Medicaid data contain International Classification of Diseases, Clinical Modification (ICD-9-CM) codes indicating maltreatment, yet there is a little information on how valid these codes are for the ...purposes of identifying maltreatment from health, as opposed to child welfare, data. This study assessed the validity of Medicaid codes in identifying maltreatment. Participants (n = 2,136) in the first National Survey of Child and Adolescent Well-Being were linked to their Medicaid claims obtained from 36 states. Caseworker determinations of maltreatment were compared with eight sets of ICD-9-CM codes. Of the 1,921 children identified by caseworkers as being maltreated, 15.2% had any relevant ICD-9-CM code in any of their Medicaid files across 4 years of observation. Maltreated boys and those of African American race had lower odds of displaying a maltreatment code. Using only Medicaid claims to identify maltreated children creates validity problems. Medicaid data linkage with other types of administrative data is required to better identify maltreated children.
Objectives
To examine retention of Medicaid coverage over time for children in the child welfare system.
Methods
We linked a national survey of children with histories of abuse and neglect to their ...Medicaid claims files from 36 states, and followed these children over a 4 year period. We estimated a Cox proportional hazards model on time to first disenrollment from Medicaid.
Results
Half of our sample (50 %) retained Medicaid coverage across 4 years of follow up. Most disenrollments occurred in year 4. Being 3–5 years of age and rural residence were associated with increased hazard of insurance loss. Fee-for-service Medicaid and other non-managed insurance arrangements were associated with a lower hazard of insurance loss.
Conclusions for Practice
A considerable number of children entering child environments seem to retain Medicaid coverage over multiple years. Finding ways to promote entry of child welfare-involved children into health insurance coverage will be critical to assure services for this highly vulnerable population.
American Indian and Alaska Native (AI/AN) populations report poor physical and mental health outcomes while tribal health providers and the Indian Health Service (IHS) operate in a climate of ...significant under funding. Understanding how the Patient Protection and Affordable Care Act (ACA) affects Native American tribes and the IHS is critical to addressing the improvement of the overall access, quality, and cost of health care within AI/AN communities. This paper summarizes the ACA provisions that directly and/or indirectly affect the service delivery of health care provided by tribes and the IHS.
Abstract This study quantifies racial/ethnic differences in Medicaid expenditures on psychotropic drugs among a national sample of children with suspected maltreatment. We linked 4,445 child ...participants in the National Survey of Child and Adolescent Well-Being (NSCAW) – consisting of children investigated for suspected abuse and neglect – to their Medicaid claims obtained from 36 states. We used propensity score matching to construct a comparison group of children without known child welfare involvement, and estimated two-part generalized linear models to examine differences in annual psychotropic drug expenditures per child between children of different races/ethnicities. When compared to a matched sample of children, African American and Latino children incur $292 and $144 less expenditures on psychotropic drugs, respectively, than white children. Among NSCAW children alone, African American children display $614 less spending on psychotropic drugs when compared to white children. Racial/ethnic differences in expenditures on psychotropic drugs occur among all children on Medicaid, but the differences are especially pronounced among African American children in contact with the child welfare system. These findings demonstrate that policymakers will need to pay special attention to the needs of children of color as Medicaid expansions proceed nationwide.
We describe the synthesis of triazole-containing carboline derivatives and their utility as bromodomain and extra-terminal (BET) inhibitors. A convergent synthetic route permitted the detailed ...investigation of deuteration and fluorination strategies to reduce clearance while maintaining a favorable in vitro profile. This work led to the identification of a potent BET inhibitor, 2-{8-fluoro-3-4-(2H3)methyl-1-methyl-1H-1,2,3-triazol-5-yl-5-(S)-(oxan-4-yl)(phenyl)methyl-5H-pyrido3,2-bindol-7-yl}propan-2-ol (15), which demonstrated reduced clearance and an improved pharmacokinetic (PK) profile across preclinical species. Importantly, no major metabolite was observed when 15 was incubated with human hepatocytes (hHEP) for 2 h. This study culminated with the evaluation of 15 in a mouse triple-negative breast cancer (TNBC) tumor model where it demonstrated robust efficacy at low doses.
Eighty plasma biomarkers were obtained at presentation in the emergency department based on the literature including procalcitonin (PCT) and compared each alone or in combination using the area under ...the receiver operating characteristic curve (AUC) to identify severe sepsis.
Children in the child welfare system are the most expensive child population to insure for their mental health needs. The objective of this article is to estimate the amount of Medicaid expenditures ...incurred from the purchase of psychotropic drugs - the primary drivers of mental health expenditures - for these children.
We linked a subsample of children interviewed in the first nationally representative survey of children coming into contact with U.S. child welfare agencies, the National Survey of Child and Adolescent Well-Being (NSCAW), to their Medicaid claims files obtained from the Medicaid Analytic Extract. Our data consist of children living in 14 states, and Medicaid claims for 4 years, adjusted to 2010 dollars. We compared expenditures on psychotropic medications in the NSCAW sample to a propensity score-matched comparison sample obtained from Medicaid files.
Children surveyed in NSCAW had over thrice the odds of any psychotropic drug use than the comparison sample. Each maltreated child increased Medicaid expenditures by between $237 and $840 per year, relative to comparison children also receiving medications. Increased expenditures on antidepressants and amphetamine-like stimulants were the primary drivers of these increased expenditures. On average, an African American child in NSCAW received $399 less expenditure than a white child, controlling for behavioral problems and other child and regional characteristics. Children scoring in the clinical range of the Child Behavior Checklist received, on average, $853 increased expenditure on psychotropic drugs.
Each child with child welfare involvement is likely to incur upwards of $1482 in psychotropic medication expenditures throughout his or her enrollment in Medicaid. Medicaid agencies should focus their cost-containment strategies on antidepressants and amphetamine-type stimulants, and expand use of instruments such as the Child Behavior Checklist to identify high-cost children. Both of these strategies can assist Medicaid agencies to better predict and plan for these expenditures.
An 80Kb logic Embedded Multi-Time Programmable Memory (MTPM) employs charge trapping and de-trapping behavior in 32nm/22nm High-K transistor, resulting in no added process complexity. Multi-step ...verification with overwrite protection employs block-write and signal margin degradation (~30%) to satisfy 10 year retention at 105° C.
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