1,952 results match your criteria medicaid expansion

Medical Debt in the US, 2009-2020.

JAMA 2021 07;326(3):250-256

National Bureau of Economic Research, Cambridge, Massachusetts.

Importance: Medical debt is an increasing concern in the US, yet there is limited understanding of the amount and distribution of medical debt, and its association with health care policies.

Objective: To measure the amount of medical debt nationally and by geographic region and income group and its association with Medicaid expansion under the Affordable Care Act.

Design, Setting, And Participants: Data on medical debt in collections were obtained from a nationally representative 10% panel of consumer credit reports between January 2009 and June 2020 (reflecting care provided prior to the COVID-19 pandemic). Read More

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Crowdfunding for Gender-Affirming Mastectomy: Balancing Fundraising With Loss of Privacy.

Ann Plast Surg 2021 Jul 13. Epub 2021 Jul 13.

From the Department of Dermatology, Brigham and Women's Hospital Tufts University School of Medicine, Boston, MA Loyola Stritch School of Medicine, Maywood, IL Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA.

Introduction: Limitations in insurance coverage may cause patients to turn to crowdfunding to raise money for gender-affirming procedures. In this study, we analyze the impact of Medicaid insurance coverage on gender-affirming mastectomy campaigns posted on GoFundMe.com. Read More

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Evaluation of Insurance Coverage and Cancer Stage at Diagnosis Among Low-Income Adults With Renal Cell Carcinoma After Passage of the Patient Protection and Affordable Care Act.

JAMA Netw Open 2021 Jul 1;4(7):e2116267. Epub 2021 Jul 1.

Department of Urology, University of California, San Diego, School of Medicine, La Jolla.

Importance: The association of the Patient Protection and Affordable Care Act (ACA) with insurance status and cancer stage at diagnosis among patients with renal cell carcinoma (RCC) is unknown.

Objective: To test the hypothesis that the ACA may be associated with increased access to care through expansion of insurance, which may vary based on income.

Design, Setting, And Participants: This retrospective cohort analysis included patients diagnosed with RCC from January 1, 2010, to December 31, 2016, in the National Cancer Database. Read More

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Evaluating Medicaid Expansion Benefits for Patients with Cancer: National Cancer Database Analysis and Systematic Review.

J Cancer Policy 2021 Sep 5;29. Epub 2021 Jun 5.

Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State Street, Suite 3300, Los Angeles, CA, 90033, USA.

Background: Insurance status modifies healthcare access and inequities. The Affordable Care Act expanded Medicaid coverage for people with low incomes in the United States. This study assessed the consequences of this policy change for cancer care after expansion in 2014. Read More

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September 2021

Early Medicaid Expansion and Cancer Mortality.

J Natl Cancer Inst 2021 Jul 14. Epub 2021 Jul 14.

Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.

Background: While Medicaid expansion is associated with decreased uninsured rates and earlier cancer diagnoses, no study has demonstrated an association between Medicaid expansion and cancer mortality. Our primary objective was to quantify the relationship between early Medicaid expansion and changes in cancer mortality rates.

Methods: We obtained county-level data from the National Center for Health Statistics for adults ages 20-64 who died from cancer from 2007-2009 (pre-expansion) and 2012-2016 (post-expansion). Read More

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The 2014 New York State Medicaid Expansion and Severe Maternal Morbidity During Delivery Hospitalizations.

Anesth Analg 2021 Aug;133(2):340-348

From the Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.

Background: Medicaid expansions under the Affordable Care Act have increased insurance coverage and prenatal care utilization in low-income women. However, it is not clear whether they are associated with any measurable improvement in maternal health outcomes. In this study, we compared the changes in the incidence of severe maternal morbidity (SMM) during delivery hospitalizations between low- and high-income women associated with the 2014 Medicaid expansion in New York State. Read More

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Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018.

JAMA 2021 07;326(2):154-164

AcademyHealth, Washington, DC.

Importance: There is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees.

Objective: To examine the use of medications for OUD and potential indicators of quality of care in multiple states.

Design, Setting, And Participants: Exploratory serial cross-sectional study of 1 024 301 Medicaid enrollees in 11 states aged 12 through 64 years (not eligible for Medicare) with International Classification of Diseases, Ninth Revision (ICD-9 or ICD-10) codes for OUD from 2014 through 2018. Read More

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Health insurance enrollment strategies during the Affordable Care Act (ACA): a scoping review on what worked and for whom.

Arch Public Health 2021 Jul 12;79(1):129. Epub 2021 Jul 12.

Institute of Population Health Sciences, Queen Mary University of London, London, UK.

Background: The Affordable Care Act (ACA) provided an opportunity for millions of people in the U.S. to get coverage from the publicly funded Medicaid program or private insurance from the newly established marketplace. Read More

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Potential association between public medical insurance, waitlist mortality, and utilization of living donor liver transplantation: An analysis of the Scientific Registry of Transplant Recipients.

Clin Transplant 2021 Jul 8. Epub 2021 Jul 8.

Division of Hepatobiliary and Abdominal Organ Transplant Surgery, University of Southern California, Los Angeles, California, USA.

Background: The Affordable Care Act (ACA) and subsequent Medicaid expansion has increased utilization of public health insurance. Living donor liver transplantation (LDLT) increases access to transplant and is associated with improved survival but consistently represents < 5% of LT in the United States.

Study Design: National registry data were analyzed to evaluate the impact of insurance payor on waitlist mortality and LDLT rates at LDLT centers since implementation of the ACA. Read More

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Influence of payer coverage and out-of-pocket costs on ordering of NGS panel tests for hereditary cancer in diverse settings.

J Genet Couns 2021 Jul 7. Epub 2021 Jul 7.

Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.

The landscape of payment for genetic testing has been changing, with an increase in the number of laboratories offering testing, larger panel offerings, and lower prices. To determine the influence of payer coverage and out-of-pocket costs on the ordering of NGS panel tests for hereditary cancer in diverse settings, we conducted semi-structured interviews with providers who conduct genetic counseling and order next-generation sequencing (NGS) panels purposefully recruited from 11 safety-net clinics and academic medical centers (AMCs) in California and North Carolina, states with diverse populations and divergent Medicaid expansion policies. Thematic analysis was done to identify themes related to the impact of reimbursement and out-of-pocket expenses on test ordering. Read More

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Prevalence and Determinants of Difficulty in Accessing Medical Care in U.S. Adults.

Am J Prev Med 2021 Jul 4. Epub 2021 Jul 4.

Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Health Policy, Quality & Informatics Program, Center for Innovations in Quality, Effectiveness and Safety, U.S. Department of Veterans Affairs, Houston, Texas; Research & Development, Michael E. DeBakey VA Medical Center, U.S. Department of Veterans Affairs, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Houston, Texas; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas. Electronic address:

Introduction: Ensuring adequate access to health care is essential for timely delivery of preventive services. It is important to evaluate the prevalence and determinants of difficulty in accessing medical care in the overall U.S. Read More

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Acute Care Reimagined: Home Hospital Care Can Support the Triple Aim and Reduce Health Disparities.

Emily E Johnson

J Healthc Manag 2021 Jul-Aug 01;66(4):258-270

Master of Healthcare Administration Program, School of Public Health, University of Minnesota, Minneapolis, Minnesota.

Executive Summary: Home hospital care (HHC) is a new and exciting concept that holds the promise of achieving all three components of the Triple Aim and reducing health disparities. As an innovative care delivery model, HHC substitutes traditional inpatient hospital care with hospital care at home for older patients with certain conditions. Studies have shown evidence of reduced cost of care, improved patient satisfaction, and enhanced quality and safety of care for patients treated through this model. Read More

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California's Health4All Kids Expansion And Health Insurance Coverage Among Low-Income Noncitizen Children.

Health Aff (Millwood) 2021 Jul;40(7):1075-1083

Melody K. Schiaffino is an assistant professor in the School of Public Health, San Diego State University.

More than one-third of US children receive coverage through Medicaid and the Children's Health Insurance Program (CHIP), but undocumented immigrant children are not eligible for public coverage in most states. California's May 2016 Health4All Kids coverage expansion allowed children with qualifying household incomes to enroll in Medi-Cal, California's Medicaid and CHIP program, regardless of their immigration status. We examined the effects of California's expansion on noncitizen children's uninsurance rates and sources of coverage, using data from the 2012-18 American Community Survey. Read More

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Financial sustainability of payment models for office-based opioid treatment in outpatient clinics.

Addict Sci Clin Pract 2021 Jul 5;16(1):45. Epub 2021 Jul 5.

Department of Medicine, University of Minnesota Medical School and Division of Addiction Medicine, Hennepin Healthcare, Minneapolis, United States.

Background: Office-Based Opioid Treatment (OBOT) is a delivery model which seeks to make medications for opioid use disorder (MOUD), particularly buprenorphine, widely available in general medical clinics and offices. Despite evidence supporting its effectiveness and cost-effectiveness, uptake of the OBOT model has been relatively slow. One important barrier to faster diffusion of OBOT may be the financial challenges facing clinics that could adopt it. Read More

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Association of rural location and long acting reversible contraceptive use among Oregon Medicaid recipients.

Contraception 2021 Jul 2. Epub 2021 Jul 2.

Center for Health Systems Effectiveness, Oregon Health & Science University.

Objective: To evaluate whether the use of long-acting, reversible contraception (LARC) is equitably accessible to Medicaid recipients in rural and urban areas. We also determined whether women's health specialists' availability was associated with the type of LARC used.

Study Design: We used claims data for 242,057 adult women who were continuously enrolled in Oregon Medicaid for at least one year and at risk of pregnancy from January 1, 2015, through December 31, 2017 to assess the association between LARC utilization and (1) rurality and (2) provider supply. Read More

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Black clients in expansion states who used opioids were more likely to access medication for opioid use disorder after ACA implementation.

J Subst Abuse Treat 2021 Jun 11:108533. Epub 2021 Jun 11.

Boston University School of Public Health, 715 Albany Street, Suite 116W, Boston, MA 02118, United States of America. Electronic address:

Introduction: Black people in the United States who use opioids receive less treatment and die from overdoses at higher rates than White people. Medication for opioid use disorder (MOUD) decreases overdose risk. Implementation of the Affordable Care Act (ACA) in the United States was associated with an increase in MOUD. Read More

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Impact of Medicaid expansion on mental health and substance use related emergency department visits.

Subst Abus 2021 Jul 2:1-8. Epub 2021 Jul 2.

College of Pharmacy, University of Georgia, Athens, GA, USA.

Although Medicaid expansion under the Affordable Care Act reduces uninsurance, little evidence exists on its impact on mental health and substance use (MHSU) related healthcare utilization. Therefore, the objectives of this study are to examine the impact of Medicaid expansion on emergency department visits related to mental health and substance use disorders and to examine its effect on the variation in payer mix. The study utilizes state-level quarterly emergency department (ED) visit data from Healthcare Cost and Utilization Project's Fast Stats Database, along with state socio-demographic and health policy data for the analysis. Read More

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Medicaid Expansion and Medical Debt: Evidence From Louisiana, 2014-2019.

Am J Public Health 2021 Jul 2:e1-e7. Epub 2021 Jul 2.

Kevin Callison and Brigham Walker are with the Department of Health Policy and Management, Tulane School of Public Health and Tropical Medicine, New Orleans, LA. Brigham Walker is also with ConcertAI, Boston, MA.

To identify the association between Medicaid eligibility expansion and medical debt. We used difference-in-differences design to compare changes in medical debt for those gaining coverage through Louisiana's Medicaid expansion with those in nonexpansion states. We matched individuals gaining Medicaid coverage because of Louisiana's Medicaid expansion (n=196 556) to credit report data on medical debt and compared them with randomly selected credit reports of those living in Southern nonexpansion state zip codes with high rates of uninsurance (n=973 674). Read More

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Welcome Mats and On-Ramps for Older Adults: The Impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid.

J Policy Anal Manage 2021 26;40(1):12-41. Epub 2020 Sep 26.

Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.

For many low-income Medicare beneficiaries, Medicaid provides important supplemental insurance that covers out-of-pocket costs and additional benefits. We examine whether Medicaid participation by low-income adults age 65 and up increased as a result of Medicaid expansions to working-age adults under the Affordable Care Act (ACA). Previous literature documents so-called "welcome mat" effects in other populations but has not explicitly studied older persons dually eligible for Medicare and Medicaid. Read More

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September 2020

State health policies and interest in PrEP: evidence from Google Trends.

AIDS Care 2021 Jun 30:1-9. Epub 2021 Jun 30.

College of Liberal Arts and Sciences, University of Illinois, Urbana-Champaign, IL, USA.

This study investigated the association between interest in Pre-exposure Prophylaxis (PrEP) in the US using Google Health Trends as a source of big data and state policy variables of Medicaid expansions under the Affordable Care Act (ACA) and initiation of PrEP Assistance Programs (PrEP-AP). As of December 2019, thirty-three states and the District of Columbia have accepted federal Medicaid funding provided through the ACA to expand eligibility to low-income adults. Among these expansion states, eight states also implemented PrEP-AP, a program that finances PrEP. Read More

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Changes in Hospitalizations at US Safety-Net Hospitals Following Medicaid Expansion.

JAMA Netw Open 2021 Jun 1;4(6):e2114343. Epub 2021 Jun 1.

Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.

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Access to Urologic Care at Urgent Care Centers.

Urology 2021 Jun 24. Epub 2021 Jun 24.

Yale School of Medicine, Department of Urology, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven and Newington, Connecticut. Electronic address:

Objective: To evaluate Medicaid insurance access disparities for urologic care at urgent care centers (UCCs) in the United States.

Materials And Methods: We conducted a cross-sectional study using a "secret shopper" methodology. We sampled 240 UCCs across eight states. Read More

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Cancer genetic testing in marginalized groups during an era of evolving healthcare reform.

J Cancer Policy 2021 Jun 16;28. Epub 2021 Feb 16.

Genetics and Newborn Screening Unit, North Carolina Department of Health and Human Services, C/O CDSA of the Cape Fear, 3311 Burnt Mill Dr., Wilmington, NC, 28403, United States.

Background: The Affordable Care Act and subsequent reforms pose tradeoffs for racial-ethnic, rural, and sex-related groups in the United States experiencing disparities in genetic counseling and testing and colorectal cancer screening, calling for policy changes.

Methods: A working group of the American Public Health Association Genomics Forum Policy Committee engaged in monthly meetings to examine ongoing literature and identify policy alternatives in the coverage of cancer genetic services for marginalized groups. 589 items were collected; 408 examined. Read More

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Unpacking a Telemedical Takeover: Recommendations for Improving the Sustainability and Usage of Telemedicine Post-COVID-19.

Qual Manag Health Care 2021 Jun 23. Epub 2021 Jun 23.

Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Telemedicine technology and regulation have been steadily growing over the last 2 decades. Prior to the coronavirus disease-2019 (COVID-19) pandemic, the availability of telemedicine in health systems and coverage of telemedicine were variable. Sudden and improved access to telemedicine was propelled by the COVID-19 pandemic, during which governments, insurers, and health systems ramped up telemedical utilization with short-term exceptions and waivers. Read More

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State Policymaking and Stated Reasons: Prenatal Care for Undocumented Immigrants in an Era of Abortion Restriction.

Milbank Q 2021 Jun 24. Epub 2021 Jun 24.

Clinical Center, National Institutes of Health.

Policy Points States can create policies that provide access to publicly funded prenatal care for undocumented immigrants that garner support from diverse political coalitions. Policymakers have used a wide range of moral and practical reasons to support the expansion of care to this population, which can be tailored to frame prenatal policies for different stakeholder groups.

Context: Even though nearly 6% of citizen babies born in the United States have at least one undocumented parent, undocumented immigrants are ineligible for most public health insurance. Read More

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Patient need and provider referrals to diabetes self-management education.

Am J Manag Care 2021 Jun 1;27(6):e201-e207. Epub 2021 Jun 1.

Department of Population Health, Dell Medical School, University of Texas at Austin, 1601 Trinity St, Bldg B, Austin, TX 78712. Email:

Objectives: This study measured the likelihood of adult patients with diabetes being referred to diabetes self-management education (DSME) when "in need" according to clinical guidelines and identified which types of clinical need predict a greater likelihood of provider referral to DSME.

Study Design: This repeated cross-sectional analysis utilized patient electronic health records (EHRs) and a statewide health information exchange database to examine a 7-year panel (2010-2016) of adult patients with diabetes. Our analytic sample included 8782 adult patients with diabetes with a total of 356,631 encounters. Read More

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Tailoring services in opioid treatment programs for patients involved in America's criminal justice system: national associations and variation by state and Medicaid expansion status.

Subst Abuse Treat Prev Policy 2021 Jun 19;16(1):50. Epub 2021 Jun 19.

Southern Public Health and Criminal Justice Research Center and the Department of Health Behavior and Health Education in the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, USA.

Background: Opioid treatment programs (OTPs) are the primary source of medication-assisted treatment (MAT) for many individuals with opioid use disorder, including poor and uninsured patients and those involved in the criminal justice (CJ) system. Substance use treatment services that are tailored to the unique needs of patients often produce better outcomes, but little national research has addressed characteristics associated with whether OTPs offer services specifically tailored to community members involved in the CJ system. Medicaid expansion under the Affordable Care Act has broadly strengthened MAT services, but the role of expansion in supporting MAT services that are specifically tailored towards CJ-involved populations remains unknown. Read More

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Impact of Insurance Expansion on Disposition for Pediatric Trauma Patients: A National Trauma Data Bank Cohort Study.

J Surg Res 2021 Jun 16;267:109-116. Epub 2021 Jun 16.

Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah.

Background: The insurance status of pediatric trauma patients is associated with access to post-discharge resources, including inpatient rehabilitation. Our goal was to understand the impact of changes in insurance coverage on access to post-acute care resources for pediatric trauma patients.

Materials And Methods: We utilized the National Trauma Data Bank from 2012 to 2016 for all pediatric trauma patients with a highest body region abbreviated injury score >2. Read More

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North Carolina Specialty Courts, Treatment Access, and the Substance Use Crisis: A Promising but Underfunded Model.

Psychiatr Serv 2021 Jun 18:appips202000868. Epub 2021 Jun 18.

Division of Child/Family Mental Health and Community Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Easter, Swanson, Robertson, Swartz).

Treatment courts aim to reduce criminal recidivism by addressing the behavioral health care needs of persons with psychiatric or substance use disorders that contribute to their offending. Stable funding and access to behavioral health providers are crucial elements of success for the treatment court model. What happens when courts lose state funding and must rely on local initiatives and resources? In this study, a survey of North Carolina treatment court professionals identified resource gaps and unmet needs. Read More

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