Factors influencing molecular tumor profiling in uterine cancer: overcoming health disparities in the Deep South
Christine HudeAnnelise WilhiteRajesh PaladuguNicholas TinkerJennifer ScaliciJennifer Young PierceNathaniel JonesRodney P. Rocconi
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Profiling (computer programming)
A new Medicaid Analytic eXtract (MAX) chartbook summarizes the Medicaid program and the MAX data system. Developed for state Medicaid directors, policymakers, researchers, and others interested in the Medicaid program, the chartbook is a research tool and reference guide on Medicaid enrollees and their Medicaid experiences in 2008. It consists of illustrative graphs, descriptive text, and an extensive data appendix with summary national- and state-level information on enrollees' demographic and eligibility characteristics, Medicaid service use, and Medicaid expenditures in 2008, as well as trends in key enrollment and utilization patterns over time.
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A new Medicaid Analytic eXtract (MAX) chartbook summarizes the Medicaid program and the MAX data system. Developed for state Medicaid directors, policymakers, researchers, and others interested in the Medicaid program, the chartbook is a research tool and reference guide on Medicaid enrollees and their Medicaid experiences in 2008. It consists of illustrative graphs, descriptive text, and an extensive data appendix with summary national- and state-level information on enrollees' demographic and eligibility characteristics, Medicaid service use, and Medicaid expenditures in 2008, as well as trends in key enrollment and utilization patterns over time.
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To identify ICD-10-CM diagnostic codes associated with the social determinants of health (SDOH), determine frequency of use of the code for homelessness across time, and examine the frequency of interrupted periods of Medicaid eligibility (ie, Medicaid churn) for beneficiaries with and without this code.Retrospective data analyses of New York State (NYS) Medicaid claims data for years 2006-2017 to determine reliable indicators of SDOH hypothesized to affect Medicaid churn, and for years 2016-2017 to examine frequency of Medicaid churn among patients with and without an indicator for homelessness.Any interruption in the eligibility for Medicaid insurance (Medicaid churn), assessed via client identification numbers (CIN) for continuity.Analyses were conducted to assess the frequency of use and pattern of New York State Medicaid claims submission for SDOH codes. Analyses were conducted for Medicaid claims submitted for years 2016-2017 for Medicaid patients with and without a homeless code (ie, ICD-10-CM Z59.0) in 2017.ICD-9-CM / ICD-10-CM codes for lack of housing / homelessness demonstrated linear reliability over time (ie, for years 2006-2017) with increased usage. In 2016-2017, 22.9% of New York Medicaid patients with a homelessness code in 2017 experienced at least one interruption of Medicaid eligibility, while 18.8% of Medicaid patients without a homelessness code experienced Medicaid churn.Medicaid policies would do well to take into consideration the barriers to continued enrollment for the Medicaid population. Measures ought to be enacted to reduce Medicaid churn, especially for individuals experiencing homelessness.
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Objective
To examine the possible impact of changes in the organization and management of the Medicaid program on hospitalization patterns for children with chronic and nonchronic conditions between January 1, 1991, and December 31, 1998.Design
Longitudinal retrospective study of hospitalization patterns of children in 4 strata: Medicaid, non-Medicaid, chronic conditions, and nonchronic conditions.Setting
Washington State.Patients
Hospital discharge abstract records for all children aged 0 to 17 years profiled into those with and without a chronic condition, Medicaid, and non-Medicaid using a diagnosis-based classification system.Main Outcome Measures
Hospitalization and multiple hospitalization rates and length of hospital stay.Results
In 1991, hospitalization and multiple hospitalization rates were higher for all Medicaid vs non-Medicaid children. From 1991 to 1998, there was a decrease in the hospitalization and multiple hospitalization rates for Medicaid children only. By 1998, rates for Medicaid children approximated those for non-Medicaid children. This decrease was greater for nonchronically ill children than for chronically ill children. Total hospitalizations in Medicaid children decreased by 4.5%. The mean length of stay in 1991 for all Medicaid hospitalized children was higher than that for non-Medicaid children (6.1 vs 5.1 days). By 1998, the length of stay decreased for both groups (5.7 vs 4.9 days).Conclusion
The declines in hospitalization and multiple hospitalization rates observed in Washington State Medicaid children from 1991 to 1998 may be the result of many statewide efforts to increase access and improve management for this population.Cite
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Medicaid cut-backs during the Reagan Administration may have combined with other factors to affect physicians' willingness to participate in Medicaid. The author analyzed participation rates for two comparable groups of physicians: one group surveyed in 1977-78 and the other surveyed in 1984-85. Over this time period, there was a small, but statistically significant, decline in Medicaid participation rates (from 12.1-9.5%). Regression analysis showed, however, that physicians remain sensitive to important policy variables, such as fee levels and eligibility criteria. Physicians treat significantly more Medicaid patients when Medicaid fees are relatively high and when there is a relatively large number of people eligible for Medicaid in their area. These findings reinforce recent Congressional mandates to expand Medicaid eligibility and to raise payment levels for obstetric and pediatric services. Increased participation on the part of urban physicians, however, may be limited by the residential segregation of many Medicaid eligible people in the inner city.
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Abstract Objective To quantify impacts of early Affordable Care Act (ACA) Medicaid expansions on Medicaid participation for primary care physicians. Data Sources The study uses secondary Medicaid Analytic eXtract (MAX) data from the United States for 2009–2012, as well as secondary National Plan and Provider Enumeration System (NPPES) data from the United States for 2015. Study Design The study uses a quasi‐experimental difference‐in‐differences study design where the policy change is Medicaid expansion in six states that adopted early ACA Medicaid expansions during 2010 and 2011: California, Connecticut, the District of Columbia, Minnesota, New Jersey, and Washington. The key outcome variables are five monthly measures of physician participation: the number of Medicaid visits, the number of Medicaid patients, seeing at least 1 Medicaid patient, seeing at least 25 Medicaid patients, and seeing at least 50 Medicaid patients. Data Collection/Extraction Methods The sample consists of all physicians who were active between 2005 and 2015, according to the NPPES. Principal Findings For primary care physicians, Medicaid expansion led to a 29% increase in Medicaid visits (5.88 per month; 95% CI: 2.49–9.27), a 29% increase in Medicaid patients (4.59 per month; 95% CI: 2.16–7.02), and did not affect the probability of any Medicaid participation. Medicaid expansion also led to a 22% increase in the probability of seeing at least 25 Medicaid patients per month (4.58 percentage points; 95% CI: 1.27–7.89) and a 31% increase in the probability of seeing at least 50 Medicaid patients per month (2.99 percentage points; 95% CI: 0.99–4.99). Conclusions Early ACA Medicaid expansions led to increased Medicaid visits for primary care physicians but did not affect the probability of any Medicaid participation. Primary care physicians who had previously served Medicaid patients responded to early ACA Medicaid expansions by serving substantially more Medicaid patients.
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The Supplemental Security Income (SSI) program for children and adolescents has experienced a fourfold enrollment growth since 1989. Most SSI recipients also receive Medicaid, and SSI growth could therefore lead to major new Medicaid expenditures if new SSI recipients were not previous Medicaid enrollees. Using Medicaid claims for 1989-92, we determined whether SSI expansions included many children new to Medicaid as well as whether children with certain disabilities were more likely to have had Medicaid prior to SSI enrollment. Rates of new SSI enrollees without previous Medicaid coverage decreased from 53 percent in 1989 to 39 percent by 1992.
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Physician participation rates in Medicaid vary widely across the country, and, overall, there has been a decline in recent years. We performed an evaluation in California of whether the expansion of Medicaid managed care and a physician payment increase were associated with an increase over time in the percentage of physicians caring for Medicaid patients. Surveys performed before and after these strategies were used did not reveal an increase over time in physicians' participation in California's Medicaid program. Budgetary constraints will force policy makers to confront the priorities of the Medicaid program, to question the policy objectives for physician participation in Medicaid, and to consider more far-reaching reforms in Medicaid and the overall health care system.
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Background: Although the myriad of provisions under the Affordable Care Act (ACA) have generally increased coverage and financial access to the health systems, language barriers represent a serious challenge to access to care among Limited English Proficiency (LEP) populations. Objective: The aim of this study was to examine the effect of Medicaid expansions under the ACA on the availability of language services and Medicaid acceptance in substance abuse treatment (SAT) facilities. Research Design: A quasi-experimental difference-in-differences design with multiple time periods was used to compare changes in the availability of language services and Medicaid as a payment source between Medicaid expansion and nonexpansion states. Facility-level observational data in the National Survey of Substance Abuse Treatment Services 2010–2019 was included. Measures: Availability of LEP services and Medicaid acceptance in the SAT facilities. Results: The proportion of SAT facilities that provide LEP services increased from 40% in 2013 to 53% in 2019. The proportions by state are heterogeneous, ranging from approximately 20% to 70%. The ACA Medicaid expansions are not associated with changes in the availability of LEP services in the facilities. Moreover, Medicaid acceptance in the expansion states increased gradually following the expansion; however, the estimates are not statistically significant. Conclusion: The ACA Medicaid expansion had no impact on the availability of LEP services and the acceptance of Medicaid as a payment source in the SAT facilities.
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