Medicaid Eligibility Files Research Articles

The Effect of Continuous Versus Pregnancy-Only Medicaid Eligibility on Routine Postpartum Care in Wisconsin, 2011-2015.

To compare patterns of routine postpartum health care utilization for women in Wisconsin with continuous Medicaid eligibility versus pregnancy-only Medicaid METHODS: This analysis used Medicaid records and linked infant birth certificates for Medicaid paid births in Wisconsin during 2011-2015 (n = 105,718). We determined if women had continuous or pregnancy-only eligibility from the Medicaid eligibility file. We used a standard list of billing codes to identify if women received routine postpartum care. We examined maternal characteristics and receipt of postpartum care overall and by Medicaid eligibility category. Finally, we used a binomial model to calculate the relationship between Medicaid eligibility category and receipt of postpartum care, adjusted for maternal characteristics. Women with continuous Medicaid had profiles more consistent with low postpartum visit attendance rates (e.g., younger, more likely to use tobacco) than women with pregnancy-only Medicaid. However, after adjusting for maternal characteristics, women with continuous Medicaid eligibility had a postpartum visit rate that was 6 percentage points higher than the rate for women with pregnancy-only Medicaid (RD: 6.27, 95% CI 5.72, 6.82). Women with pregnancy-only Medicaid were less likely to have received routine postpartum care than women with continuous Medicaid. Medicaid coverage beyond the current guaranteed 60days postpartum could help provide more women access to postpartum care.

Do Residents Participating in Minnesota's Return to Community Initiative Experience Similar Postdischarge Outcomes to Their Peers?

The objective of this study was to evaluate the impact of Minnesota's Return to Community Initiative (RTCI) on postdischarge outcomes for nursing home residents transitioned through the program. Secondary data were from the Minimum Data Set and RTCI staff (January 2015 to December 2016), state Medicaid eligibility files and death records. The sample consisted of 29,201 nursing home discharges in Minnesota occurring in 2015. Cox proportional hazard models were used to compare 1-year postdischarge outcomes of nursing home readmission, mortality, and Medicaid conversion for RTCI assisted community discharges and a propensity-matched sample of unassisted community discharges. The majority (60%) of RTCI assisted discharges remained alive, in the community and not having converted at Medicaid at 1 year after discharge. Time to mortality was significantly lower for the assisted group than the unassisted group, but time to readmission and Medicaid conversion were similar. The RTCI assisted residents fared well postdischarge in their time to mortality, nursing home readmission, and Medicaid conversion; they lived longer than a propensity-matched sample of their peers.

Maternal and child patterns of Medicaid retention: a prospective cohort study

BackgroundWe sought to determine whether maternal Medicaid retention influences child Medicaid retention because caregivers play a critical role in assuring children’s health access.MethodsWe conducted a longitudinal prospective cohort study of a convenience sample of 604 Medicaid-eligible mother-child dyads followed from the infant’s birth through 24 months of age with parent surveys. Individual enrollment status was abstracted from administrative Medicaid eligibility files. Generalized estimating equations quantified the effect of maternal Medicaid enrollment status on child Medicaid retention, adjusting for relevant covariates. Because varying lengths of gaps may have different effects on child health outcomes, Medicaid enrollment status was further categorized by length of gap: any gap, > 14-days, and > 60-days.ResultsThis cohort consists primarily of African-American (94%), unmarried mothers (88%), with a mean age of 23.2 years. In multivariable analysis, children whose mothers experienced any gaps in coverage had 12.6 times greater odds of experiencing gaps when compared to children whose mothers were continuously enrolled. Use of varying thresholds to define coverage gaps resulted in similar odds ratios (> 14-day gap = 11.8, > 60-day gap = 16.8). Cash assistance receipt and maternal knowledge of differences between Temporary Assistance to Needy Families and Medicaid eligibility criteria demonstrated strong protective effects against child Medicaid disenrollment.ConclusionsMedicaid disenrollment remains a significant policy problem and maternal Medicaid retention patterns show strong effects on child Medicaid retention. Policymakers need to invest in effective outreach strategies, including family-friendly application processes, to reduce enrollment barriers so that all eligible families can take advantage of these coverage opportunities.

A Statewide Model for Assisting Nursing Home Residents to Transition Successfully to the Community.

Minnesota’s Return to Community Initiative (RTCI) is a novel, statewide initiative to assist private paying nursing home residents to return to the community and to remain in that setting without converting to Medicaid. The objective of this manuscript is to describe in detail RTCI’s development and design, its key operational components, and characteristics of its clients and their care outcomes. Data on client characteristics and outcomes come from the Minimum Data Set, staff assessments of clients and caregivers, and Medicaid eligibility files. Most clients transitioned by the RTCI had entered the nursing facility from a hospital. Clients overwhelmingly wanted to return to the community and fit a health and functional profile making them good candidates for community discharge. Most clients went to a private residence, living alone or with a spouse; yet, adult children were the most frequent caregivers. At one year of follow-up 76% of individuals were alive and living in the community and only a small percentage (8.2%) had converted to Medicaid. The RTCI holds promise as a successful model for states to adopt in assisting individuals who are at risk to become long stay nursing home residents instead to return to the community.

High mortality rate of unintentional poisoning due to prescription opioids in adults enrolled in Medicaid compared to those not enrolled in Medicaid in Montana

BackgroundUnintentional death due to prescription drug-related poisoning has been a growing problem nationally. Some sub-populations have been shown to be at higher risk than others. MethodsIn 2014, we matched death records to Medicaid eligibility files to determine enrollment status at the time of unintentional death from prescription opioid poisoning from 2003 to 2012 in Montana. Medicaid prescription claims for decedents were used to assess prescribing patterns and time between refills. ResultsThe age-adjusted mortality rate per 100,000 from opioid poisoning for adults aged 18–64 years and enrolled in Medicaid at the time of death was eight times higher than the rate for non-Medicaid Montana adults (38.2 [95% CI (30.7–45.7)] vs. 4.7 [95% CI (4.1–5.3)]). Twenty-eight percent of unintentional poisoning deaths during this time frame were among Medicaid members. Only 33% of the Medicaid decedents had a claim for an opioid prescription during the month before their death. ConclusionOur findings suggest that more needs to be done to address prescription opioid use in Montana. Adults enrolled in Medicaid continue to be at high risk for prescription opioid unintentional poisoning deaths. Data on prescribing practices suggest that there are opportunities to intervene and provide education on use of opioid medications for Medicaid members and prescribing providers.

Cancer Incidence in Elderly Medicare and Dually Eligible Beneficiaries

We assessed how Medicaid enrollment and race influence cancer incidence among patients age 65 years and older. DATA SOURCES AND METHOD: Population-based Michigan Tumor Registry was merged with Medicaid eligibility files for 1996 through 2000. All analyses were age-adjusted and gender-specific. We compared cancer incidence in the elderly Medicaid population to the cancer incidence in the Medicare population. We then examined cancer incidence in patients continuously enrolled in Medicaid 12 or more months relative to the incidence in the Medicare population. When comparing cancer incidence in Medicaid patients without regard to enrollment before diagnosis, the incidence rates of prostate cancer in black men and colorectal cancer in black women were statistically higher relative to the incidence rates in white patients. The overall cancer incidence rate for all cancers combined was statistically significantly higher for black women and men compared with white women and men (incidence rate ratio=1.18 and 1.48, 95 percent confidence interval 1.05-1.32 and 1.28-1.71, respectively). In dually eligible patients enrolled 12 or more months before diagnosis, an excess cancer incident was observed for black patients relative to white patients in every cancer site examined with the exception of lung cancer. Medicaid data in addition to Medicare data revealed patterns of cancer incidence that varied according to Medicaid enrollment and race. These findings suggest that the cancer burden among African Americans and dually eligible patients is substantial.

The Contribution of Medicaid Managed Care to the Increasing Undercount of Medicaid Beneficiaries in the Current Population Survey

The Current Population Survey (CPS) is an important source of data for comparing beneficiaries across insurance groups. However, the CPS routinely underestimates the Medicaid population, and for unexplained reasons these underestimates have been increasing over time. We sought to determine whether the penetration of Medicaid managed care is associated with the magnitude of the underestimate of Medicaid beneficiaries in the CPS using a pooled cross-sectional comparison of survey and administrative databases on all California Medicaid beneficiaries younger than 65 years of age. We compared the CPS estimates of Medicaid beneficiaries in California from 1995 to 1999 with the gold-standard number derived from the Medicaid eligibility file for the same time period and examined the association between the CPS underestimate and penetration of managed care in the beneficiary's county. The CPS underestimated the Medicaid population by approximately a third. At the county level, errors in estimated numbers of Medicaid beneficiaries in the CPS increased in association with the penetration of Medicaid managed care. Each percentage point increase in the penetration of managed care was associated with an underestimate in the CPS of 0.4 percentage points. A substantial portion of the increase in the underestimates of the number of Medicaid beneficiaries in the CPS can be explained by the growth of Medicaid managed care. Steps must be taken to improve the CPS if this survey is to remain useful for making accurate estimates of Americans' health insurance status.

Involvement in the Child Welfare System Among Mothers With Serious Mental Illness

Involvement in the Child Welfare System Among Mothers With Serious Mental Illness

A Sampling Bias in Identifying Children in Foster Care Using Medicaid Data

Prior research identified foster care children using Medicaid eligibility codes specific to foster care, but it is unknown whether these codes capture all foster care children. To describe the sampling bias in relying on Medicaid eligibility codes to identify foster care children. Using foster care administrative files linked to Medicaid data, we describe the proportion of children whose Medicaid eligibility was correctly encoded as foster child during a 1-year follow-up period following a new episode of foster care. Sampling bias is described by comparing claims in mental health, emergency department (ED), and other ambulatory settings among correctly and incorrectly classified foster care children. Twenty-eight percent of the 5683 sampled children were incorrectly classified in Medicaid eligibility files. In a multivariate logistic regression model, correct classification was associated with duration of foster care (>9 vs <2 months, odds ratio [OR] 7.67, 95% confidence interval [CI] 7.17-7.97), number of placements (>3 vs 1 placement, OR 4.20, 95% CI 3.14-5.64), and placement in a group home among adjudicated dependent children (OR 1.87, 95% CI 1.33-2.63). Compared with incorrectly classified children, correctly classified foster care children were 3 times more likely to use any services, 2 times more likely to visit the ED, 3 times more likely to make ambulatory visits, and 4 times more likely to use mental health care services (P < .001 for all comparisons). Identifying children in foster care using Medicaid eligibility files is prone to sampling bias that over-represents children in foster care who use more services.

The Impact of Medicaid Managed Care on Hospitalizations for Ambulatory Care Sensitive Conditions

To determine whether Medicaid managed care is associated with lower hospitalization rates for ambulatory care sensitive conditions than Medicaid fee-for-service. We also explored whether there was a differential effect of Medicaid managed care by patient's race or ethnicity on the hospitalization rates for ambulatory care sensitive conditions. Electronic hospital discharge abstracts for all California temporary assistance to needy families (TANF)-eligible Medicaid beneficiaries less than age 65 who were admitted to acute care hospitals in California between 1994 and 1999. We performed a cross-sectional comparison of average monthly rates of admission for ambulatory care-sensitive conditions among TANF-eligible Medicaid beneficiaries in fee-for-service, voluntary managed care, and mandatory managed care. We calculated monthly rates of ambulatory care-sensitive condition admission rates by counting admissions for specified conditions in hospital discharge files and dividing the monthly count of admissions by the size of the at-risk population derived from a separate monthly Medicaid eligibility file. We used multivariate Poisson regression to model monthly hospital admission rates for ambulatory care-sensitive conditions as a function of the Medicaid delivery model controlling for admission month, admission year, patient age, sex, race/ethnicity, and county of residence. The adjusted average monthly hospitalization rate for ambulatory care-sensitive conditions per 10,000 was 9.36 in fee-for-service, 6.40 in mandatory managed care, and 5.25 in voluntary managed care (p<.0001 for all pairwise comparisons). The difference in hospitalization rates for ambulatory care sensitive conditions in Medicaid fee-for-service versus managed care was significantly larger for patients from minority groups than for whites. Selection bias in voluntary Medicaid managed care programs exaggerates the differences between managed care and fee-for-service, but the 33 percent lower rate of hospitalizations for ambulatory care sensitive conditions found in mandatory managed care compared with fee-for-service suggests that Medicaid managed care is associated with a large reduction in hospital utilization, which likely reflects health benefits. The greater effect of Medicaid managed care for minority compared with white beneficiaries is consistent with other findings that suggest that managed care is associated with improvements in access to ambulatory care for those patients who have traditionally faced the greatest barriers to health care.

Schizophrenia and major affective disorder among Medicaid recipients with HIV/AIDS in New Jersey.

This study sought to identify and characterize seriously mentally ill patients with HIV infection. Medicaid beneficiaries with HIV/AIDS were identified through the merging of New Jersey HIV/AIDS Registry and Medicaid eligibility files. Claims histories were used to classify individuals as having schizophrenia, major affective disorder, or no serious mental illness. Of 8294 individuals, 476 (5.7%) were classified as having schizophrenia, and 564 (6.8%) were classified as having major affective disorder. Those with serious mental illness were more likely than other groups to be injection drug users and to have claims indicative of substance abuse. Individuals with serious mental illness are a significant but little-recognized subgroup of those with HIV infection.

Characteristics of persons with mental retardation and HIV/AIDS infection in a statewide Medicaid population.

Very little is known about the characteristics of people with mental retardation who are infected with HIV. Using a datafile created by a match between the New Jersey HIV and AIDS Registry file through March 1996 and the New Jersey Medicaid eligibility file for the period August 1993 to March 1996, we identified the largest group of HIV-infected persons with mental retardation (N = 119) that has been reported to date. Compared to other HIV-infected New Jersey Medicaid recipients, individuals in this subgroup were more likely to be female, Black, and have injection drug use as a route of infection. Implications for delivery of appropriate services are discussed.

Estimating the Proportion of Unnecessary Cesarean Sections in Ohio Using Birth Certificate Data

The main objective of the study is to present a method that estimates the proportion of unnecessary Cesarean sections (C-sections) using birth certificate data. This population-based cross-sectional study uses two major databases—Ohio birth certificates and Medicaid eligibility files—and includes singleton infants born during the period July 1991 through June 1993 ( n = 262,013). A total of 57 variables indicative of adverse events, including maternal medical risk factors, complications of labor and delivery, and congenital anomalies that are available on the birth certificate, are examined to estimate the rate of unnecessary C-sections. The results obtained through this method indicate that nearly 40% of the repeat C-sections had no documented abnormalities on the birth certificate to justify a C-section. Because studies using medical records have yielded similar results, we believe that using birth certificate data may be a reliable method to measure and monitor the rate of unnecessary C-sections.