227 results match your criteria nonexpansion states


Baseline Evaluation of Cancer Mortality in US States that Expanded Medicaid vs Nonexpansion States.

JAMA Oncol 2021 Jul 22. Epub 2021 Jul 22.

Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.

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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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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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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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National disparities in access to physical therapy after rotator cuff repair between patients with Medicaid vs. private health insurance.

JSES Int 2021 May 16;5(3):507-511. Epub 2021 Jan 16.

Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA.

Background: Arthroscopic rotator cuff repair is an effective treatment for patients with symptomatic rotator cuff tears. Ensuring timely and appropriate postoperative access to physical therapy (PT) is paramount to the achievement of optimal patient outcomes. Extended immobility due to a lack of formal rehabilitation can lead to decreased range of motion, continued pain, and potential reoperation for stiffness. Read More

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Medicaid Expansion Association With End-Stage Liver Disease Mortality Depends on Leniency of Medicaid Hepatitis C Virus Coverage.

Liver Transpl 2021 Jun 12. Epub 2021 Jun 12.

Department of Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY.

The Affordable Care Act expanded Medicaid around the same time that direct-acting antivirals became widely available for the treatment of hepatitis C virus (HCV). However, there is significant variation in Medicaid HCV treatment eligibility criteria between states. We explored the combined effects of Medicaid expansion and leniency of HCV coverage under Medicaid on liver outcomes. Read More

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Characterizing Hypertensive Disorders of Pregnancy Among Medicaid Recipients in a Nonexpansion State.

J Womens Health (Larchmt) 2021 Jun 10. Epub 2021 Jun 10.

Department of Health Care Organization and Policy, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA.

The incidence of hypertensive disorders of pregnancy (HDP) are on the rise in the United States, especially in the South, which has a heavy chronic disease burden and large number of Medicaid nonexpansion states. Sizeable disparities in HDP outcomes exist by race/ethnicity, geography, and health insurance coverage. Our objective is to explore HDP in the Alabama Medicaid maternity population, and the association of maternal sociodemographic, clinical, and care utilization characteristics with HDP diagnosis. Read More

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Impact of the affordable care act's medicaid expansion on tertiary, pediatric surgical care: Medicaid Expansion's Impact on Pediatric Surgical Care.

J Pediatr Surg 2021 Apr 28. Epub 2021 Apr 28.

Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. Electronic address:

Background: Many children gained insurance with the 2014 Affordable Care Act's (ACA) Medicaid Expansion (ME), yet its impact on access to pediatric tertiary surgical care remains unknown. We examined the effect of ME on rates of elective, ambulatory surgery (EAS), especially among publicly-insured and ethnoracial-minority patients.

Methods: Surgical patients ≤18 years between 2012 and 2018 were identified using the Pediatric Health Information System. Read More

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Association of Medicaid Expansion With In-Hospital Outcomes After Abdominal Aortic Aneurysm Repair.

J Surg Res 2021 May 19;266:201-212. Epub 2021 May 19.

Division of Vascular Surgery, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania. Electronic address:

Objectives: Multiple studies have shown improved outcomes and higher utilization of care with the increase of insurance coverage. This study aims to assess whether Medicaid expansion (ME) has changed the utilization and outcomes of abdominal aortic aneurysm (AAA) repair in the United States.

Design: Retrospective observational study. Read More

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Protecting and Expanding Medicaid to Improve Women's Health: ACOG Committee Opinion Summary, Number 826.

Authors:

Obstet Gynecol 2021 Jun;137(6):1144-1145

Abstract: Medicaid, the state-federal health insurance program for individuals with low incomes, serves as a safety net for women throughout the life span. Historically, expansions of Medicaid have been associated with improved access to health care, less delay in obtaining health care, better self-reported health, and reductions in mortality. Compared with nonexpansion states, states that have participated in the Affordable Care Act's Medicaid expansion have experienced improvements in maternal and infant mortality and decreases in uninsured rates and have decreased racial inequities for these measures. Read More

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Associations of Medicaid Expansion With Insurance Coverage, Stage at Diagnosis, and Treatment Among Patients With Genitourinary Malignant Neoplasms.

JAMA Netw Open 2021 May 3;4(5):e217051. Epub 2021 May 3.

Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia.

Importance: Health insurance coverage is associated with improved outcomes in patients with cancer. However, it is unknown whether Medicaid expansion through the Patient Protection and Affordable Care Act (ACA) was associated with improvements in the diagnosis and treatment of patients with genitourinary cancer.

Objective: To assess the association of Medicaid expansion with health insurance status, stage at diagnosis, and receipt of treatment among nonelderly patients with newly diagnosed kidney, bladder, or prostate cancer. Read More

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The Impact of the Affordable Care Act Medicaid Expansions on the Sources of Health Insurance Coverage of Undergraduate Students in the United States.

Med Care Res Rev 2021 May 19:10775587211015816. Epub 2021 May 19.

University of North Carolina at Greensboro, Greensboro, NC, USA.

This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Read More

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Medicaid healthy behavior incentives and use of dental services.

Health Serv Res 2021 May 18. Epub 2021 May 18.

Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.

Objective: To examine changes in access to dental care in states using Section 1115 waivers to implement healthy behavior incentive (HBI) programs in their Medicaid expansion under the ACA, compared to traditional expansion states and nonexpansion states.

Data Sources: Behavioral Risk Factor Surveillance System from 2008 to 2018.

Study Design: We used difference-in-differences analysis to compare changes in three Medicaid expansion states with HBI (Iowa, Indiana, Michigan) to traditional expansion (Minnesota, North Dakota, Ohio) and nonexpansion states (Nebraska, South Dakota, Wyoming) in the same mid-Western region of the country. Read More

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Effect of Medicaid Expansion on Receipt of Definitive Treatment and Time to Treatment Initiation by Racial and Ethnic Minorities and at Minority-Serving Hospitals: A Patient-Level and Facility-Level Analysis of Breast, Colon, Lung, and Prostate Cancer.

JCO Oncol Pract 2021 05;17(5):e654-e665

Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Purpose: We sought to investigate the association between Medicaid expansion under the Affordable Care Act and access to stage-appropriate definitive treatment for breast, colon, non-small-cell lung, and prostate cancer for underserved racial and ethnic minorities and at minority-serving hospitals (MSHs).

Methods: We conducted a retrospective, difference-in-differences study including minority patients with nonmetastatic breast, colon, non-small-cell lung, and prostate cancer and patients treated at MSHs between the age of 40 and 64, with tumors at stages eligible for definitive treatment from the National Cancer Database. We not only defined non-Hispanic Black and Hispanic cancer patients as racial and ethnic minorities but also report findings for non-Hispanic Black cancer patients separately. Read More

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Effects of the Affordable Care Act Medicaid Expansion on the Distribution of New General Internists Across States.

Med Care 2021 Jul;59(7):653-660

Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.

Background: Some states expanded Medicaid under the Affordable Care Act, boosting their low-income residents' demand for health care, while other states opted not to expand.

Objective: The objective of this study was to determine whether the Medicaid expansion influenced the states selected by physicians just completing graduate medical education for establishing their first practices.

Research Design: Using 2009-2019 data from the American Medical Association Physician Masterfile and information on states' Medicaid expansion status, we estimated conditional logit models to compare where new physicians located during the 6 years following implementation of the expansion to where they located during the 5 years preceding implementation. Read More

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Medicaid expansion and the management of pancreatic cancer.

J Surg Oncol 2021 May 3. Epub 2021 May 3.

Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Background: Medicaid expansion under the Affordable Care Act has improved access to screening and treatment for certain cancers. It is unclear how this policy has affected the diagnosis and management of pancreatic cancer.

Methods: Using a quasi-experimental difference-in-differences (DID) approach, we analyzed Medicaid and uninsured patients in the National Cancer Data Base during two time periods: pre-expansion (2011-2012) and postexpansion (2015-2016). Read More

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Association of Medicaid expansion and insurance status, cancer stage, treatment and mortality among patients with cervical cancer.

Cancer Rep (Hoboken) 2021 May 2:e1407. Epub 2021 May 2.

Harvard Medical School, Boston, Massachusetts, USA.

Background: Currently, little is known about the effect of the Patient Protection and Affordable Care Act's Medicaid expansion on care delivery and outcomes in cervical cancer.

Aim: We evaluated whether Medicaid expansion was associated with changes in insurance status, stage at diagnosis, timely treatment, and survival outcomes in cervical cancer.

Methods And Results: Using the National Cancer Database, we performed a difference-in-differences (DID) cross-sectional analysis to compare insurance status, stage at diagnosis, timely treatment, and survival outcomes among cervical cancer patients residing in Medicaid expansion and nonexpansion states before (2011-2013) and after (2014-2015) Medicaid expansion. Read More

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Development of an Emergency Department-Based Intervention to Expand Access to Medications for Opioid Use Disorder in a Medicaid Nonexpansion Setting: Protocol for Engagement and Community Collaboration.

JMIR Res Protoc 2021 Apr 29;10(4):e18734. Epub 2021 Apr 29.

Department of Emergency Medicine, Vanderbilt University, Nashville, TN, United States.

Background: The opioid epidemic has disproportionately impacted areas in the Appalachian region of the United States. Characterized by persistent Medicaid nonexpansion, higher poverty rates, and health care access challenges, populations residing in these areas of the United States have experienced higher opioid overdose death rates than those in other parts of the country. Jefferson County, Alabama, located in Southern Appalachia, has been especially affected, with overdose rates over 2 times greater than the statewide average (48. Read More

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Medicaid Expansions and Participation in Supplemental Security Income by Noncitizens.

Am J Public Health 2021 06 15;111(6):1106-1112. Epub 2021 Apr 15.

Felix M. Muchomba is with the School of Social Work, Rutgers University, New Brunswick, NJ. Neeraj Kaushal is with the School of Social Work, Columbia University, New York, NY, and the National Bureau of Economic Research, Cambridge, MA.

To estimate the effect of Medicaid expansion on noncitizens' and citizens' participation in the Supplemental Security Income (SSI) program. The Affordable Care Act (ACA) expanded Medicaid eligibility to cover low-income nonelderly adults without children, thus delinking their Medicaid participation from participation in the SSI program. Using data from the Social Security Administration for 2009 through 2018 (n = 1020 state-year observations) and the Current Population Survey for 2009 through 2019 (n = 78 776 respondents), we employed a difference-in-differences approach comparing SSI participation rates in US states that adopted Medicaid expansion with participation rates in nonexpansion states before and after ACA implementation. Read More

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Post-ACA, More Than One-Third Of Women With Prenatal Medicaid Remained Uninsured Before Or After Pregnancy.

Health Aff (Millwood) 2021 04;40(4):571-578

Lisa Dubay is a senior fellow in the Health Policy Center, Urban Institute.

Medicaid has a long history of serving pregnant women, but many women are not eligible for Medicaid before pregnancy or after sixty days postpartum. We used data for new mothers with Medicaid-covered prenatal care in 2015-18 from forty-three states participating in the Pregnancy Risk Assessment Monitoring System (PRAMS) to describe patterns of perinatal uninsurance and health outcomes of women experiencing uninsurance. We found that 26. Read More

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Medicaid Expansion and Incidence of Kidney Failure among Nonelderly Adults.

J Am Soc Nephrol 2021 Jun 1;32(6):1425-1435. Epub 2021 Apr 1.

Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.

Background: Low-income individuals without health insurance have limited access to health care. Medicaid expansions may reduce kidney failure incidence by improving access to chronic disease care.

Methods: Using a difference-in-differences analysis, we examined the association between Medicaid expansion status under the Affordable Care Act (ACA) and the kidney failure incidence rate among all nonelderly adults, aged 19-64 years, in the United States, from 2012 through 2018. Read More

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Protecting and Expanding Medicaid to Improve Women's Health: ACOG Committee Opinion, Number 826.

Authors:

Obstet Gynecol 2021 Jun;137(6):e163-e168

Abstract: Medicaid, the state-federal health insurance program for individuals with low incomes, serves as a safety net for women throughout the life span. Historically, expansions of Medicaid have been associated with improved access to health care, less delay in obtaining health care, better self-reported health, and reductions in mortality. Compared with nonexpansion states, states that have participated in the Affordable Care Act's Medicaid expansion have experienced improvements in maternal and infant mortality and decreases in uninsured rates and have decreased racial inequities for these measures. Read More

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Changes in Buprenorphine Treatment After Medicaid Expansion.

Psychiatr Serv 2021 Jun 18;72(6):633-640. Epub 2021 Mar 18.

Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York City (Olfson); School of Management, Yale University, New Haven, Connecticut (Zhang, King); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Mojtabai).

Objective: The authors examined changes in buprenorphine treatment following Medicaid expansion, including the contribution of Medicaid-financed prescriptions.

Methods: Buprenorphine pharmacy claims for patients were identified in the 2012-2018 IQVIA Longitudinal Prescription Data (LRx) data set, including 79.8% of U. Read More

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Eligibility for and Enrollment in Medicaid Among Nonelderly Adults After Implementation of the Affordable Care Act.

Med Care Res Rev 2021 Mar 3:1077558721996851. Epub 2021 Mar 3.

San Diego State University, San Diego, CA, USA.

The Affordable Care Act's (ACA) Medicaid expansion resulted in substantial gains in coverage. However, little research has documented eligibility or participation rates among eligible adults in the post-ACA period in part because of the complexities involved in assigning eligibility status. We used simulation modeling to examine Medicaid eligibility and participation during 2014 to 2017. Read More

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Association of Medicaid Expansion With Quality in Safety-Net Hospitals.

JAMA Intern Med 2021 May;181(5):590-597

Perelman School of Medicine, Division of General Internal Medicine, University of Pennsylvania, Philadelphia.

Importance: Safety-net hospitals (SNHs) operate under limited financial resources and have had challenges providing high-quality care. Medicaid expansion under the Affordable Care Act led to improvements in hospital finances, but whether this was associated with better hospital quality, particularly among SNHs given their baseline financial constraints, remains unknown.

Objective: To compare changes in quality from 2012 to 2018 between SNHs in states that expanded Medicaid vs those in states that did not. Read More

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Heterogeneous Effects of Affordable Care Act Medicaid Expansions Among Women with Dependent Children by State-Level Pre-Expansion Eligibility.

J Womens Health (Larchmt) 2021 Feb 8. Epub 2021 Feb 8.

Department of Health Management and Policy, University of Iowa, Iowa City, Iowa, USA.

This study explores the heterogeneity in effects of the 2014 Affordable Care Act (ACA) Medicaid expansions on insurance coverage, health care access, and health status of low-income women with dependent children by pre-expansion state-level income eligibility. We employ a quasiexperimental difference-in-differences design comparing outcome changes in Medicaid expansion states to nonexpansion states. We estimate effects separately for three groups of expansion states based on pre-expansion (2013) parent income eligibility: low pre-expansion eligibility (<90% of federal poverty level [FPL]), high eligibility (90% to <138% FPL), and full eligibility (≥138% FPL). Read More

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February 2021

Association of the Affordable Care Act's Medicaid expansion with the diagnosis and treatment of clinically localized melanoma: A National Cancer Database study.

J Am Acad Dermatol 2021 Jun 4;84(6):1628-1635. Epub 2021 Feb 4.

Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.

Background: The Affordable Care Act's Medicaid expansion is associated with earlier diagnosis and improved care among lower socioeconomic status populations with cancer, but its impact on melanoma is undefined.

Objective: To determine the association of Medicaid expansion with stage of diagnosis and use of sentinel lymph node biopsy in nonelderly adult patients with newly diagnosed clinically localized melanoma.

Methods: Quasi-experimental, difference-in-differences retrospective cohort analysis using data from the National Cancer Database from 2010 to 2017. Read More

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National Recommendations against Prostate Specific Antigen Screening versus Statewide Medicaid Expansion Initiatives: A Battle of the Titans.

J Urol 2021 Jun 3;205(6):1641-1647. Epub 2021 Feb 3.

Maine Medical Center Research Institute, Portland, Maine.

Purpose: Medicaid expansion under the Patient Protection and Affordable Care Act occurred almost concurrently with 2012 U.S. Preventive Services Task Force recommendations against prostate specific antigen screening. Read More

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Association of Medicaid Expansion with Tunneled Dialysis Catheter Use at the Time of First Arteriovenous Access Creation.

Ann Vasc Surg 2021 Jan 26. Epub 2021 Jan 26.

Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA. Electronic address:

Background: In the United States, many low-income patients initiating hemodialysis are uninsured before qualifying for Medicare. Inadequate access to predialysis care may delay their arteriovenous (AV) access creation and increase tunneled dialysis catheter (TDC) use. The 2014 Affordable Care Act expanded eligibility for Medicaid among low-income adults, but not every state adopted this measure. Read More

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January 2021

The Future of the Indispensable Insurer: The Biden Administration and Medicaid.

Authors:
Sara Rosenbaum

J Health Polit Policy Law 2021 Aug;46(4):611-625

George Washington University.

Medicaid presents both legislative and regulatory challenges and opportunities. As it moves a legislative agenda forward, the Biden administration also will confront a series of immediate regulatory matters, some of which have been made urgent because of pending judicial action. Chief among these pressing matters are ending Medicaid work requirements and block grant experiments, rescinding the public charge rule, ensuring optimal use of Medicaid's enrollment and renewal simplification tools, rescinding the Title X family planning rule (which has enormous implications for Medicaid beneficiaries), and, when the time comes, preparing states to wind down the "Families First" Medicaid maintenance of effort protection while avoiding erroneous beneficiary disenrollment. Read More

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