Problems with expanding Medicaid for the uninsured

Emergency department utilization in the Texas Medicaid emergency waiver following Hurricane Katrina

OBJECTIVE

To estimate the enrollment and emergency department (ED) utilization in TexKat, the Texas Medicaid emergency waiver implemented following Hurricane Katrina.

DATA SOURCES

Individual-level enrollment and utilization data from the 2005 Medicaid Analytic Extract.

STUDY DESIGN

Descriptive analysis is performed on variables that describe enrollment levels, the demographic characteristics of enrollees, and the most common diagnoses in ED visits. A Poisson regression model is also employed to quantify the factors related to an enrollee's probability of having an ED visit and the average number of ED visits.

PRINCIPAL FINDINGS

There were 44,246 individuals enrolled in TexKat in 2005. Roughly 13% of these enrollees had at least one ED visit during the sample period, with one quarter of these individuals having more than one visit. Across all enrollees the most common diagnosis was "other upper respiratory infection," but there were significant differences in diagnosis patterns across racial/ethnic groups. The regression analysis suggests little difference in ED utilization across genders, but significant contrasts across racial/ethnic and age groups.

CONCLUSIONS

As very little is known about Medicaid emergency waivers, our analysis may provide important information to policymakers who have to react quickly following a disaster. Our findings may help providers estimate potential increases in ED utilization and prepare for relatively common diagnoses. Furthermore, the analysis across racial/ethnic groups may help government officials identify important areas for outreach among vulnerable populations.

A disease-specific Medicaid expansion for women. The Breast and Cervical Cancer Prevention and Treatment Act of 2000

The Breast and Cervical Cancer Prevention and Treatment Act of 2000 (BCCPTA) allows states the option of extending Medicaid eligibility to women diagnosed with breast or cervical cancer through a large federal screening program that does not include resources for treatment. Using qualitative data from interviews with 22 key informants and other sources, we present an analysis of the history and passage of the BCCPTA as a policy response to a perceived "treatment gap" in a national screening program. The results suggest that organizational policy entrepreneurs-primarily the National Breast Cancer Coalition-constructed an effective problem definition (that the government screening program was "unethical" and "broken") with a viable policy solution (an optional disease-specific Medicaid expansion), and pushed this proposal through a policy window opened by a budget surplus and an election year in which women's health issues had broad bipartisan appeal.

How much did the Medicaid expansions for children cost? An analysis of state Medicaid spending, 1984-1994

The authors examine the relationship between the Medicaid eligibility expansions for children and state Medicaid spending during the period from 1984 to 1994. They find that the Medicaid expansions had relatively low incremental cost per enrollee--substantially below the average Medicaid expenditure for children. Expansion children tend to be older and have fewer disabilities. Moreover, many of the most expensive expansion children would have been covered by Medicaid-medically-needy provisions had the expansions not occurred. The authors examine the implications of our findings for intensified Medicaid outreach efforts and for the State Children's Health Insurance Program.