollment according to specified eligibility criteria. Errors in enrollment present themselves in the form of eligible individuals not taking up coverage (missed take-up), individuals continually moving on and off the program (churn), and ineligible individuals receiving coverage (fraud). In addition to posing problems for the coverage and continuity of care of vulnerable populations, enrollment errors create difficulties for state program planning, budgeting, and contract arrangements. Despite passage of the Affordable Care Act in 2010, state Medicaid programs remain varied in the structure of their eligibility categories and their processes for determination and enrollment of beneficiaries. There are multiple levels of prescribed action and discretion in these systems, and both short (month-to-month) and long (multiple year) time horizons are of interest. Previous studies model enrollment outcomes as a deterministic function of personal characteristics (e.g., race/ethnicity) and general economic indicators (e.g., unemployment rate). The policies and procedures defining design and administration of the program are rarely included in models estimating enrollment patterns, thus ignoring potentially important sources of enrollment dynamics. The purpose of this research is to understand the mechanism by which Medicaid eligibility criteria are transformed into enrollment outcomes among state program populations. Drawing on insights from systems science and implementation research, this study uses simulated experiments with program structure to describe and explain the dynamics of Medicaid eligibility determination and enrollment processes. Program-level state Medicaid enrollment patterns are modeled in terms of the dynamics among individual characteristics, program eligibility criteria, and administrative procedures within relevant social, economic, demographic, and political contexts. The effects of federal guidelines, along with exemplary cases of state eligibility rules and determination procedures, are analyzed through a set of system dynamics models of program-level enrollment patterns. This study tests the possible effects of a number of implementation strategies drawn from the Medicaid enrollment literature on eligibility determination and benefit enrollment errors. Interrelationships among defined eligibility categories and (re)determination procedures create enrollment implementation error in Medicaid systems even when household economic conditions and decision making are stable. Delays in (re)determination processes lead to accumulations of households in enrollment states not consistent with their eligibility. A nonlinear relationship between the demand for benefits and the administrative capacity to process applications leads to further accumulation of misclassified households. Enrollment errors, including missed take-up, churn, and fraud, are shown to arise form the structure and dynamics of the program system itself, rather than solely from individual circumstance or exogenous economic shock. These simulations allow policy makers and scholars to experiment with various implementation strategies with effectively zero social costs. Illuminating the core dynamics of the Medicaid enrollment mechanism aids in forecasting enrollment and spending levels, revealing administrative leverage points to improve system performance, and evaluating potential tradeoffs between costs and coverage over time. Additionally, the simulations can be tailored to specific economic, demographic, and program conditions, providing a picture of the possible range of outcomes associated with specific administrative actions.No embarg

Power and Surrender: African American Sunni Women and Embodied Agency

This thesis addresses the lack of scholarly attention devoted to African American Sunni women by examining how they use collective memory to negotiate embodied agency. Through an analysis of African American Sunni women’s narratives of testifying conversion, and vignettes from diaries and interviews, I show how African American Sunni women utilize racial, religious, and spiritual memory in the form of ritual practices and Islamic texts to multiply construct their bodies, and how this construction allows them to enact multimodal and nomadic forms of agency. A contextual analysis also illustrates how environment and interpretation (tafsir) further mobilizes forms of agency, articulating a need for flexibility in regard to the concept of embodied agency and challenging the dichotomy prevalent in Western and Eurocentric conceptions of liberatory agency

A Blueprint for the Charles City Public School’s “Community Den”

Charles City County Public Schools (CCPS) submitted a Request for Assistance to work with a capstone team that would conduct a thorough analysis of the Community Den program and offer a blueprint that would sustain the Den’s efforts well into the future. To address this request, a doctoral Capstone team primarily utilized qualitative methods of data collection in a 3-phrase approach, including, an extensive process of literature review, asset mapping, which is a strength-based approach of connecting communities with resources, document analysis, site visits, interviews, and focus groups. These approaches allowed the capstone team to gain a better understanding of the resources available to the Community Den, the needs of the students and community members it serves, and existing best practices in rural community resource and support initiatives. Findings indicated that improving access to resources, prioritizing community connection, increasing student engagement, and optimizing the physical space as critical elements for the Community Den successful operation. Recommendations focused on opportunities for student engagement, marketing outreach, community engagement, improvements for data management, and physical spacing were formatted as initial steps within the blueprint to improve the overall operations of the Community Den

Hogwash: Coming to Terms with Critical Race Theory in Adult Education

Today’s adult and community education classrooms and sites of practice are increasingly diverse. As adult educators, we have a responsibility to appropriately meet each student at their level of need. Critical race theory provides a non-hegemonic lens for understanding and meeting the needs of our diverse student population

The Ohio COVID-19 Survey: Preliminary Findings and Their Use During the Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic has created exceptional health and economic uncertainty for Ohioans in 2020. In the spring of 2020, the state commissioned the Ohio COVID-19 Survey (OCS) to ask residential Ohio adults about how the pandemic was affecting them. The purpose of this research is to provide state leadership with real-time information about the effects of the pandemic and concurrent recession on Ohio households.Methods: The OCS is a special supplement to the Ohio Medicaid Assessment Survey (OMAS), a stratified random digit dial, cell phone and landline telephone survey. This study includes data collected weekly between April 20, 2020, and August 24, 2020. We conducted descriptive time-series analysis of the survey data and provided updates to the state's COVID-19 Response Team throughout the survey period.Results: Preliminary findings from the OCS reflect 3 themes among respondents: 1) elevated levels of concern over health and household economics; 2) disproportionate effects that exacerbate existing inequities; and 3) majority adjustment to "new normal" and acceptance of public health guidelines .Conclusion: Preliminary findings indicate that groups that were struggling before the pandemic have faced the biggest challenges with regard to health and household economics since it began. Data from the OCS enabled us to provide real-time analysis to state leadership regarding Ohioans' experience during the first 6 months of the COVID-19 pandemic. Further analysis and integration of additional data will allow us to provide deeper insights as Ohio seeks to move into recovery

Comparison of Pharmaceutical Calculations Learning Outcomes Achieved Within a Traditional Lecture or Flipped Classroom Andragogy

Objective. To compare learning outcomes achieved from a pharmaceutical calculations course taught in a traditional lecture (lecture model) and a flipped classroom (flipped model). Methods. Students were randomly assigned to the lecture model and the flipped model. Course instructors, content, assessments, and instructional time for both models were equivalent. Overall group performance and pass rates on a standardized assessment (Pcalc OSCE) were compared at six weeks and at six months post-course completion. Results. Student mean exam scores in the flipped model were higher than those in the lecture model at six weeks and six months later. Significantly more students passed the OSCE the first time in the flipped model at six weeks; however, this effect was not maintained at six months. Conclusion. Within a 6 week course of study, use of a flipped classroom improves student pharmacy calculation skill achievement relative to a traditional lecture andragogy. Further study is needed to determine if the effect is maintained over time

Mental and physical health profile of Syrian resettled refugees

BACKGROUND: Newly arriving Syrian refugees can present with specific health characteristics and medical conditions when entering the United States. Given the lack of epidemiological data available for the refugee populations, our study examined the demographic features of Syrian refugees resettled in the state of Kentucky. Specifically, we examined mental and physical health clinical data in both pre-departure health screenings and domestic Refugee Health Assessments (RHA; Kentucky Office for Refugees, n.d.) performed after resettlement. METHOD: The current study adopted a cross-sectional research design. We analyzed outcome data collected from participants from 2013 and 2015. Specifically, a comparative cross-sectional analysis was performed using clinical data from Syrian refugees who underwent an RHA as part of the resettlement process between January 2015 and August 2016. Those data were compared to data derived from refugees from other countries who resettled in Kentucky between 2013 and 2015. RESULTS: Mental health screenings using the Refugee Health Screener (RHS-15; Hollifield et al., 2013) found that 19.5% (n = 34) of adult Syrian refugees reported signs and symptoms from posttraumatic stress, depressive symptoms, and/or anxiety, and nearly 40% (n = 69) reported personal experiences of imprisonment or violence, and/or having witnessed someone experiencing torture or violence. Intestinal parasites and lack of immunity to varicella were the most prevalent communicable diseases among Syrian refugees. Dental abnormalities and decreased visual acuity account for the first and second most prevalent non-communicable conditions. When comparing these results to all refugees arriving during the same years, significant differences arose in demographic variables, social history, communicable diseases, and non-communicable diseases. CONCLUSION: This study provides an initial health profile of Syrian refugees resettling in Kentucky, which reflects mental health as a major healthcare concern. Posttraumatic stress and related symptoms are severe mental health conditions among Syrian refugees above and beyond other severe physical problems

Sexual citizenship in Belfast, Northern Ireland

In this article we examine the contours and construction of sexual citizenship in Belfast, Northern Ireland through in-depth interviews with 30 members of the GLBT community and a discursive analysis of discourses of religion and nationalism. In the first half of the article we outline how sexual citizenship was constructed in the Irish context from the mid-nineteenth century onwards, arguing that a moral conservatism developed as a result of religious reform and the interplay between Catholic and Protestant churches, and the redefining of masculinity and femininity with the rise of nationalism. In the second half of the article, we detail how the Peace Process has offered new opportunities to challenge and destabilise hegemonic discourses of sexual citizenship by transforming legislation and policing, and encouraging inward investment and gentrification

Childhood cancer burden: a review of global estimates.

5-year net survival of children and adolescents diagnosed with cancer is approximately 80% in many high-income countries. This estimate is encouraging as it shows the substantial progress that has been made in the diagnosis and treatment of childhood cancer. Unfortunately, scarce data are available for low-income and middle-income countries (LMICs), where nearly 90% of children with cancer reside, suggesting that global survival estimates are substantially worse in these regions. As LMICs are undergoing a rapid epidemiological transition, with a shifting burden from infectious diseases to non-communicable diseases, cancer care for all ages has become a global focus. To improve outcomes for children and adolescents diagnosed with cancer worldwide, an accurate appraisal of the global burden of childhood cancer is a necessary first step. In this Review, we analyse four studies of the global cancer burden that included data for children and adolescents. Each study used various overlapping and non-overlapping statistical approaches and outcome metrics. Moreover, to provide guidance on improving future estimates of the childhood global cancer burden, we propose several recommendations to strengthen data collection and standardise analyses. Ultimately, these data could help stakeholders to develop plans for national and institutional cancer programmes, with the overall aim of helping to reduce the global burden of cancer in children and adolescents