Background: Health disparities and low-income backgrounds play a role in obesity and its comorbidities. Tertiary care pediatric Weight Management Clinics (WMC) have a high initial visit no-show rate. ...In 2022, we implemented a virtual WMC pre-visit group orientation (JUMP START), decreasing our no-show rate from 31% to 14%. However, patients insured by Medicaid had a higher no-show rate at 16% compared to 7% in those privately insured. Our new project aimed to decrease this to 13% in a nine-month period. Methods: A multidisciplinary team used an A3 quality improvement framework to identify root causes and improvement approaches. Iterative improvement cycles included: (1) modification of script used to schedule patients, and (2) conducting two JUMP START sessions in Spanish. Primary outcome measure was the initial visit no-show rate for patients with Medicaid. We also reviewed data on no-show rescheduling rates. Results: 356 patients (35% of referrals) attended JUMP START from July 2022 to Mar 2023 (37% privately insured, 60% Medicaid insured and 3% self-pay). A total of 256 attendees scheduled an initial visit from Sept 2022 to May 2023. No-show rate for the initial scheduled visit was 15.6% (n = 40; 19.2% Medicaid, 10.2% private). 19% of no-show patients rescheduled and 47% of those attended and another 18% have pending appointments. Conclusions: Prior improvement work reduced initial visit no-show rates in our WMC, but disparities by insurance status existed. Improving scheduling scripts and offering the pre-visit virtual orientation in Spanish did not change the differential between the rates of no-show of Medicaid insured and private insured patients. A small group of patients many of them on Medicaid rescheduled after a no-show and attended the rescheduled visit. Ongoing improvement is needed to reduce barriers to attending JUMP START and the first visit. Next steps include revisiting root causes, addressing caregiver identified barriers and additional help to reschedule and attend missed visits.
Before the implementation of the Affordable Care Act (ACA), most children in low-income families were already eligible for public insurance through Medicaid or the Children's Health Insurance ...Program. Increased coverage observed for these children since the ACA's implementation suggest that the legislation potentially had important spillover or "welcome mat" effects on the number of eligible children enrolled. This study used data from the 2013-15 American Community Survey to provide the first national-level (analytical) estimates of welcome-mat effects on children's coverage post ACA. We estimated that 710,000 low-income children gained coverage through these effects. The study was also the first to show a link between parents' eligibility for Medicaid and welcome-mat effects for their children under the ACA. Welcome-mat effects were largest among children whose parents gained Medicaid eligibility under the ACA expansion to adults. Public coverage for these children increased by 5.7 percentage points-more than double the 2.7-percentage-point increase observed among children whose parents were ineligible for Medicaid both pre and post ACA. Finally, we estimated that if all states had adopted the Medicaid expansion, an additional 200,000 low-income children would have gained coverage.
Objective: The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid ...beneficiaries residing in Maryland, Ohio, and West Virginia. Methods: A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. Results: In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios IRR = 1.47), Hispanics (IRR = 1.63), polypharmacy (IRR = 1.89), and tobacco use (IRR = 2.23). Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33). The county-level factors associated with ED visits were unemployment rate (IRR = 0.94) and number of urgent care clinics (IRR = 0.96). Conclusion: Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options.
Medicaid, one of the largest federal programs in the United States, gives grants to states to provide health insurance for over 60 million low-income Americans. As private health insurance benefits ...have relentlessly eroded, the program has played an increasingly important role. Yet Medicaid's prominence in the health care arena has come as a surprise. Many astute observers of the Medicaid debate have long claimed that "a program for the poor is a poor program" prone to erosion because it serves a stigmatized, politically weak clientele. Means-tested programs for the poor are often politically unpopular, and there is pressure from fiscally conservative lawmakers to scale back the $350-billion-per-year program even as more and more Americans have come to rely on it. For their part, health reformers had long assumed that Medicaid would fade away as the country moved toward universal health insurance. Instead, Medicaid has proved remarkably durable, expanding and becoming a major pillar of America's health insurance system. InMedicaid Politics, political scientist Frank J. Thompson examines the program's profound evolution during the presidential administrations of Bill Clinton, George W. Bush, and Barack Obama and its pivotal role in the epic health reform law of 2010. This clear and accessible book details the specific forces embedded in American federalism that contributed so much to Medicaid's growth and durability during this period. It also looks to the future outlining the political dynamics that could yield major program retrenchment.
•We examine which policies increased coverage under the Affordable Care Act (ACA).•We assessed premium subsidies, the individual mandate, and Medicaid expansion.•Premium subsidies created 40% of the ...ACA coverage increase, and Medicaid 60%.•Medicaid was 30% woodwork effect, 10% early expansion, 20% newly-eligible adults.•The mandate penalty amount had negligible effects on coverage gains.
Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. We provide the first comprehensive assessment of these provisions’ effects, using the 2012–2015 American Community Survey and a triple-difference estimation strategy that exploits variation by income, geography, and time. Overall, our model explains 60% of the coverage gains in 2014–2015. We find that coverage was moderately responsive to price subsidies, with larger gains in state-based insurance exchanges than the federal exchange. The individual mandate's exemptions and penalties had little impact on coverage rates. The law increased Medicaid among individuals gaining eligibility under the ACA and among previously-eligible populations (“woodwork effect”) even in non-expansion states, with no resulting reductions in private insurance. Overall, exchange premium subsidies produced 40% of the coverage gains explained by our ACA policy measures, and Medicaid the other 60%, of which 1/2 occurred among previously-eligible individuals.
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