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Masoumirad M, Harvey SM, Bui LN, Yoon J. Use of Sexual and Reproductive Health Services Among Women Living in Rural and Urban Oregon: Impact of the Affordable Care Act Medicaid Expansion. J Womens Health (Larchmt) 2023; 32:300-310. [PMID: 36716274 DOI: 10.1089/jwh.2022.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Objectives: We compared the use of sexual and reproductive health (SRH) services for Medicaid-enrolled women of reproductive age (WRA) living in Oregon by urban/rural status and examined the effect of the Affordable Care Act (ACA) Medicaid expansion on the use of SRH services for these women. Methods: We linked Oregon Medicaid enrollment files and claims for the years 2008-2016 to identify 392,111 WRA. Outcome measures included receipt of five key SRH services. The main independent variables were urban/rural status (urban, large rural cities, and small rural towns) and an indicator for the post-Medicaid expansion time period (2014-2016). We performed (conditional) fixed-effects logistic regression and multiple-group interrupted time-series analyses. Results: Women living in small rural towns were less likely than women living in urban areas to receive well-woman visits (odds ratio [OR] = 0.87; 95% confidence interval [95% CI] [0.80-0.94]), sexually transmitted infection (STI) screening (OR = 0.81; 95% CI [0.72-0.90]), and pap tests (OR = 0.91; 95% CI [0.84-0.99]). Women living in large rural cities were less likely than women living in urban areas to receive STI screening (OR = 0.91; 95% CI [0.84-0.98]). Following the implementation of ACA Medicaid expansion, the average number of all five SRH services increased for all women. With the exception of contraceptive services, the average number of SRH services examined increased more for urban women than for women living in small rural towns. Conclusions: Although Medicaid expansion contributed to increased use of SRH services for all WRA, the policy was unsuccessful in reducing disparities in access to SRH services for WRA living in rural areas compared with urban areas.
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Affiliation(s)
- Mandana Masoumirad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - S Marie Harvey
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Linh N Bui
- School of Natural Sciences, Mathematics, and Engineering, California State University, Bakersfield, Bakersfield, California, USA
| | - Jangho Yoon
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA.,School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
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Khouja T, Burgette JM, Donohue JM, Roberts ET. Association between Medicaid expansion, dental coverage policies for adults, and children's receipt of preventive dental services. Health Serv Res 2020; 55:642-650. [PMID: 32700423 PMCID: PMC7518821 DOI: 10.1111/1475-6773.13324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine whether low-income children's use of preventive dental services is linked to variation in state Medicaid policies that affect parents' access to dental care in Medicaid. DATA SOURCES Medical Expenditure Panel Survey (2011-2016), Area Health Resources File, and Medicaid adult dental coverage policies. STUDY DESIGN We conducted a quasi-experimental analysis using linked parent-child dyads in low-income families (≤125 percent of the Federal Poverty Level). We assessed whether expansions of Medicaid to low-income adults under the Affordable Care Act were associated with increases in the use of preventive dental services among low-income children when state Medicaid programs did vs did not cover these services for adults. PRINCIPAL FINDINGS Over the study period, 37.8 percent of low-income children received at least one annual preventive dental visit. We found no change in children's receipt of preventive dental care associated with Medicaid expansions in states that covered (1.26 percentage points; 95% CI: -3.74 to 6.27) vs did not cover preventive dental services for adults (3.03 percentage points; 95% CI: -2.76 to 8.81). (differential change: -1.76 percentage points; 95% CI: -8.09, 4.56). However, our estimates are imprecise, with wide confidential intervals that are unable to rule out sizable effects in either direction. CONCLUSION We did not find an association between Medicaid expansions with concurrent coverage of preventive dental services for adults and children's use of these services. Factors other than parental access to dental benefits through Medicaid may be more salient determinants of preventive dental care use among low-income children.
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Affiliation(s)
- Tumader Khouja
- Department of Health Policy and ManagementUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvania
| | - Jacqueline M. Burgette
- Departments of Dental Public Health and Pediatric Dentistry, School of Dental MedicineUniversity of PittsburghPittsburghPennsylvania
| | - Julie M. Donohue
- Department of Health Policy and ManagementUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvania
| | - Eric T. Roberts
- Department of Health Policy and ManagementUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvania
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Dy CJ, Barker AR, Brown DS, Keller M, Chang P, Yamaguchi K, Olsen MA. Unmet Need for Total Joint Arthroplasty in Medicaid Beneficiaries After Affordable Care Act Expansion. J Bone Joint Surg Am 2020; 102:1495-1500. [PMID: 32898378 PMCID: PMC8313181 DOI: 10.2106/jbjs.20.00125] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The utilization of total hip arthroplasty (THA) and total knee arthroplasty (TKA) increased after Medicaid expansion under the U.S. Affordable Care Act (ACA), suggesting a potential unmet need for THA and TKA. We examined the timing of THA and TKA in patients after obtaining Medicaid expansion insurance coverage. We hypothesized that patients with Medicaid expansion insurance would undergo a surgical procedure sooner than patients in traditional Medicaid populations. METHODS We used administrative data from a Medicaid managed care company to determine the timing of primary THA and TKA in patients who were 18 to 64 years of age in 4 states with Medicaid expansion (Illinois, Ohio, Oregon, and Washington) and 4 states without Medicaid expansion (Louisiana, Mississippi, Texas, and Wisconsin) from 2008 to 2015. The insurance types were Medicaid expansion, Medicaid plans for Supplemental Security Income (SSI), or Temporary Assistance for Needy Families (TANF). Roughly, these 3 groups correspond to relatively healthy childless adults, relatively unhealthy disabled adults, and parents of children with Medicaid insurance. The main outcome measure was time from enrollment to the surgical procedure. The primary exposure of interest was insurance type. We used a generalized linear regression model to adjust for patient age, sex, social deprivation, surgeon supply and reimbursement, and state-level Medicaid enrollment. RESULTS In the unadjusted analysis of 4,117 patients, there was a significantly shorter time from enrollment to THA and TKA for the expansion group (median, 7.5 months) relative to the SSI group (median, 16.1 months; p < 0.0001) and the TANF group (median, 12.2 months; p < 0.0001). In the adjusted analysis, the time from enrollment to THA and TKA was significantly shorter in the expansion group (β, -1.21 [95% confidence interval (CI), -1.35 to -1.07]; p < 0.001) compared with the TANF group (β, -0.27 [95% CI, -0.38 to -0.17]; p < 0.001) and the SSI group (reference). Compared with the SSI group, these coefficients are equivalent to a 70% shorter time to the surgical procedure in the expansion group and a 24% shorter time to the surgical procedure in the TANF group. CONCLUSIONS Our findings suggest an unmet need for THA and TKA among newly enrolled Medicaid expansion beneficiaries. This need should be considered by surgeons, hospitals, and policymakers in ensuring access to care. Furthermore, consideration should be given to existing insurance-based disparities in access to orthopaedic care, as these may be exacerbated by an increased demand for THA and TKA from Medicaid expansion beneficiaries.
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Affiliation(s)
- Christopher J. Dy
- Department of Orthopaedic Surgery (C.J.D., P.C., and K.Y.), Division of Public Health Sciences, Department of Surgery (C.J.D., A.R.B., D.S.B., and M.A.O.), and Division of Infectious Diseases, Department of Medicine (M.K. and M.A.O.), Washington University School of Medicine, St. Louis, Missouri
| | - Abigail R. Barker
- Department of Orthopaedic Surgery (C.J.D., P.C., and K.Y.), Division of Public Health Sciences, Department of Surgery (C.J.D., A.R.B., D.S.B., and M.A.O.), and Division of Infectious Diseases, Department of Medicine (M.K. and M.A.O.), Washington University School of Medicine, St. Louis, Missouri
| | - Derek S. Brown
- Department of Orthopaedic Surgery (C.J.D., P.C., and K.Y.), Division of Public Health Sciences, Department of Surgery (C.J.D., A.R.B., D.S.B., and M.A.O.), and Division of Infectious Diseases, Department of Medicine (M.K. and M.A.O.), Washington University School of Medicine, St. Louis, Missouri
| | - Matthew Keller
- Department of Orthopaedic Surgery (C.J.D., P.C., and K.Y.), Division of Public Health Sciences, Department of Surgery (C.J.D., A.R.B., D.S.B., and M.A.O.), and Division of Infectious Diseases, Department of Medicine (M.K. and M.A.O.), Washington University School of Medicine, St. Louis, Missouri
| | - Peter Chang
- Department of Orthopaedic Surgery (C.J.D., P.C., and K.Y.), Division of Public Health Sciences, Department of Surgery (C.J.D., A.R.B., D.S.B., and M.A.O.), and Division of Infectious Diseases, Department of Medicine (M.K. and M.A.O.), Washington University School of Medicine, St. Louis, Missouri
| | - Ken Yamaguchi
- Department of Orthopaedic Surgery (C.J.D., P.C., and K.Y.), Division of Public Health Sciences, Department of Surgery (C.J.D., A.R.B., D.S.B., and M.A.O.), and Division of Infectious Diseases, Department of Medicine (M.K. and M.A.O.), Washington University School of Medicine, St. Louis, Missouri
| | - Margaret A. Olsen
- Department of Orthopaedic Surgery (C.J.D., P.C., and K.Y.), Division of Public Health Sciences, Department of Surgery (C.J.D., A.R.B., D.S.B., and M.A.O.), and Division of Infectious Diseases, Department of Medicine (M.K. and M.A.O.), Washington University School of Medicine, St. Louis, Missouri
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Molina Y, San Miguel C, Sanz S, San Miguel L, Rankin K, Handler A. Adapting to a Shifting Health Care Landscape: Illinois Breast and Cervical Cancer Program Lead Agencies' Perspectives. Health Promot Pract 2018; 20:600-607. [PMID: 29759013 DOI: 10.1177/1524839918776012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Understanding how safety net programs adapt to systemic health care changes is pivotal for creating feasible recommendations for policy implementation. This study characterizes perspectives of Lead Agency (LA) coordinators of the Illinois Breast and Cervical Cancer Program (IBCCP) in response to sociopolitical changes at state and national levels. Our cross-sectional study included 29 semistructured telephone interviews between December 2015 and January 2016. Respondents indicated some changes in the priority population served, changes in referrals and clinical services, and, a continued commitment to IBCCP. Our findings suggest that IBCCP and other safety net programs will need to be flexible to meet the ongoing needs of historically vulnerable populations in a complex, shifting environment. Implications for public health practice and policy include the need to ensure that program personnel are aware of evidence-based strategies to reach different priority populations and are kept abreast of organizational and system changes that may affect referral patterns as well as the need to educate health care providers working with safety net programs about changes in the delivery and coordination of services.
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Affiliation(s)
- Yamile Molina
- 1 University of Illinois at Chicago, Chicago, IL, USA
| | | | - Stephanie Sanz
- 2 California Department of Public Health, San Diego, CA, USA
| | | | | | - Arden Handler
- 1 University of Illinois at Chicago, Chicago, IL, USA
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Hom JK, Stillson C, Rosin R, Cahill R, Kruger E, Grande D. Effect of Outreach Messages on Medicaid Enrollment. Am J Public Health 2017; 107:S71-S73. [PMID: 28661816 DOI: 10.2105/ajph.2017.303845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To measure the impact of different outreach messages on health insurance enrollment among Medicaid-eligible adults. METHODS Between March 2015 and April 2016, we conducted a series of experiments using mail-based outreach that encouraged individuals to enroll in Pennsylvania's expanded Medicaid program. Recipients were randomized to receive 1 of 4 different messages describing the benefits of health insurance. The primary outcome was the response rate to each letter. RESULTS We mailed outreach letters to 32 993 adults in Philadelphia. Messages that emphasized the dental benefits of insurance were significantly more likely to result in a response than messages emphasizing the health benefits (odds ratio = 1.33; 95% confidence interval = 1.10, 1.61). CONCLUSIONS Medicaid enrollment outreach messages that emphasized the dental benefits of insurance were more effective than those that emphasized the health-related benefits. Public Health Implications. Although the structure and eligibility of the Medicaid program are likely to change, testing and identifying successful outreach and enrollment strategies remains important. Outreach messages that emphasize dental benefits may be more effective at motivating enrollment among individuals of low socioeconomic status.
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Affiliation(s)
- Jeffrey K Hom
- Jeffrey K. Hom is with the Department of Medicine, Crescenz VA Medical Center, Philadelphia, PA. Christian Stillson and David Grande are with the Division of General Internal Medicine, University of Pennsylvania, Philadelphia. Roy Rosin is with the Penn Medicine Center for Health Care Innovation, University of Pennsylvania. Rachel Cahill and Evelyne Kruger are with Benefits Data Trust, Philadelphia
| | - Christian Stillson
- Jeffrey K. Hom is with the Department of Medicine, Crescenz VA Medical Center, Philadelphia, PA. Christian Stillson and David Grande are with the Division of General Internal Medicine, University of Pennsylvania, Philadelphia. Roy Rosin is with the Penn Medicine Center for Health Care Innovation, University of Pennsylvania. Rachel Cahill and Evelyne Kruger are with Benefits Data Trust, Philadelphia
| | - Roy Rosin
- Jeffrey K. Hom is with the Department of Medicine, Crescenz VA Medical Center, Philadelphia, PA. Christian Stillson and David Grande are with the Division of General Internal Medicine, University of Pennsylvania, Philadelphia. Roy Rosin is with the Penn Medicine Center for Health Care Innovation, University of Pennsylvania. Rachel Cahill and Evelyne Kruger are with Benefits Data Trust, Philadelphia
| | - Rachel Cahill
- Jeffrey K. Hom is with the Department of Medicine, Crescenz VA Medical Center, Philadelphia, PA. Christian Stillson and David Grande are with the Division of General Internal Medicine, University of Pennsylvania, Philadelphia. Roy Rosin is with the Penn Medicine Center for Health Care Innovation, University of Pennsylvania. Rachel Cahill and Evelyne Kruger are with Benefits Data Trust, Philadelphia
| | - Evelyne Kruger
- Jeffrey K. Hom is with the Department of Medicine, Crescenz VA Medical Center, Philadelphia, PA. Christian Stillson and David Grande are with the Division of General Internal Medicine, University of Pennsylvania, Philadelphia. Roy Rosin is with the Penn Medicine Center for Health Care Innovation, University of Pennsylvania. Rachel Cahill and Evelyne Kruger are with Benefits Data Trust, Philadelphia
| | - David Grande
- Jeffrey K. Hom is with the Department of Medicine, Crescenz VA Medical Center, Philadelphia, PA. Christian Stillson and David Grande are with the Division of General Internal Medicine, University of Pennsylvania, Philadelphia. Roy Rosin is with the Penn Medicine Center for Health Care Innovation, University of Pennsylvania. Rachel Cahill and Evelyne Kruger are with Benefits Data Trust, Philadelphia
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