Medicaid Managed Care Enrollees Research Articles

Overlap In Carriers And Networks In Medicaid And The Individual Marketplaces.

As people lose Medicaid because of the end of the COVID-19 public health emergency, many states will route former Medicaid managed care enrollees into Affordable Care Act Marketplace coverage with the same carrier. In 2021, 52.1percent of Medicaid managed care enrollees were enrolled by a carrier that also had a plan on the Marketplace in the same county.

State-Level Variation in Medicaid Managed Care Enrollment and Specialty Care for Publicly Insured Children

Medicaid and Children's Health Insurance Program cover almost 50% of children with special health care needs (CSHCN). CSHCN often require specialty services and have been increasingly enrolled in Medicaid managed care (MMC) plans, but there is a dearth of recent national studies on specialty care access among publicly insured children and particularly CSHCN. To provide recent, nationwide evidence on the association of MMC penetration with specialty care access among publicly insured children, with a special focus on CSHCN. This cross-sectional study used nationally representative data from the 2016 to 2019 National Survey of Children's Health to identify publicly insured children in 41 states that administered comprehensive managed care organizations for Medicaid. Data analysis was performed from May 2022 to March 2023. Form CMS-416 data were used to measure state-year level share of Medicaid-enrolled children who were covered by MMC (ie, MMC penetration). Measures of specialty care access included whether, in the past year, the child had (1) any visit to non-mental health (MH) specialists, (2) any visit to MH professionals, and (3) any unmet health care needs and (4) whether the caregiver ever felt frustrated getting services for their child. Logistic regression models were used to examine the association of MMC penetration with specialty care access among all publicly insured children, and separately for CSHCN and non-CSHCN. Among 20 029 publicly insured children, 7164 (35.8%) were CSHCN, 9537 (48.2%) were female, 4110 (37.2%) were caregiver-reported Hispanic, and 2812 (21.4%) were caregiver-reported non-Hispanic Black (all percentages are weighted). MMC was not associated with significant changes in any visit to non-MH specialists and unmet health care needs. In addition, MMC penetration was positively associated with caregiver frustration among all children (adjusted odds ratio, 1.23; 95% CI, 1.03-1.48; P = .02) and was negatively associated with any visit to MH professionals among CSHCN (adjusted odds ratio, 0.75; 95% CI, 0.58-0.98; P = .04). In this cross-sectional study evaluating MMC and specialty care access for publicly insured children, increased MMC enrollment was not associated with improved specialty care access for publicly insured children, including CSHCN. MMC was associated with less access to specialties like MH and increased frustrations among caregivers seeking services for their children.

Evaluating Medicaid Managed Care Network Adequacy Standards And Associations With Specialty Care Access For Children.

Medicaid managed care plans cover more than 80percent of Medicaid-enrolled children, including many children with special health care needs (CSHCN). Federal rules require states to set network adequacy standards to improve specialty care access for Medicaid managed care enrollees. Using a quasi-experimental design and 2016-19 National Survey of Children's Health data, we examined the association between quantitative network adequacy standards and access to specialty care among 8,614 Medicaid-enrolled children, including 3,157 with special health care needs, in eighteen states. Outcomes included whether the child had any visit to non-mental health specialists, any visit to mental health professionals, or any unmet health care needs and whether the caregiver ever felt frustrated in getting services for the child in the past year. We observed no association between the adoption of any quantitative network adequacy standard and the above outcomes among Medicaid-enrolled children. Among CSHCN, however, adopting any quantitative standard was positively associated with caregivers feeling frustrated in getting services for the child, especially among CSHCN who visited non-mental health specialists. Without additional interventions, adopting new network adequacy standards may have unintended consequences for CSHCN.

Private Power in Public Programs: Medicare, Medicaid, and the Structural Power of Private Insurance

AbstractIn 2019, nearly 70 percent of Medicaid beneficiaries received their health insurance coverage through a private, managed care organization (MCO). Twenty-five years earlier, 9.5 percent of Medicaid beneficiaries were enrolled in MCOs. This dramatic growth in Medicaid managed care enrollment represents the delegation of significant power by federal and state governments over a critical social program to private actors and market forces. Medicare, too, experienced a similar pattern of transformation. Together, Medicaid and Medicare, two critical pillars of American social policy, paid more than half a trillion dollars to private insurance companies in 2019 to provide public health insurance to 75 million people. This manuscript examines the policy consequences of building private firms directly into the structure of American social policies. In contrast to existing work on “submerged” or “delegated” policies, this manuscript highlights the structural power that such policies bestow on the government's private partners and develops a new theory of structural power in which firms are able to constrain health policy reform through their threats to disrupt the delivery of public policies and social benefits to millions of people across the United States.

1254. An Increase in Single-tablet Regimen (STR) Utilization for People Living with HIV (PLWH) Enrolled in Medicaid had Minimal Impact on Pharmacy Costs

Abstract Background The shift to antiretroviral single-tablet regimens (STR) from multiple-tablet regimens (MTR) has lagged for people living with HIV (PLWH) covered by Medicaid. This study examines STR and MTR utilization and pharmacy costs over a 5-year period for PLWH enrolled in Medicaid. Methods This retrospective study used IQVIA’s Prescription Claims (Rx) data to identify two mutually exclusive cohorts based on STR or MTR use within each of 5 calendar years (2016-2020). For the STR cohort, the date of the first STR claim in each calendar year was termed the index date. For the MTR cohort, the date of the first MTR drug in the first observed complete MTR regimen in each calendar year was termed the index date; a window of 5 days between prescription fills for the agents used in an MTR regimen was allowed. The regimen received on the index date was used to assign the study cohort for each year and study measures were reported for each of the 5 calendar years. Additional eligibility criteria are provided in Table 1. Results The final STR cohort was 47,140 (14.5% of the initial sample) in 2016 and 73,111 (13.5%) in 2020 (Table 1). The final MTR cohort was 36,007 (15.5%) in 2016 and 20,264 (13.5%) in 2020. The distribution of PLWH with Medicaid Fee-For-Service (FFS) or Medicaid managed care was generally similar by year for both STR and MTR cohorts from 2016 to 2019 (Figure 1); Medicaid managed care enrollment for both cohorts increased in 2020 (62.4-62.9%). Among PLWH, STR use increased annually from 56.7% in 2016 to 78.3% in 2020 (Figure 2). Conversely, MTR use decreased from 43.3% to 21.7% over the same time period. The increase in STR utilization over time was consistent for both plan types. Mean HIV-specific per member per month (PMPM) pharmacy costs were similar across years for both STR and MTR cohorts, ranging from $2,016-$2,342 for STR cohorts and $2,247-$2,380 for MTR cohorts (Figure 3). Conclusion Between 2019 and 2020, PLWH enrolled in Medicaid shifted from FFS towards managed care. STR use among PLWH enrolled in Medicaid increased from 2016 to 2020 with minimal differences in PMPM pharmacy costs compared with PLWH enrolled in Medicaid receiving MTR. Disclosures Andrew P. Brogan, PhD, ViiV Healthcare: Employee, Salary|ViiV Healthcare: Stocks/Bonds Cindy Garris, MS, ViiV Healthcare: Employee|ViiV Healthcare: Stocks/Bonds Julie Priest, MSPH, ViiV Healthcare: Employee, Salary|ViiV Healthcare: Stocks/Bonds Victoria Divino, BA, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Jing He, PhD, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Justin Chen, MHS, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Mitch DeKoven, MHSA, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support.

Medicaid Managed Care: Access To Primary Care Providers Who Prescribe Buprenorphine.

Medicaid managed care insurers play a crucial role in facilitating access to buprenorphine to treat opioid use disorder. Using a novel set of provider directory and prescription claims data, we examined variation in access to in-network buprenorphine-prescribing primary care providers among Medicaid managed care enrollees. Approximately 32.2percent of enrollees had fewer than one in-network buprenorphine prescriber per 100,000 county residents. On average, there were a greater number of in-network buprenorphine-prescribing primary care providers in states with higher compared with lower overdose death rates. However, most enrollees lived in areas with a shortage of these providers. We found that a 25percent higher network participation rate by prescribers compared with nonprescribers could improve the probability that enrollees see a prescriber by approximately 25percent. Policies to improve access within Medicaid managed care include using primary care provider assignment algorithms to match patients with buprenorphine prescribers and requiring that networks include a minimum number of buprenorphine prescribers.

Racial And Ethnic Disparities In Patient Experience Of Care Among Nonelderly Medicaid Managed Care Enrollees.

Medicaid managed care enrollees who are members of racial and ethnic minority groups have historically reported worse care experiences than White enrollees. Few recent studies have identified disparities within and between Medicaid managed care plans. Using 2014-18 data on 242,274 nonelderly Medicaid managed care enrollees in thirty-seven states, we examined racial and ethnic disparities in four patient experience metrics. Compared with White enrollees, minority enrollees reported significantly worse care experiences. Overall adjusted disparities for Black enrollees ranged between 1.5 and 4.5percentage points; 1.6-3.9percentage points for Hispanic or Latino enrollees; and 9.0-17.4percentage points for Asian American, Native Hawaiian, or other Pacific Islander enrollees. Disparities were largely attributable to worse experiences by race or ethnicity within the same plan. For all outcomes, disparities were smaller in plans with the highest percentages of Hispanic or Latino enrollees, and for some outcomes, there were smaller disparities in plans with the highest percentages of Asian American, Native Hawaiian, or other Pacific Islander enrollees. Interventions to mitigate racial and ethnic inequities in care experiences include collection of comprehensive race and ethnicity data, adoption of health equity performance metrics, plan-level enrollee engagement, and multisectoral initiatives to dismantle structural racism.

176 Emergency Department Visits for Low-Acuity Conditions and Primary Care: Substitutes or Complements in Medicaid?

Historically, emergency departments (ED) evolved to serve as a substitute for primary care (PC), especially among populations that tend to lack PC access, such as the uninsured and Medicaid enrollees. Although the Affordable Care Act (ACA) policy makers aimed to decrease ED visits by expanding insurance coverage and thus PC access, the ACA Medicaid expansion increased ED visit rate among patients with Medicaid coverage. Additionally, the substitution assumption is under scrutiny, given increasing evidence on referrals from PC providers to the ED, which would indicate complementarity instead. We empirically tested whether primary care and ED visits for primary care treatable (PCT) conditions are substitutes or complements. Using consumer choice theory from economics, we developed a testable model that differentiates between substitution and complementarity between PC and ED visits. In both cases, ED visit rates are represented as a spline function, with an estimated knot, of PC supply; negative slope on the left spline indicates substitution and positive slope indicates complementarity. We used non-linear least squares to estimate the function. We used a unique data linkage from New York state: county-month level Medicaid managed care enrollment and county-quarter level provider data from NY Department of Health, and ED visit data from SPARCS (9/2014-9/2015) (N=793). In selecting covariates and fixed effects, we assessed model fit. The best- fitting model specification includes county fixed effects and three time-varying covariates: poverty rate, unemployment rate, and percent population in Medicaid managed care. Bootstrap standard errors were calculated. ED visits for PCT conditions by population aged 0-64 y.o. were included in the analysis. Using the NYU ED classification algorithm, we identified conditions that are 100% PCT, based on both the principal and admitting diagnoses. ED and PC visits were substitutes for one another statewide (slope coefficient -0.28, P<0.05), but served as complements during nights and weekends in highly urban and poorer counties (slope coefficient 0.63, P<0.01; population in poverty 21.7-31.5%). PC physician supply was associated with decreased ED use in rural counties during the day (-0.11, P<0.10) but increased ED use during nights and weekends in highly urban (0.23, P<0.01) and richer counties (population in poverty 5.8-9.0%). These relationships reversed when advanced practice providers (APPs) were considered instead (0.19, P<0.05 during the day across all counties; -0.24, P<0.01 during nights and weekends in highly urban and in richer counties, ie, population in poverty 5.8-11.3%). While the ED is used as a substitute for primary care during the day, complementarity at night and on weekends indicates increasing prominence of referrals, the rates of which appear to vary across areas. While during the day, higher PC physician supply appears to divert Medicaid enrollees from the ED, PC APP supply contributes to more ED use for low-acuity conditions. Policy makers should not assume that increasing PC access will necessarily reduce low-acuity ED visits. More nuanced understanding suggests that policies to decrease low-acuity ED use via PC access improvements in Medicaid will be more effective if they focus on increasing actual appointment availability, ideally by primary care physicians, in areas with low primary care supply.

Changes in Plan Composition and Measured Quality Associated with Medicaid Expansion Among Nonelderly Medicaid Managed Care Enrollees

Research ObjectiveMedicaid managed care (MMC) has become the dominant method of delivering health services for low‐income Americans enrolled in Medicaid. Following state decisions to extend Medicaid eligibility through the Affordable Care Act, MMC plans enrolled nearly 80% of newly eligible beneficiaries. Many states are adopting performance measurement systems to hold MMC plans accountable for quality of care. Despite the growing importance of measured quality of care in MMC payment and delivery, there is limited understanding of changes in MMC enrollee characteristics or performance measures associated with Medicaid expansion. We examined changes in plan composition among nonelderly MMC enrollees and measured quality of care associated with Medicaid expansion.Study DesignWe used 2012–2018 National Committee on Quality Assurance Adult Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) data, which are enrollee‐level surveys submitted by state Medicaid agencies and individual MMC plans. Enrollee characteristics included age, gender, race/ethnicity, educational attainment, and self‐reported health status. Our four outcomes measured patient experience of care: whether a respondent answered that it was “always or usually” easy to get needed care, had a personal doctor, had timely access to a checkup or routine care, and had timely access to specialty care. We estimated multivariable linear probability models comparing pre‐ versus post‐expansion changes in plan composition and measured quality in expansion versus non‐expansion states. The post‐expansion period was modeled as an event‐study regression to account for changes over time, where the coefficient of interest was a Medicaid expansion‐by‐year term. Models adjusted for sociodemographic characteristics, self‐reported health, and included state, year, and plan fixed effects. Standard errors were clustered at the state level.Population Studied315,563 adult MMC enrollees age 18–64 in the 39 states with comprehensive MMC plans.Principal FindingsMedicaid expansion was associated with statistically significant decreases in the proportion of female MMC enrollees (−8.4 percentage points [PP], p &lt; 0.01), and increases in the proportion of MMC enrollees who were age 55–64 (6.8 PP, p &lt; 0.01), White non‐Hispanic (4.4 PP, p &lt; 0.01), and with a college degree or higher (2.3 PP, p &lt; 0.01). Relative to MMC enrollees in non‐expansion states, enrollees in expansion states were significantly less likely to report access to a personal doctor (−1.6 PP, 95% CI ‐3.0 to −0.1 PP, p &lt; 0.05) and less likely to report timely access to specialty care (−2.1 PP, 95% CI ‐3.4 to −0.8 PP, p &lt; 0.01) in the first year after expansion. Differences were not statistically significant by the second year post‐expansion.ConclusionsMedicaid expansion was associated with substantial changes in MMC plan composition, and there were modest, but temporary, reductions in measured quality of care in the first year post‐expansion.Implications for Policy or PracticeStates use MMC performance data to assign bonus payments based on meeting or exceeding quality targets, withhold capitated payments, and auto‐assign enrollees to plans. State policymakers should recognize that expansions of Medicaid eligibility may change the composition of plan enrollees, with implications for measured quality of care. Particularly for states that compare a plan's performance on measured quality to national benchmarks, accounting for a state's decision to expand Medicaid may mitigate unfair penalization.

State-Level Managed Care Penetration in Medicaid and Rates of Preventive Care Visits for Children.

To examine time trends in receipt of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services in serial cohorts of Medicaid beneficiaries <21 years, as Medicaid managed care (MMC) was adopted by states. Using annual state-level data from the Centers for Medicare & Medicaid Services, we performed national analyses of Medicaid beneficiaries <21 years from 2000 to 2017. We used generalized linear models to assess the relationship between MMC enrollment and EPSDT encounters, accounting for repeated measures, first at the national level overall and then specifying random effects at the state level. From 2000 to 2017, there was an increase at the national level in Medicaid beneficiaries <21 years enrolled in MMC, from 65% to 94%. At the national level, for every additional 100 enrollees in MMC there was an associated increase of 36 beneficiaries with an EPSDT visit (95% confidence interval: 19-53; P < .001). When accounting for state-level variation, for every additional 100 enrollees in MMC, there was an increase of 6 beneficiaries with an EPSDT visit (95% confidence interval: 2-10; P=.003). Examining the association between MMC penetration and EPSDT participation within each state, including the 50 states and Washington DC, there were 17 states with a significant positive association between MMC ratio and EPSDT participation, and 6 states with a significant negative association. As managed care has become the predominant form of Medicaid coverage, there has been a modest increase in preventive visits as indicated by EPSDT participation, with marked variation across states.

Association of Medicaid-Focused or Commercial Medicaid Managed Care Plan Type With Outpatient and Acute Care

Enrollment in Medicaid managed care plans has increased rapidly, particularly in national commercial insurance plans. Whether the type of managed care plan is associated with the use of health services for Medicaid beneficiaries is unknown. To compare the use of outpatient and acute care between Medicaid enrollees randomly assigned to a national commercial managed care plan or a local Medicaid-focused managed care plan. This natural experiment of a cohort of Medicaid enrollees randomly assigned to 2 managed care plans in a Northeastern US state was conducted from June 30, 2009, to June 30, 2013. Statistical analysis was performed from September 1, 2019, to August 30, 2020. Assignment to a Medicaid-focused insurance plan or a commercial managed care plan. Outpatient visits, emergency department visits, and total inpatient and ambulatory care-sensitive hospitalizations. A total of 8010 patients were included in the analysis: 4737 were assigned to a Medicaid-focused plan (2795 female [59.0%]; mean [SD] age, 17.8 [3.2] years) and 3273 to a commercial managed care plan (1915 female [58.5%]; mean [SD] age, 17.9 [3.3] years). Those randomly assigned to the Medicaid-focused plan had a mean (SD) of 6.67 (9.18) annual outpatient visits per person, and those assigned to the commercial plan had a mean (SD) of 8.36 (11.77) annual outpatient visits per person (adjusted absolute difference, 1.72 [95% CI, 1.31-2.13]; 22% relative difference). The increased use of outpatient visits in the commercial plan was associated with an increase in specialty care visits (mean [SD], 2.34 [6.31] visits in Medicaid-focused plan vs 3.75 [9.32] visits in commerical plan; adjusted absolute difference, 1.43 visits [95% CI, 1.25-1.56 visits]; 61% relative difference). Mean (SD) annual emergency department visits were 0.49 (1.39) per person in the Medicaid-focused plan and 0.51 (1.40) in the commercial plan (adjusted absolute difference, 0.02 [95% CI, -0.02 to 0.05]). Mean (SD) annual inpatient admissions were 0.067 (0.45) per person in the Medicaid-focused plan and 0.069 (0.53) in the commercial plan (adjusted absolute difference, 0.003 [95% CI, -0.01 to 0.02]). Plan assignment was not significantly associated with ambulatory care-sensitive admissions. Results were consistent in instrumental variables analyses that accounted for disenrollment and switching. Compared with Medicaid managed care enrollees assigned to a Medicaid-focused plan, those assigned to a commercial plan had more outpatient visits, particularly for specialty care, but had similar rates of emergency department visits and hospitalizations. These findings suggest that the type of managed care plan may be associated with health services use and spending among Medicaid beneficiaries and that random assignment may help states understand how well different plans perform for enrollees.

Care management reduced infant mortality for Medicaid managed care enrollees in Ohio.

In 2012, the Ohio Department of Medicaid introduced requirements for enhanced care management to be delivered by Medicaid managed care organizations (MCOs). This study evaluated the impact of care management on reducing infant mortality in the largest Medicaid MCO in Ohio. Observational study using infant and maternal individual-level enrollment and claims data (2009-2015), which used a quasi-experimental research design built on a sibling-comparison approach that controls for within-family confounders. Using individual-level data from the largest MCO in Ohio, we estimated linear probability models to examine the effect of infant engagement in care management on infant mortality. We used a within-family fixed-effects research design to determine if care management reduced infant mortality and estimated models separately for healthy infants and nonhealthy infants. Infant engagement in care management was associated with a reduction of 7.4 percentage points (95% CI, -10.7 to -4.1; P <.001) in infant mortality among the most vulnerable infants, those identified as not well at birth. This effect was larger in recent years and likely driven by new statewide enhanced care management requirements. Infant mortality was unchanged for healthy infants engaged in care management (coefficient = 0.03; 95% CI, -0.01 to 0.08). This study provides evidence that care management can be effective in reducing infant mortality among Medicaid MCO enrollees, a population at high risk of mortality. Few infants were engaged in care management, suggesting to policy makers that there is room for many additional infants to benefit from this intervention.

Access to Elective Orthopaedic Surgery After the Affordable Care Act Medicaid Expansion: The New York State Experience.

As part of the Patient Protection and Affordable Care Act, states were given the option of expanding Medicaid coverage to include adults younger than age 65 years with income at or below 138% of the federal poverty level. Although this expansion was intended to provide health care coverage to an estimated 20 million Americans, several studies have shown increased coverage does not equate to increased access to care by specialty providers. We queried the New York Statewide Planning and Research Cooperative System database and identified all patients who underwent the 10 most common elective orthopaedic surgeries from January 1, 2012, through March 31, 2016. Medicaid monthly enrollment for the 4-year study period was obtained from NY Department of Health Medicaid Managed Care Enrollment Reports. Our query identified 700,159 patients who underwent the investigated orthopaedic surgeries. Of these, 60,786 were Medicaid recipients. During the 4-year study period, Medicaid enrollment and the number of procedures reimbursed by Medicaid increased significantly (P < 0.001 for both). Affordable Care Act-supported Medicaid expansion was associated with an increase in Medicaid enrollment and a concomitant increase in the utilization of orthopaedic surgery by Medicaid beneficiaries in New York State.

OIG cites severe BH problems in New Mexico as officials work to rebuild system

New Mexico is in dire need of behavioral health services, especially given that the state has among the highest rates for suicide and deaths from overdose in the nation, according to an Office of Inspector General (OIG) report released last month, following a congressional request to look into concerns about behavioral health provider shortages and the availability of care for Medicaid managed care enrollees.

Utilization of and Relationships With Primary Care Providers During the Transition to Medicaid Managed Care

The objective of this study was to determine whether seniors and disabled adults in Illinois’s Medicaid managed care (MMC) were more likely to see, maintain longitudinal relationships with, and have continuity of care with a primary care provider (PCP) compared with fee-for-service (FFS) Medicaid enrollees. Medicaid PCP service claims for 13,221 MMC and 54,625 FFS enrollees were analyzed using an inverse propensity score weighted difference-in-differences design to match the groups by demographic characteristics and historical Medicaid utilization. All data came from Medicaid claims data and corresponding administrative records. Regression analyses showed that enrollment in MMC was significantly related to each of the three outcomes; MMC enrollees were more likely than the FFS group to see a PCP during the 1-year post-period and have high levels of continuity of care with a single PCP. However, FFS enrollees were more likely to maintain a relationship with their PCP providers from the pre-period through the post-period. Therefore, while more people in MMC than FFS visit a PCP each year, for people in MMC, it is often a new provider relationship, which can be problematic for people with disabilities. Additional training for PCPs, to prepare them for working with people with disabilities, and additional efforts to expand the MMC network of providers are needed.

Medicaid managed care enrollees report numerous problems in mandated support

A survey of Medicaid enrollees with serious mental illness (SMI) in a state with significant experience in integrating behavioral health and medical care is pointing out many shortcomings in managed care's response to these individuals' complex needs.

Longitudinal appraisals of family caregiving for people with disabilities enrolled in Medicaid managed care

Objective: To longitudinally examine the impact of public family support on appraisals of caregiving burden, satisfaction, and self-efficacy among families of adults with disabilities.Background: Little research exists on family support and the family experience within Medicaid managed care across disabilities and longitudinally.Method: Illinois Medicaid managed care enrollees with disabilities and their family members completed surveys over 2 years. Only families and enrollees who lived together were included (N = 182 pairs).Results: Family members with more unmet family support needs had increased caregiving burden and decreased satisfaction and self-efficacy. Family members providing more unpaid care reported higher burden. Black family members had significantly lower burden, and parents had significantly lower satisfaction and self-efficacy. Family members of enrollees with intellectual and developmental disabilities had higher self-efficacy.Conclusion: Family support is important to caregiving appraisals.Implications: There is a need for including family needs for services within assessments for services and within policy.Implications for rehabilitationFamilies provide a substantial amount of care for their family members with disabilities.More family support for family caregivers of people with disabilities is related to better caregiving appraisals within Medicaid managed care.Family caregiver support needs should be taken into account within policy and service assessments.

Effect of Process- and Outcome-Based Financial Incentives on Weight Loss Among Prediabetic New York Medicaid Patients: A Randomized Clinical Trial.

To determine whether different financial incentives are effective in promoting weight loss among prediabetic Medicaid recipients. Four-group, multicenter, randomized clinical trial. Medicaid managed care enrollees residing in New York, aged 18 to 64 years, and diagnosed as prediabetic or high risk for diabetes (N = 703). In a 16-week program, participants were randomly assigned to one of 4 arms: (1) control (no incentives), (2) process incentives for attending weekly Diabetes Prevention Program sessions, (3) outcome incentives for achieving weekly weight loss goals, and (4) combined process and outcome incentives. Weight loss over a 16-week period; proportion who completed educational sessions; proportion who met weight loss goals. No intervention arm achieved greater reduction in weight than control (outcome incentive -6.6 lb [-9.1 to -4.1 lb], process incentive -7.3 lb [-9.5 to -5.1 lb], combined incentive -5.8 lb [-8.8 to -2.8 lb], control -7.9 lb [-11.1 to -4.7 lb]; all P > .29). Session attendance in the process incentive arm (50%) was significantly higher than control (31%; P < .0001) and combined incentive arms (28%; P < .0001), but not significantly higher than the outcome incentive arm (38%). Process incentives increased session attendance, but when combined at half strength with outcome incentives did not achieve that effect. There were no significant effects of either process or outcomes incentives on weight loss.

Exploding asthma and ADHD caseloads: The role of medicaid managed care

In the U.S., nearly 11% of school-age children have been diagnosed with ADHD, and approximately 10% of children suffer from asthma. In the last decade, the number of children diagnosed with these conditions has inexplicably been on the rise. This increase has been concentrated in the Medicaid caseload nationwide. One of the most striking changes in Medicaid has been the transition from fee-for-service (FFS) reimbursement to Medicaid managed care (MMC), which had taken place in 80% of states by 2016. Using Medicaid claims from South Carolina, we show that this change contributed to the increase in asthma and ADHD caseloads. Empirically, we rely on variation in MMC enrollment due to a change in the “default” Medicaid plan from FFS to MMC, and on rich panel data that allow us to follow the same children before and after they were required to switch. We find that the transition from FFS to MMC explains about a third of the rise in the number of Medicaid children being treated for ADHD and asthma, along with increases in treatment for many other conditions. These are likely to be due to the incentives created by the risk adjustment and quality control systems in MMC.

Out of Sight, Out of Mind? Measuring the Relationship between Privatization and Medicaid Self-Reporting.

Privatization has grown exponentially, both in salience and in form, over the past several decades. This shifting of administrative authority away from the state can make it difficult for program recipients to link their use of a federal program back to government, a disconnect known as "submerging" the state. However, privatization is a process that occurs in degrees, and not all privatization initiatives look alike. This study leverages variation in the implementation of Medicaid managed care, which is the most widespread form of Medicaid privatization, to examine how privatization maps onto state submersion and affects state visibility. This analysis shows that, although Medicaid managed care enrollment, at large, does not relate to recipients' self-reported Medicaid enrollment, when privatized Medicaid plans introduce administrative designs that obscure the role of government, Medicaid self-reporting declines. These findings demonstrate that policy recipients are less able to recognize both the personal relevance of a specific public program and the public nature of this interaction when privatized programs utilize design features that attenuate signals of government involvement. In highlighting this disconnect, this article shows how privatization makes it more difficult for policy recipients to engage in the civic sphere as informed advocates for their self-interest.