Medicaid Policy Research Articles

Impact of a Medicaid policy on preventive oral health services for children with intellectual disabilities, developmental disabilities, or both

BackgroundIntegrating preventive oral health services (POHS) into medical offices may ease access to care for children with intellectual and developmental disabilities (IDD). The authors examined the impact of state policies allowing delivery of POHS in medical offices on receipt of POHS among Medicaid enrollees with IDD. MethodsThe authors used 2006 through 2014 Medicaid data for children with IDD aged 6 months through 5 years from 38 states. IDD were defined using 14 condition codes from Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse. The length of the state’s medical POHS policy (no policy, < 1 year, 1 year, 2 years, 3 years, or ≥ 4 years) was interacted with an indicator that the child was younger than 3 years. The authors used logistic regression models to estimate the likelihood that a child received POHS in a medical office or in a medical or dental office in a given year. ResultsAmong 447,918 children with IDD, 1.6% received POHS in medical offices. Children younger than 3 years in states with longer-enacted policies had higher rates of receiving POHS. For example, the predicted probability of receiving POHS was 40.6% (95% confidence interval, 36.3% to 44.9%) for children younger than 3 years in states with a medical POHS policy for more than 4 years compared with 30.6% (95% confidence interval, 27.8% to 33.5%) for children in states without a policy. ConclusionsState Medicaid policies allowing delivery of POHS in medical offices increased receipt of POHS among Medicaid-enrolled children with IDD who were younger than 3 years. Practical ImplicationsFew children with IDD receive POHS in any setting. Efforts are needed to reduce barriers to POHS for publicly insured children with IDD.

Addressing social determinants of health in sickle cell disease: The role of Medicaid policy.

Addressing social determinants of health in sickle cell disease: The role of Medicaid policy.

Differences in Availability and Use of Medications for Opioid Use Disorder in Residential Treatment Settings in the United States

While many individuals with opioid use disorder seek treatment at residential facilities to initiate long-term recovery, the availability and use of medications for opioid use disorder (MOUDs) in these facilities is unclear. To examine differences in MOUD availability and use in residential facilities as a function of Medicaid policy, facility-level factors associated with MOUD availability, and admissions-level factors associated with MOUD use. This cross-sectional study used deidentified facility-level and admissions-level data from 2863 residential treatment facilities and 232 414 admissions in the United States in 2017. Facility-level data were extracted from the 2017 National Survey of Substance Abuse Treatment Services, and admissions-level data were extracted from the 2017 Treatment Episode Data Set-Admissions. Statistical analyses were conducted from June to November 2019. Admissions for opioid use disorder at residential treatment facilities in the United States that identified opioids as the patient's primary drug of choice. Availability and use of 3 MOUDs (ie, extended-release naltrexone, buprenorphine, and methadone). Of 232 414 admissions, 205 612 (88.5%) contained complete demographic data (166 213 [80.8%] aged 25-54 years; 136 854 [66.6%] men; 151 867 [73.9%] white). Among all admissions, MOUDs were used in only 34 058 of 192 336 (17.7%) in states that expanded Medicaid and 775 of 40 078 (1.9%) in states that did not expand Medicaid (P < .001). A relatively low percentage of the 2863 residential treatment facilities in this study offered extended-release naltrexone (854 [29.8%]), buprenorphine (953 [33.3%]), or methadone (60 [2.1%]). Compared with residential facilities that offered at least 1 MOUD, those that offered no MOUDs had lower odds of also offering psychiatric medications (odds ratio [OR], 0.06; 95% CI, 0.05-0.08; Wald χ21 = 542.09; P < .001), being licensed by a state or hospital authority (OR, 0.39; 95% CI, 0.27-0.57; Wald χ21 = 24.28; P < .001), or being accredited by a health organization (OR, 0.28; 95% CI, 0.23-0.33; Wald χ21 = 180.91; P < .001). Residential facilities that did not offer any MOUDs had higher odds of accepting cash-only payments than those that offered at least 1 MOUD (OR, 4.80; 95% CI, 3.47-6.64; Wald χ21 = 89.65; P < .001). In this cross-sectional study of residential addiction treatment facilities in the United States, MOUD availability and use were sparse. Public health and policy efforts to improve access to and use of MOUDs in residential treatment facilities could improve treatment outcomes for individuals with opioid use disorder who are initiating recovery.

Variation in Tdap and Influenza Vaccination Coverage Among Pregnant Women by Insurance Type — Florida, 2016–2018

Infants are at increased risk for pertussis-associated morbidity and mortality, and pregnant women and their infants are more likely than other patient populations to experience severe influenza-related illness (1,2). The Advisory Committee on Immunization Practices (ACIP) recommends that all women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, preferably during the early part of gestational weeks 27-36 (3). ACIP also recommends that women who are or might be pregnant during the influenza season receive the inactivated influenza vaccine at any time during pregnancy (4). Despite these recommendations, coverage with Tdap and influenza vaccines during pregnancy has been low, with approximately one half of women receiving each vaccine and only one third receiving both, based on a survey during March-April 2019 (5). Data obtained through a retrospective chart review of randomly selected pregnant women who delivered at the University of Florida Health Shands Hospital in Gainesville, Florida, from January 1, 2016, to December 31, 2018, were analyzed to assess vaccination coverage by insurance type. Because the Florida Medicaid policy at that time did not cover these vaccines during pregnancy, the hospital system offered Tdap and influenza vaccines at no additional cost to mothers during the immediate postpartum hospital stay. Among 341 women, 68.6% of privately insured and 13.4% with Medicaid received Tdap during pregnancy, and among 316 women, 70.4% of privately insured and 35.6% with Medicaid received influenza vaccine during pregnancy. Many women, especially those with Medicaid, were vaccinated in the immediate postpartum period, when vaccination was available at no cost, increasing Tdap vaccination rates to 79.3% for privately insured and 51.7% for women with Medicaid; influenza vaccination rates rose to 72.0% for privately insured and 43.5% for women with Medicaid. These data suggest that the state Medicaid policy to not cover these vaccines during pregnancy might have significantly reduced coverage among its enrollees.

Coverage of immediate postpartum long-acting reversible contraception has improved birth intervals for at-risk populations

In 2012, South Carolina revised the Medicaid policy to cover reimbursement for immediate postpartum long-acting reversible contraception. Immediate postpartum long-acting reversible contraception may improve health outcomes for populations at risk with a subsequent short-interval pregnancy. We examined the impact of the Medicaid policy change on the initiation of long-acting and reversible contraception (immediate postpartum and postpartum) within key populations. We determined whether immediate postpartum long-acting and reversible contraception use varied by adequate prenatal care (>7 visits), metropolitan location, and medical comorbidities. We also tested the association of immediate postpartum and postpartum long-acting, reversible contraception on interpregnancy interval of less than 18 months. We conducted a historical cohort study of live births among Medicaid recipients in South Carolina between 2010 and 2017, 2 years before and 5 years after the policy change. We used birth certificate data linked with Medicaid claims. Our primary outcome was immediate postpartum long-acting and reversible contraception, and our secondary outcome was short interpregnancy interval. We characterize trends in long-acting and reversible contraception use and interpregnancy interval over the study period. We used logistic regression models to test the association of key factors (rural, inadequate prenatal care, and medical comorbidities) with immediate and outpatient postpartum long-acting and reversible contraception following the policy change and to test the association of immediate postpartum and postpartum long-acting and reversible contraception with short interpregnancy interval. Our sample included 187,438 births to 145,973 women. Overall, 44.7% of the sample was white, with a mean age of 25.0 years. A majority of the sample (61.5%) was multiparous and resided in metropolitan areas (79.5%). The odds of receipt of immediate postpartum long-acting and reversible contraception use increased after the policy change (adjusted odds ratio, 1.39, 95% confidence interval, 1.34-1.43). Women with inadequate prenatal care (adjusted odds ratio, 1.50, 95% confidence interval, 1.31-1.71) and medically complex pregnancies had higher odds of receipt of immediate postpartum long-acting and reversible contraception following the policy change (adjusted odds ratio, 1.47, 95% confidence interval, 1.29-1.67) compared with women with adequate prenatal care and normal pregnancies. Women residing in rural areas were less likely to receive immediate postpartum long-acting and reversible contraception (adjusted odds ratio, 0.36, 95% confidence interval, 0.30-0.44) than women in metropolitan areas. Utilization of immediate postpartum long-acting and reversible contraception was associated with a decreased odds of a subsequent short interpregnancy interval (adjusted odds ratio, 0.62, 95% confidence interval, 0.44-0.89). Women at risk of a subsequent pregnancy and complications (inadequate prenatal care and medical comorbidities) are more likely to receive immediate postpartum long-acting and reversible contraception following the policy change. Efforts are needed to improve access in rural areas.

Beneficiary Work: The Hidden Labor of Medicaid Users Pursuing Cross‐State Moves

For users of Medicaid personal care assistance (PCA) services and their families, interstate variation in eligibility and service availability act as structural barriers to cross‐state movement. However, program users desire and pursue cross‐state moves. In this article, we provide a grounded theory analysis of 18 interviews with Medicaid PCA users with physical disabilities who expressed desire for or pursued cross‐state moves. Our analysis identified six forms of previously unnamed and unrecognized work. As PCA users plan or pursue cross‐state moves, they are also (1) assessing service ecosystems, (2) finding the right door, (3) persisting through the bureaucratic gauntlet, (4) advocating for systems cooperation, (5) reestablishing networks of support, and (6) responding to service gaps/lapses. Collectively, we describe this hidden labor as beneficiary work, the unremunerated work that program users must do in order to retain access to benefits for which they qualify. Beneficiary work, while hidden, is not optional; it is necessary for continued access to community and broadly, for survival. Identifying and describing beneficiary work expands on Feminist and interactionist perspectives on disability, poverty, and work, and highlights the need for changes to Medicaid policy that address PCA users as mobile citizens.

Massachusetts Community-Based Organization Perspectives on Medicaid Redesign

The purpose of the study is to investigate how community-based organizations perceive Medicaid policy changes to address the social determinants of health. This study included 46 key informant interviews, representing 44 community-based organizations across Massachusetts conducted from September 2017 to March 2018. The interviews were designed to collect community-based organizations' perceptions of Medicaid policy changes. An Advisory Board was empaneled for feedback on data collection and analysis. Massachusetts was chosen as a study site in light of explicit policy efforts to incentivize healthcare organizations to take a more active role in social determinants of health, most notably through the creation of Medicaid Accountable Care Organizations. The community-based organizations expressed optimism about future partnerships with healthcare organizations. This optimism existed alongside the recognition that healthcare organizations and community-based organizations can have conflicting agendas, including misaligned outcomes of interest and timelines. Community-based organizations struggled to define a clear strategy for partnership in the face of incomplete information about how the final Medicaid redesign would proceed and what healthcare providers would be looking for in a partner. Changes to Medicaid policy can catalyze interest in partnership between healthcare organizations and community-based organizations. To minimize the impact of conflicting agendas, policymakers and healthcare leadership should ensure community-based organizations are part of strategy development and social service program implementation. This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.

MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS: POLICY INNOVATION AND EVIDENCE GENERATION

Twenty-two states have turned to managed care organizations to finance and deliver long-term services and supports (LTSS) as a way to control costs, improve quality and shift the locus of care away from institutional settings. These programs, referred to as Managed Long-Term Services and Supports (MLTSS) have been undertaken under several CMS authorities, and vary in terms of the program design and populations covered. Some programs such as the financial alignment demonstration, have integrated Medicaid and Medicare financing, while others have used waiver authority and three-party agreements to achieve coordination. However, all efforts share the same goal of improving the linkage between LTSS and both physical and behavioral health care. This presentation will provide conceptual framework for understanding and assessing program impact using the example of the multi-method evaluation of the $4 billion Pennsylvania Community HealthChoices program, one of the largest transitions in Medicaid policy to date.

State variation in the characteristics of Medicare-Medicaid dual enrollees: Implications for risk adjustment.

To examine between-state differences in the socioeconomic and health characteristics of Medicare beneficiaries dually enrolled in Medicaid, focusing on characteristics not observable to or used by policy makers for risk adjustment. 2010-2013 Medicare Current Beneficiary Survey. Retrospective analyses of survey-reported health and socioeconomic status (SES) measures among low-income Medicare beneficiaries and low-income dual enrollees. We used hierarchical linear regression models with state random effects to estimate the between-state variation in respondent characteristics and linear models to compare the characteristics of dual enrollees by state Medicaid policies. Between-state differences in health and socioeconomic risk among low-income Medicare beneficiaries, as measured by the coefficient of variation, ranged from 17.5 percent for an index of socioeconomic risk to 20.3 percent for an index of health risk. Between-state differences were comparable among the subset of low-income beneficiaries dually enrolled in Medicare and Medicaid. Dual enrollees with incomes below the Federal Poverty Level were in better health and had higher SES in states that offered Medicaid to individuals with relatively higher incomes. Duals' average incomes were higher in states with Medically Needy programs. Characteristics of dual enrollees differ substantially across states, reflecting differences in states' low-income Medicare populations and Medicaid policies. Risk-adjustment methods using dual enrollment to proxy for poor health and low SES should account for this state-level heterogeneity.

Medicaid's EPSDT Benefit: An Opportunity to Improve Pediatric Screening for Social Determinants of Health.

The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit is a key component of Medicaid policy intended to define an essential set of services provided to patients younger than age 21. Given increasing attention to social determinants of health in pediatric health care, this qualitative review examines the extent to which EPSDT might be used to implement structured screening to identify environmental and social factors affecting children's health. Themes derived from semistructured interviews conducted in 2017 were triangulated with a review of the recent literature to describe how states currently consider the EPSDT benefit with respect to social determinants of health screening. Our findings suggest that, with sufficient stakeholder advocacy given the evidence supporting social determinants of health screening as "medically necessary," EPSDT benefits could be considered as a funding source to incentivize the incorporation of social determinants of health screening into the basic package of well-child care.

Musculoskeletal Urgent Care Centers in Connecticut Restrict Patients with Medicaid Insurance Based on Policy and Location.

Musculoskeletal urgent care centers are a new development in the urgent care landscape. Anecdotally, these centers are known to screen patients based on their insurance status, denying care to those with Medicaid insurance. It is important to know whether the practice of denying musculoskeletal urgent care to patients with Medicaid insurance is widespread because this policy could exacerbate existing musculoskeletal healthcare disparities. (1) Do musculoskeletal urgent care centers in Connecticut provide access for patients with Medicaid insurance? (2) Do musculoskeletal urgent care centers have the same Medicaid policies as the entities that own them? (3) Are musculoskeletal urgent care centers more likely to be located in affluent neighborhoods? An online search was conducted to create a list of musculoskeletal urgent care centers in Connecticut. Each center was interviewed over the telephone using a standardized list of questions to determine ownership and Medicaid policy. Next, the entities that owned these musculoskeletal centers were called and asked the same questions about their Medicaid policy. Medicaid policy was compared between musculoskeletal urgent care centers and the practices that owned them. The median household income for each ZIP code containing a musculoskeletal urgent care center was compared with the median household income for Connecticut. The median household income was also compared between the ZIP codes of musculoskeletal urgent care centers that accepted or denied patients with Medicaid insurance. Of the 29 musculoskeletal urgent care centers in Connecticut, only four (13%) accepted patients regardless of their insurance type, 19 (66%) did not accept any form of Medicaid insurance, and six (21%) required that certain requisites and stipulations be met for patients with Medicaid insurance to receive access, such as only permitting a patient for an initial visit and then referring them to a local hospital system for all future encounters, or only permitting patients with Medicaid insurance who lived in the same town as the clinic. All 29 musculoskeletal urgent care centers were owned by private practice groups and nine of 14 of these groups had the same policy towards patients with Medicaid insurance as their respective musculoskeletal urgent care centers. All 29 musculoskeletal urgent care centers were co-located in a private practice clinic office. Musculoskeletal urgent care centers were located in areas with greater median household incomes than the Connecticut state median (95% CI, USD 112,322 to USD 84,613 versus the state median of USD 73,781; p = 0.001). Most musculoskeletal urgent care centers in Connecticut do not accept patients with Medicaid insurance and have similar or stricter Medicaid policies as the groups that own them. Additionally, musculoskeletal urgent care centers were located in affluent neighborhoods. These findings are important because they suggest private practices are using musculoskeletal urgent care centers to capture patients with more favorable insurance. This is likely a result of the relatively low Medicaid reimbursement rates in Connecticut and reflects a need for an increase in either reimbursement or incentives to treat patients with Medicaid insurance. The financial impact of capturing well-insured patients from public and academic medical centers and directing Medicaid patients to these urgent care centers is not known. Additionally, although most of these 29 musculoskeletal urgent care clinics denied care to patients with Medicaid, the specific healthcare disparities caused by decreased access to care must be further studied.

Medicaid Policy Commentaries: An Expanded Academic Pediatrics Section

Medicaid Policy Commentaries: An Expanded Academic Pediatrics Section

Medicaid Expansion during the Trump Presidency: The Role of Executive Waivers, State Ballot Measures, and Attorney General Lawsuits in Shaping Intergovernmental Relations

AbstractThis article assesses developments in the first two years of the Trump presidency regarding implementation of the Affordable Care Act (ACA), with a focus on Medicaid policy. Trump administration officials relied on executive actions to chip away at various elements of the ACA and encouraged and granted state requests for waivers allowing work-requirements and other personal-responsibility rules for Medicaid beneficiaries. Governors and state attorneys general were actively involved in lawsuits that led to several federal court rulings blocking implementation of Medicaid work requirements as well as a ruling that re-opened the legitimacy of the entire ACA. Citizens and interest groups had a major impact at the ballot box by approving several ballot measures that expanded Medicaid in states where expansion was opposed by elected officials. These developments demonstrate how policy adjustments and disputes are worked out in the U.S. federal system in a polarized era, with Congress essentially a bystander and other institutions and actors coming to the fore and resulting in variable speed federalism characterized by different partisan trajectories of state implementation of national policies.

Learning More for Children From Medicaid and CHIP Policy Experiments

Learning More for Children From Medicaid and CHIP Policy Experiments

Public Health Law and Policy: Medicaid Policies and Procedures to Reduce Healthcare Disparities

Prior research suggests that in the United States there is a historical fact pattern of “inequality and social economic disparities in regard to minorities, which has led to intentional and unintentional consequences of social injustices against minority groups” (Strickland, 2017). As with many other societal issues geographical information such as location often reveals a connection within the data. For example, low-income relates to poverty low credit scores (“Equifax Places: Credit Rankings, Fraud Index, Avg Score by Zip,” n.d.), lower education attainment and the use of government subsidies(Bureau, n.d.). Race, ethnicity and location also reveal correlating connections to the above references which some argue have created a public health crisis related to stress of lower credit scores (Birkenmaier, Curley, & Kelly, 2015) In addition, the most recent societal concern findings in public health suggest that there are income disparity resulting in inequality in health care disparities among the same minority groups. In other words, the inner connection social determinants such as race and low-income has contributed to healthcare disparities (“Social determinants of health gain traction as UnitedHealthcare and Intermountain build new programs,” 2018). Furthermore, public health research shows a pattern of (Medicaid) insurance-based discrimination. Most of the research discovered used a connection of income disparity, and inequality which correlations with geographical statistics that support disproportionate healthcare outcomes (Medicaid/Medicare) for minorities as shown in prior research which include supporting statistics (“Are Medicaid’s Payment Rates So Low They’re Discriminatory?,” n.d.). The challenge is that because the Medicaid rates are often lower than the rate paid by private health insurance companies for health care and often has more guidelines and stipulations for the provider accepting the subsidy. In fact, it is suggested that there are additional fact patterns of physicians refusing to accept Medicaid which raises moral and ethical concerns about the health care providers’ oath to save lives and the duty to treat (“Doctors who refuse to accept Medicaid patients breach their social contract,” 2017). Therefore, findings during this research indicates that healthcare providers are seemingly not motivated to accept or take on new Medicaid patients; which poses the question of whether or not public health can be injured by a reduction in providers to accept Medicaid plans as a method of payment for services, which could also have discriminatory outcomes based on the social determinants of those who qualify for Medicaid. More specifically, Medicaid discrimination, from the prospective of health care, is when providers are refusing to accept Medicaid payment as well as other government subsidies. In fact, the STAT article, suggests that are fact patterns of physicians refusing to accept Medicaid as a form of payment for care which raises moral and ethical concerns. The main concern is that health care providers’ have an oath to save lives and the duty to treat a patient is denied care of access to care is limited based on the type of medical insurance the patient has is a violation of their oath and may have the potential to be considered a breach of the health care providers social contract (“Doctors who refuse to accept Medicaid patients breach their social contract,” 2017). Most currently, the introduction of the Affordable Care Act (ACA, 2010) and the healthcare reform has reduced some of the health care disparities between private insurances and government subsidies because of the ACA’s goal to create equal opportunities for healthcare insurance for everyone, even for those with prior health conditions formerly legalized discrimination; which allowed health insurance companies to deny coverage based on prior health conditions as stated in the ACA statute . Moreover, the ACA, has bought about several policy implementations to reduce healthcare disparities, discrimination such as insurance based discrimination, quality care, and access to care for Medicaid enrollees (“Affordable Care Act (ACA) âHealthCare.gov Glossary,” n.d.).

How Government Created and Shaped the U.S. Nursing Home Industry

Beginning in the 1960s, U.S. government policy largely created, and subsequently facilitated the corporatization of, a powerful, multi-billion dollar nursing home industry. Using data from trade publications, government agency reports, Congressional hearings, newspaper reports and existing scholarly research, I chart the relationship between the state and the U.S. nursing home industry over four time periods to reveal how, at different moments, government policy contributed to first the creation, then the corporatization and consolidation of the industry. I argue that the trajectory of Medicare and Medicaid policy is not wholly neoliberal but neither should it be considered progressive.

Association Between South Carolina Medicaid’s Change in Payment for Immediate Postpartum Long-Acting Reversible Contraception and Birth Intervals

This study evaluates whether a 2012 change in the South Carolina Medicaid policy to reimburse hospitals for provision of immediate postpartum long-acting reversible contraception (IPP-LARC) separately from global payment for all services in a delivery hospitalization was associated with changes in IPP-LARC use and short-interval births between 2010 and 2017.

Opportunities for Community Health Worker Training to Improve Access to Health Care for Medicaid Enrollees.

Limited access to care can negatively affect population health, which is particularly concerning for individuals of lower socioeconomic status. Shortages of US health care providers in areas that predominantly serve Medicaid enrollees contribute to a lack of access. The Ohio Medicaid Technical Assistance and Policy Program Healthcare Access Initiative was designed as a workforce development initiative to train and deploy community health workers (CHWs). The authors conducted 55 key informant interviews with preceptors, CHWs, and administrators across 5 sites with the specific aim of improving understanding of common barriers to and benefits of CHW program implementation across different CHW programs in Ohio. CHW programs reportedly act as a bridge between the patient and providers, and program benefits were reported for participants, organizations, and patients. This study found that CHW programs enabled training of health professionals that can empower participants while allowing them to also give back to their communities. Organizations employing CHWs reported being able to extend clinic services, increase utilization of community resources, and improve patient compliance through the efforts of CHWs; program impacts also led to increased patient support, patient education, and overall better care. To better integrate CHWs into health care organizations, organizations should focus on clearly defining the CHW role and ensuring adequate infrastructure to support CHW efforts.

Factors Influencing Receipt of Interventional Pain Management Among Medicaid Beneficiaries with Cancer

Background: Pain is common among cancer patients. Nonclinical factors may affect receipt of pain management among Medicaid beneficiaries with cancer. Objectives: To examine associations of patient characteristics and US state-level Medicaid policies on receipt of interventional pain management among Medicaid beneficiaries with breast or colorectal cancer. Study Design: A retrospective analysis of 2006-2008 Medicaid claims data. Setting: Claims data from facilities providing care to Medicaid beneficiaries. Methods: Interventional pain management among Medicaid beneficiaries aged 18-64 years with breast or colorectal cancer was identified using procedure codes in Medicaid claims data. State-level Medicaid policy variables included physician visit reimbursements, required patient copayments, and time period for Medicaid eligibility recertification (12 vs. &lt; 12 months). Analyses also examined beneficiary race/ethnicity, age, comorbidities, and cancer treatment. Generalized estimating equations controlling for clustering by state assessed factors influencing receipt of interventional pain management. Results: The study included 8,438 Medicaid beneficiaries with breast or colorectal cancer. Colorectal cancer (vs. breast cancer) patients were significantly more likely to receive interventional pain management. Medicaid policies were not significantly associated with receipt of interventional pain services. Among breast cancer patients, older age and non-Hispanic white race/ethnicity were associated with decreased likelihood of receiving interventional pain management; more comorbidities and receipt of breast conserving surgery were associated with increased likelihood. Demographic characteristics were not significantly associated with receipt of interventional pain management among colorectal cancer patients. Limitations: Sample size of Medicare beneficiaries with cancer receiving interventional pain management; limited information included in Medicare claims data. Conclusions: State-level Medicaid policies were not significantly associated with receipt of interventional pain management for breast or colorectal cancer patients; disparities in receipt of these services were observed only for breast cancer patients. These results may help develop policies to enhance access to appropriate pain management services. Key words: Cancer pain, pain management, Medicaid, health care disparities, breast neoplasms, colorectal neoplasms, health policies, physician practice patterns, retrospective studies, claims analyses

Long-acting reversible contraceptive utilization after policy change increasing device reimbursement to wholesale acquisition cost in Louisiana

Unintended pregnancies, occurring in nearly 1 out of every 2 (45%) pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives, namely intrauterine devices and implants. Inadequate reimbursement for long-acting reversible contraceptive devices may be an access barrier to long-acting reversible contraceptive uptake. In 2014, the Louisiana Department of Health Bureau of Health Services Financing implemented a policy change that increased the Medicaid reimbursement rates for acquiring long-acting reversible contraceptive devices to the wholesale acquisition cost. To examine the association of a Medicaid policy change that increased the long-acting reversible contraceptive device reimbursement rate to the wholesale acquisition cost (ie, price set by the manufacturers) on long-acting reversible contraceptive uptake among women at risk for unintended pregnancy. This retrospective, repeated cross-sectional study used 2013-2015 Louisiana Medicaid claims data and contraceptive provision measures to assess associations between patient (age, race, urban/rural residence, postpartum status) and provider (urban/rural location, specialty) characteristics and long-acting reversible contraceptive uptake among contraceptive users (N= 193,623) using bivariate and logistic regression analyses. After long-acting reversible contraceptive reimbursement increased, there was a 2-fold likelihood increase in use in 2015 vs 2013 (odds ratio, 2.08; 95% confidence interval, 1.69-2.55). Long-acting reversible contraceptive uptake was more likely across all patient and provider subgroups in 2015 vs 2013 but notably among patients receiving contraceptive care from family planning clinics (odds ratio, 3.93; 95% confidence interval, 2.34-6.62). Removal of a provider-level financial barrier to long-acting reversible contraceptive provision was associated with increased long-acting reversible contraceptive uptake among women at risk for unintended pregnancy. Efforts to improve long-acting reversible contraceptive access should focus on equitable healthcare reimbursement for healthcare providers of reproductive-aged women.