This JAMA Forum discusses eligibility restrictions for emergency Medicaid coverage, cuts to health care coverage for legal immigrants, and the broader pattern of health care cuts made by the Trump administration and Congressional allies.

This study examined state-level Medicaid hearing aid coverage for adults ages twenty-one and older across the United States. Using policy surveillance principles, we compiled a cross-sectional data set detailing hearing aid coverage policies from fifty states and Washington, D.C., as of December31, 2023. We then merged these data with individual-level American Community Survey data to estimate national rates of Medicaid hearing aid coverage and identify how coverage varies according to demographic characteristics. We identified thirty-two states with Medicaid hearing aid coverage for adults, with substantial variability in policy features of that coverage. Approximately 70percent of Medicaid beneficiaries ages twenty-one and older lived in a state with coverage. Women, working-age adults, and Black adults had slightly lower odds of coverage, whereas Hispanic and Latino and other or multiple race beneficiaries had higher odds of coverage. Expanding and standardizing Medicaid coverage of hearing aid benefits in line with best practices could improve access and utilization.

Medicaid Coverage of Dental Services and Dental Hygiene During Pregnancy

Background: The Department of Vermont Health Access (DVHA) administers Medicaid and currently reimburses for institutional palliative care (PC) for both adults and children. While home-based palliative care (HBPC) is reimbursed for pediatric beneficiaries, HBPC for adults is an uncovered service. Objective: To assess the need for adult HBPC Medicaid coverage and evaluate barriers to providing HBPC services from the perspective of local medical professionals and home health agencies (HHAs) in the state of Vermont. Design: Qualitative and descriptive study. Setting/Subjects: Six clinicians from Vermont, United States, were individually interviewed. DVHA recruited 10 HHA representatives to participate in a focus group and 1 HHA representative who was unable to attend but participated in a separate interview. All participants (n = 17) received an information packet with a proposed PC service package developed prior to participation. Measurements: Recordings of the interviews and focus group were transcribed and analyzed using thematic content analysis with NVivo software (version 14). The independent coders reviewed the transcripts and identified key themes and subthemes. Results: Four overarching themes were identified: (1) Treatments, Purpose, and Quality of Care; (2) Interdisciplinary Team, Staffing, and Referrals; (3) Education, Communication Barriers, and Defining PC; and (4) Accessibility and HHA Financial Considerations. Conclusions: Overall, clinicians and HHA representatives suggested that HBPC may provide benefit for patients through enhanced quality of life, but many believe that further education and staffing are necessary to appropriately deliver these services. Further research into Medicaid reimbursement models will be helpful to assess the feasibility of HBPC delivery.

To determine whether pandemic-era Medicaid policies to increase postpartum coverage to 1 year were effective in preventing coverage loss into the second-year postpartum. The analytic sample included 7967 cases (N = 4632 in the pandemic era) from the 2019 and 2021-2024 Current Population Survey, Annual Social and Economic Supplement. On multivariable analysis of the entire sample, era was not associated with the type or continuity of insurance coverage. Among families living below 100% Federal Poverty Level, the relative risk of coverage gaps compared with continuous private coverage decreased by 58% (95% confidence interval: 19%, 79%, P = 0.010). Pandemic-era Medicaid policies appeared effective in preventing postpartum coverage loss in the second year after birth, especially among families living below the poverty line.

Background: Catheter ablation is a guideline-directed therapy for symptomatic supraventricular tachycardia (SVT), yet disparities in its utilization across patient populations remain inadequately characterized. Objective: To evaluate demographic and hospital-level factors associated with catheter ablation among hospitalized patients with SVT in the United States. Methods: We analyzed adult hospitalizations with a diagnosis of SVT (ICD-10-CM I47.1) from the National Inpatient Sample (NIS) for the years 2016 through 2020. Catheter ablation was identified using ICD-10-PCS procedure codes. Survey-weighted logistic regression was used to assess associations between demographic characteristics and the odds of receiving ablation. Age was evaluated both as a continuous and categorical variable. Analyses accounted for the complex survey design of the NIS. Results: Among approximately 1.87 million weighted hospitalizations for SVT, only 4.1% underwent catheter ablation. Female patients comprised 52.5% of the SVT cohort but had 16.0% lower odds of receiving ablation compared to males (adjusted OR [aOR] 0.84; p <0.001). Black patients had 9.1% lower odds of ablation compared to White patients (aOR 0.91; p =0.002), while Hispanic and Other race groups had 18.1% (aOR 1.18; p <0.001) and 24.6% (aOR 1.25; p =0.003) higher odds, respectively. Insurance status also impacted access: patients with private insurance had 34.2% higher odds of ablation compared to Medicare recipients (aOR 1.34; p <0.001), whereas those with Medicaid had 9.7% lower odds (aOR 0.90; p =0.010). Increasing age was inversely associated with ablation use, with a 1.2% decrease in odds per year of age (aOR 0.99; 95% CI 0.987–0.989; p <0.001). Compared to patients aged 20–29, those aged 40–49 had 15.4% higher odds (aOR 1.15; p =0.018), while patients aged 60–69, 70–79, and ≥80 had 12.8%, 17.5%, and 49.1% lower odds, respectively (all p <0.05; Figure 1). Patients treated at urban teaching hospitals had 316% higher odds of ablation compared to those at rural hospitals (aOR 4.16; p <0.001). Conclusion: Significant disparities exist in the use of catheter ablation for SVT. Female sex, older age, Black race, and Medicaid coverage were associated with lower odds of ablation, while private insurance and care in urban teaching hospitals were associated with higher odds. These findings underscore the need for targeted efforts to address inequities in access to evidence-based electrophysiologic care.

Background: Prior cross-sectional studies have documented poor low-density lipoprotein cholesterol (LDL-C) control in patients with atherosclerotic cardiovascular disease (ASCVD); however, there are limited data on whether LDL-C control improves over time and whether certain patient groups have better or worse control trajectories. Methods: Using the cvMOBIUS-2 registry, which includes electronic health record data from adults with ASCVD across 17 US academic medical centers, we analyzed LDL-C levels over time amongst those with a starting LDL-C level ≥70 mg/dL and at least one follow-up LDL-C measurement after a minimum of 6 months of available follow-up. Generalized estimating equations were used to assess factors associated with higher LDL-C levels over time, accounting for repeated measurements within individuals. Results: Between 1/1/2019 and 6/24/2023, 414,736 ASCVD patients (median age, 68.5 years; 48% women) with a median baseline LDL-C of 98.0 mg/dL (interquartile range [IQR], 82.0–123.0 mg/dL) were included. The median number of follow-up LDL-C measurements per patient was 3 (IQR, 1–4). At the time of the final LDL-C measurement (median 27.9 months [IQR, 15.9–43.9 months] from baseline), the median LDL-C had decreased to 83.0 mg/dL (IQR, 66.0–107.0 mg/dL). However, approximately 70% of patients had not achieved an LDL-C <70 mg/dL and 87% had not achieved an LDL-C <55 mg/dL. Factors associated with higher LDL-C levels over time included Medicaid coverage (β = +6.0 mg/dL; 95% confidence interval [CI], 5.5–6.6; vs Medicare) and the absence of recurrent ASCVD events (β = +15.4 mg/dL; 95% CI, 15.1–15.7). Conclusion: Among ASCVD patients receiving care in academic medical centers, those with a baseline LDL-C ≥70 mg/dL often exhibited persistently elevated LDL-C levels over time, and more than two-thirds did not achieve recommended levels during follow-up. Notably, patients without recurrent ASCVD events had worse longitudinal LDL-C control. These findings highlight that even patients without recurrent ASCVD events, who are often considered clinically stable, need improved lipid-lowering strategies to achieve guideline-recommended LDL-C levels.

Outcomes for Medicaid recipients with multiple myeloma: A national retrospective trend analysis from 2015 to 2022

To examine the association between disability status and dental treatments, and to explore the differences in dental expenses and sources of payment among individuals with and without disabilities in 2019. Data included the adult population from the 2019 Medical Expenditure Panel Survey. We estimated the association between dental treatments and disability status using regressions adjusting for demographic and socioeconomic variables. The outcomes for expenditures were total dental expenditure and sources of payment. In 2019, 59.01% of adults with disabilities did not receive dental treatments. Individuals were less likely to receive any dental treatment when they had disabilities with vision (adjusted odds ratio [AOR] 0.78, 95% confidence interval [95% CI] 0.62-0.97), mobility (AOR 0.78, 95% CI 0.68-0.89), and independent living (AOR 0.72, 95% CI 0.60-0.88). Adults with cognitive disabilities had 1.28 times higher odds of receiving procedural treatment than adults without cognitive disabilities. Only 20% of the total dental expenditure was spent on individuals with disabilities, with 53.72% paid out of pocket. Significant differences exist in the dental treatments and expenses between adults with and without disabilities. Expanding Medicaid coverage, improving reimbursement rates, and promoting oral health literacy may help reduce the oral health disparities in this population.

Real-world evidence on treatment persistence and its association with alkaline phosphatase (ALP) and clinical outcomes in primary biliary cholangitis (PBC) is limited. We conducted a retrospective study using Komodo's US claims and laboratory data (09/2018-09/2023) of adults with PBC treated with ursodeoxycholic acid (UDCA), obeticholic acid (OCA), or concurrent UDCA/OCA. Persistence was defined as continuous treatment with ≤ 60-day gaps. Cox models evaluated predictors of discontinuation, logistic models examined associations between discontinuation and normal ALP, and Cox models assessed normal ALP and clinical outcomes. Among 20,139 individuals starting UDCA (n = 17,006), OCA (n = 1,709), or concurrent UDCA/OCA (n = 1,424), one-year persistence was 50%, 51%, and 49%, respectively. Significant predictors of discontinuation included pruritus (hazard ratio [HR] = 1.09), fatigue (HR = 1.09), abdominal pain (HR = 1.08), African American race (HR = 1.36), Hispanic ethnicity (HR = 1.11), Medicaid coverage (HR = 1.13), baseline cirrhosis (HR = 1.08), portal hypertension (HR = 1.11), systemic lupus erythematosus (HR = 1.13) (all p < 0.01), and urinary infection (HR = 1.06, p = 0.017). Of 626 patients with baseline ALP levels ≥ 1.67 x upper limit of normal, 33%, 17%, and 11% in the UDCA, OCA, and concurrent UDCA/OCA cohorts, respectively, had normal ALP within 6-24 months (p = 0.005 and p < 0.001 for OCA and concurrent vs. the UDCA cohort, respectively). UDCA discontinuation was associated with lower odds of having normal ALP. Normal ALP was associated with a reduced risk for mortality and clinical outcomes. Treatment persistence is crucial in PBC as it is associated with normal ALP and significant improvement in clinical outcomes. Novel strategies and therapies are needed to enhance persistence and improve clinical benefits among individuals with PBC.

This cohort study assesses the association between Medicaid coverage disruptions and short- and long-term survival outcomes among recipients of pediatric liver transplants.

Abstract Those involved with the criminal justice system have disproportionately high rates of mental illness and substance-use disorders, prompting speculation that health insurance, by improving treatment of these conditions, could reduce crime. Using the 2008 Oregon Health Insurance Experiment, which randomly made some low-income adults eligible to apply for Medicaid, we find no statistically significant impact of Medicaid coverage on criminal charges or convictions. These null effects persist for high-risk subgroups, such as those with prior criminal cases and convictions or mental health conditions. In the full sample, our confidence intervals can rule out most quasi-experimental estimates of Medicaid’s crime-reducing impact.

The study aims to analyze the impact of Medicaid Expansion on hospital finances. Medicaid eligibility may increase hospital reimbursements and lower uncompensated care costs if patients are moving from no insurance coverage to Medicaid. However, if patients taking up Medicaid are moving from a private insurance plan to Medicaid, then it is also possible that hospital reimbursements may be lower under Medicaid expansion. Medicaid expansion increased the eligibility for Medicaid coverage to a broader group of people and raised the income threshold to 138% of the federal poverty level. Some states chose to expand Medicaid while others did not. Using a natural experiment, I compare hospital revenues and uncompensated care costs in Eastern Washington, which chose to expand Medicaid in 2014, and in Idaho, which chose not to expand until 2020. Medicaid expansion may be associated with lower net revenues, higher Medicaid received, and lower uncompensated care costs per hospital bed, ceteris paribus. I find no significant impact on operating margins. This study adds to the current literature looking at Medicaid Expansion and hospital finances by looking at a different region than has been previously studied. This region offers similar demographic and economic situations in both states. These areas are more rural areas and have less populated cities, which allows for a unique perspective and contributes to the understanding of how Medicaid Expansion may impact hospital finances.

Substantial cancer underdiagnosis, especially early-stage cancers, occurred during the COVID-19 pandemic in the United States. Medicaid expansion under the Affordable Care Act could facilitate access to timely detection of cancer during pandemic-related financial and employment instability. This study examines the association of Medicaid expansion and changes in cancer stage at diagnosis during the COVID-19 pandemic. We compared changes in proportions of early-stage (stage I/II) cancer diagnosis in Medicaid expansion states versus non-expansion states among 1844515 individuals aged 18-64 years newly diagnosed with cancer in 2018-2022 from the National Cancer Database using a difference-in-differences (DD) approach. Adjusted DD estimates were calculated with linear probability models and stratified by key sociodemographic factors and cancer type. We found that Medicaid expansion was statistically significantly associated with smaller decreases in proportions of early-stage cancer diagnosis among individuals aged 18-44 years (DD = 1.26; 95% CI = 0.54 to 1.98), men (DD = 0.61; 95% CI = 0.08 to 1.14), and those with high comorbidity burden (Charlson-Deyo comorbidity score ≥ 2; DD = 1.51; 95% CI = 0.24 to 2.78), treated in academic facilities (DD = 0.55; 95% CI = 0.03 to 1.06), or diagnosed with prostate cancer (DD = 1.52; 95% CI = 0.56 to 2.47). Our findings suggest a protective effect of Medicaid expansion on early-stage cancer diagnoses during the COVID-19 pandemic and public health emergency in the United States, informing policy makers and the public in the 10 states that have yet to expand Medicaid eligibility. Findings can also inform policy makers and the public in all states about the public health implications of upcoming large federal cuts to Medicaid programs and coverage.

Objective: Many children with autism experience unmet needs, emphasizing the importance of research on service access. Methods: We surveyed English-speaking caregivers of children diagnosed with autism in 2018 at a tertiary Midwestern children’s hospital. The survey assessed satisfaction with accessing services and included open-ended questions. Results: A total of 189 caregivers participated. Most accessed speech (86.2%), occupational (90.0%), and educational services (93.7%). Fewer received behavior therapy (35.6%), applied behavior analysis (23.8%), or group therapy (15.1%). While overall satisfaction was high, families who expressed dissatisfaction noted barriers such as difficulty navigating the system, limited availability, long waitlists, and high costs. Families cited advocacy and service navigation as key facilitators. Low uptake of certain services and persistent barriers underscore the need for systemic changes. Conclusions: We outline potential solutions, including expanding Medicaid and insurance coverage, redesigning service pathways, and implementing family navigation to improve access and outcomes.

To evaluate the effects of the Family First Coronavirus Response Act (FFCRA) on work outcomes of women for whom the FFCRA effectively expanded income eligibility for Medicaid beyond 60 days postpartum by prohibiting states from redetermining Medicaid eligibility between March 2020 and March 2023. We use a difference-in-differences design that leverages the differences in income eligibility between pregnancy and non-pregnancy across states, and compares outcome changes pre-post FFCRA over these differences. Data come from the 2016-2022 American Community Survey. The sample includes 205,104 women aged 19-49 years who reported giving birth within the past 12 months in 41 states and Washington D.C. On average, the FFCRA increased postpartum Medicaid coverage by 2.8 percentage points (95% CI: 0.7-4.8) or by 9.3% relative to the 2019 Medicaid coverage rate. In contrast, the FFCRA effects on work outcomes were small and not significant: the average effect was 0.10 percentage points for labor force participation (95% CI: -1.0 to 1.2), 0.7 percentage points for employment (95% CI: -0.02 to 1.4), 0.04 h for weekly work hours (95% CI: -0.4 to 0.5), and 0.2 percentage points for full-time employment (95% CI: -1.1 to 1.5). These confidence intervals rule out an employment decline above 0.02 percentage points and full-time employment decline above 1.1 percentage points. The increase in Medicaid coverage is concentrated among states with a larger difference between pregnancy and non-pregnancy eligibility (+5.9 percentage points; 95% CI: 0.9 to 10.9) and estimates in this group also rule out relatively small declines in work outcomes. There is no evidence of declines in work outcomes following the increase in Medicaid coverage beyond 60 days postpartum that resulted from the FFCRA. The findings suggest that subsequent postpartum Medicaid coverage extensions for 12 months under the American Rescue Plan are unlikely to disincentivize work among beneficiaries.

Racial and ethnic disparities in cardiovascular care are well-documented; however, their impact on transcatheter mitral valve interventions, including transcatheter mitral valve repair (TMVr), remains underexplored. This review synthesizes the existing literature on racial and ethnic disparities in TMVr access, utilization, and outcomes to identify contributing factors, proposed solutions, and critical knowledge gaps. A comprehensive search of PubMed, EMBASE, and Cochrane databases from 2014 to 2024 yielded nine studies for final inclusion. Across studies, minority patients-particularly African American and Hispanic individuals-were consistently underrepresented among TMVr recipients relative to disease burden. They tended to present at younger ages, were more likely to be female, and more often underwent non-elective procedures at lower-volume centers. Minority patients experienced longer hospital stays, greater procedural costs, and higher healthcare resource utilization. While some studies reported higher post-procedural mortality or readmission rates among minorities, findings on complication rates were mixed. Contributing factors included socioeconomic stressors, Medicaid coverage, limited referrals to specialized centers, provider bias, and geographic barriers. Newer studies also highlighted disparities in TMVr access even within equal-access systems and identified income-related disparities independent of race. Proposed interventions included Medicaid expansion, coverage with evidence development, culturally competent care delivery, improved referral pathways, and community outreach. All included studies were retrospective and predominantly relied on administrative data. Prospective, longitudinal studies are needed to clarify causal drivers of disparity and inform equity-focused policies in structural heart interventions.

Quantifying the mortality and morbidity impact of medicaid work requirements: a modeling study

PURPOSEUnplanned treatment interruptions represent an important care quality shortfall for patients undergoing cancer radiotherapy. This study aimed to evaluate use of a centralized electronic health record warehouse and large language model–based data preprocessing to facilitate identification of risk factors for radiation therapy interruptions (RTI).METHODSWe analyzed demographic, behavioral, clinical, and neighborhood-level data for 2,130 patients treated with radiotherapy at the University of Tennessee Medical Center in Knoxville. Treatment interruptions were measured as missed days, adjusted for weekends and holidays. Multinomial logistic regression was used to identify factors associated with moderate (2-4 days) and severe (≥5 days) RTI.RESULTSModerate RTI occurred in 15.8% of patients, while 7.7% experienced severe RTI. Moderate delays were associated with genitourinary cancer (adjusted odds ratio (AOR), 3.81; 95% CI, 1.24 to 11.66), prostate cancer (AOR, 2.44; 95% CI, 1.34 to 4.46), and Medicaid coverage (AOR, 2.22; 95% CI, 1.32 to 3.73). Severe RTI was associated with marital status (AOR for divorced or separated patients, 1.86; 95% CI, 1.18 to 2.94), head and neck cancer (AOR, 2.31; 95% CI, 1.10 to 4.87), gynecologic cancer (AOR, 2.97; 95% CI, 1.30 to 6.79), Medicaid insurance (AOR, 3.43; 95% CI, 1.77 to 6.64), daily dose of ≤225 cGy (AOR, 2.55; 95% CI, 1.21 to 5.37), and a total dose of ≥6,000 cGy (AOR, 2.30; 95% CI, 1.09 to 4.88). Severe interruptions were also significantly associated with high neighborhood social vulnerability (AOR, 2.60; 95% CI, 1.32 to 5.09).CONCLUSIONAutomated data preprocessing permitted efficient identification of treatment course length, marital status, disease site, Medicaid coverage, and socially vulnerable locations as significant factors associated with RTI. These findings underscore the need for data-driven risk assessment and intervention strategies to maintain cancer treatment quality at scale.

258 Background: One in three childhood cancer survivors are enrolled in Medicaid at diagnosis, a population requiring lifelong health insurance to support long-term outcomes. However, knowledge gaps remain regarding modifiable factors to Medicaid coverage for adolescent/young adult (AYA) or adult survivors of childhood cancer. We explored healthcare provider and staff perspectives on barriers and facilitators to continuous Medicaid coverage for this high-need population. Methods: We conducted semi-structured interviews with 22 stakeholders—including oncologists, nurses, social workers (SW), and financial counselors (FC)—who directly care for AYA/adult survivors of childhood cancer. Interviews (~45 minutes) were audio-recorded, transcribed, coded using both deductive and inductive approaches, and compared across practice type. Results: Participants represented 11 cancer centers in Medicaid expansion (55%) and non-expansion (45%) states. Most were female (91%), aged 40–54 (50%), and non-Hispanic White (73%). Practice types included oncologists/nurses (54%) and SW/FC (46%). Five key barriers to continuous coverage emerged. First, many oncologists and nurses reported a lack of familiarity with Medicaid-related issues and often relied on SW/FC for information. Next, participants described administrative barriers related to burdensome application and renewal processes, including complex documentation and frequent verifications. Third, administrative barriers are particularly challenging for survivors due to unclear disability criteria, post-treatment changes in disability status, and cognitive limitations that impair survivors’ ability to navigate the system. Fourth, many survivors experience missed renewal deadlines, often due to residential transiency or failure to respond to renewal notifications. Finally, the loss of coverage after age 19 in non-expansion states was a major barrier to continuous coverage. Facilitators of continuous coverage included guidance from knowledgeable staff (e.g., SW, dedicated institutional Medicaid teams) and support from family/caregivers and advocacy organizations. To improve continuous coverage, stakeholders proposed simplifying Medicaid processes, expanding eligibility for young adult survivors, increasing Medicaid navigation resources, and educating survivors early—particularly before transitioning from pediatric care. Some participants recommended universal Medicaid coverage for childhood cancer survivors. Conclusions: Healthcare providers and staff identified multilayered barriers to Medicaid coverage for adult survivors of childhood cancer. Our findings underscore the need for reforms to Medicaid access, enhanced survivor and provider education, and greater investment in financial navigation to ensure equitable, seamless coverage for this underserved population.