Impact Of Medicaid Research Articles

Medicaid's impact on access to and utilization of health care services among racial and ethnic minority children.

Numerous studies throughout the last 30 years and the results presented here from theKaiser/Commonwealth Five State Low Income Survey support Medicaid's role in improving access to care for poor minority children. Since minority children are affected disproportionately by the unavailability of health insurance, Medicaid's role as a financing source is particularly important to these groups. It is also clear that reducing financial barriers will not eliminate completely the inequalities in health care utilization and disparities in health status across different racial and ethnic groups. As discussed above, despite Medicaid's influence, minority children still exhibit poorer quality of health. Thus, strategies for the next century should focus on ensuring that all barriers to care are removed. This will involve not only the guarantee of universal health care coverage for all children, but also the elimination of social, cultural, and behavioral barriers to optimum health and health care as well.

When is Growth Not Growth? The Curious Case of Mental Health Budgeting in New York

This article argues that the adverse impact of Medicaid on state budgets alleged in various public debates has been overstated, in some measure because of the inaccurate and misleading manner in which Medicaid expenditures are appropriated in state budgeting systems. Data on Medicaid and mental health spending in the state of New York is used for analysis. The first section provides a Medicaid spending and budgeting background. The second section discusses Medicaid and mental health in New York. The third section describes actual budgeted spending for mental health in New York, and the final section provides a discussion and concluding comments.

Has Medicaid growth crowded out state educational spending?

Researchers have argued that the dramatic increase in Medicaid spending during the late 1980s and early 1990s "crowded out" state spending on other activities, particularly education. Medicaid growth has, at least in part, been driven by increased federal eligibility and service mandates, federal court decisions on hospital and nursing home rates, and health care inflation; and the need to respond to these outside forces has placed increasing pressure on state finances. Other evidence, however, suggests that the adverse effect of Medicaid growth on state finances has been overstated. During the late 1980s and early 1990s, states shifted many human service programs from general fund to Medicaid financing and took advantage of Medicaid rules governing the use of provider donations and assessments, such as state matching and claiming payments to disproportionate-share hospitals to increase federal reimbursement without increasing the claims on their own revenues. But the increased burden of Medicaid growth on state finances may be more apparent than real. In this article, we test the crowding-out hypothesis using a two-stage, least-squares fixed-effects model of Medicaid's impact on educational spending from 1980 to 1990. Our results indicate that Medicaid growth has had no significant effect on educational spending. Rather, educational spending has responded more to changes in states' own-source revenues than to growth in Medicaid spending.

The impact of Medicaid managed care on the public health system in Arizona: case study.

This article examines the impact of a statewide Medicaid managed care program, the Arizona Health Care Cost Containment System (AHCCCS), on the local public health system in Arizona. Based on interviews with current and former state and local public health officials, the authors describe public health concerns with capitated health care delivery systems that rely on gatekeeper systems to control utilization. The authors identified difficulties in gauging the extent of the problem, since neither public health nor managed care systems collect data on use of public health clinics by AHCCCS beneficiaries. Relationships between public health officials and managed care officials are characterized by tensions resulting from differing outlooks about access, eligibility, and the need for preventive health services. The report concludes with recommendations developed by the Association of State and Territorial Health Officials (ASTHO) Primary Care Committee on roles for state health agencies in ensuring development of appropriate managed care delivery systems for vulnerable populations.

The Impact of Medicaid on Research-Based Care in Pediatric Hematology/Oncology

The dilemmas posed by Medicaid's inadequate reimbursement for health care are discussed. A short history of the intent of Medicaid is presented and Medicaid is contrasted with indigent care and care provided by health maintenance organizations or similar programs. Research care is expensive, and it is therefore often difficult to support Medicaid patients in research protocols. Current trends in research care delivery are summarized, and a potential solution is presented in which the support of the clinical research structure is transferred to support of the patient enrolled in a research protocol.

The Incentive Effects of Medicaid on Women's Labor Supply

This paper investigates Medicaid's impact on women's labor supply behavior while taking into account Medicaid's link to the AFDC program. The data were extracted from the 1986 Current Population Survey. A majorfinding is that Medicaid, valued as government-provided health insurance, has a significant negative impact on an average female head's probability of working. For instance, a I0 percent increase in Medicaid would reduce a head's probability of working by .9 to 1.3 percentage points. Contrary to expectations, Medicaid is found to have a generally insignificant effect on hours worked.

The impact of Medicaid on physician use by low-income children.

This study evaluated the determinants of physician use by low-income children, with an emphasis on the effect of Medicaid. Data are from the 1980 National Medical Care Utilization and Expenditure Survey. Regression analysis revealed that Medicaid children were more likely than both privately insured and uninsured children to visit an office-based physician. Also, Medicaid children with at least one visit to any setting had a higher number of visits than uninsured children. Such factors as age, health status, number of children in the family, educational status, and income also accounted for differences within the low-income population. The results suggest that access to physicians' services (including office-based physicians) can be increased by expanding Medicaid eligibility to uninsured low-income children and by improving private health insurance benefits among the underinsured.

The income redistribution effects of Medicaid: Application in New York State

The efficacy of Medicaid as an income redistribution mechanism among New York State counties was examined to determine tthe degree of income shifting from higher to lower income counties. A sample of 21 counties, grouped into four discrete income classes according to 1970 per capita income was taken. Costs and expenditures (attributed to Medicaid) were allocated over all counties, adjusting for federal and state aid transfers. The data were tabulated for each of the 21 counties and six key ratios (including: Medicaid expenditures per authorized recipient, etc.) were developed as measures of income distribution. The impact of Medicaid was tested using two independent statistical techniques, goodness of fit and pooled comparisons between each pair of means for each ratio. Results indicated that no appreciable shift in income from high to low counties existed. Medicaid failed 45 of 72 mean difference tests, and the true distribution of costs and expenditures across income classes did not differ significantly from a uniform distribution in 77.7% of the cases. The results indicate that the mandated funding structure of Medicaid impinges more severely on poorer counties. Lack of an adequate health care infra-structure may seriously limit the ability of lower income counties to provide care even with Medicaid covering a large share of medical costs.

The impact of Medicaid on private care for the urban poor.

A study of former welfare clients in New York City investigates the extent to which Medicaid opened up private medical care for the urban poor. Seven hundred and twenty-nine respondents were interviewed on all live interview waves; three before Medicaid and two after. The proportion who considered a private doctor their “main place” for medical care rose from 1 per cent before Medicaid to 10 per cent afterwards. The large majority continued to use clinics. Some who preferred private core were unable to take advantage of it because of practical barriers, but many others claimed to prefer clinic care.