Publications on Medicaid

In its June 2008 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended revision of the prospective payment system (PPS) for skilled nursing facilities (SNFs). The proposed revisions consist of a new component to pay for non-therapy ancillaries (NTA) based on predicted NTA costs, an alternative therapy component that bases therapy payments on predicted therapy needs, and addition of an outlier policy for the PPS. This technical report to MedPAC provides detail on the data, methods, and specific predictive models that underlie the analysis in the Report to Congress.

In April 2006, Massachusetts passed legislation intended to move the state to almost universal coverage within three years and, in conjunction with that expansion, to improve access to affordable, high-quality health care. In roughly the first year under reform, uninsurance among working-age adults was reduced by almost half among those surveyed, dropping from 13% in Fall 2006 to 7% in Fall 2007. At the same time, access to care improved and the share of adults with high out-of-pocket costs and problems paying medical bills dropped. Despite higher than anticipated costs, most residents of the state continued to support reform. Health Affairs, Web Exclusive 3 June 2008. www.healthaffairs.org

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), to ensure that all children have access to comprehensive health insurance coverage. Healthy Kids covers uninsured children below 400 percent of poverty and primarily serves poor, undocumented Latino children. A survey of parents of Healthy Kids enrollees found that in the first year of enrollment, children experienced improvements in access to and use of medical and dental care; a reduction in missed school days due to health problems; reduced unmet need; increased parent confidence in getting care and satisfaction with quality; and reduced financial worries. Moreover, use of preventive and dental services continued to improve during the children's second and third years of continuous enrollment.

Managed care is the norm for many on Medicaid. In 2005, nearly 300 plans participated in state Medicaid managed care programs, with many operating under for-profit ownership. Concerns about the impact of plan ownership on access to care arise because of differences in the incentives in place in for-profit and nonprofit organizations. Using data from the 2002 National Survey of America's Families, this study examines the link between for-profit plan ownership and enrollees' access to health care. The results suggest that access to care for Medicaid enrollees may be better under nonprofit plans than for-profit plans. (Medical Care Research and Review, 2008 Apr 22.)

This study examines the factors driving the downward trend in employer sponsored insurance coverage between 1999 and 2002 for low- and moderate-income workers. We find that while low-income workers are more likely to be uninsured and are most vulnerable to the loss of ESI coverage, many middle income workers are also in a precarious position when faced with the loss of ESI coverage. The study also finds that the drop in ESI offers over the period was driven largely by changes in the nature of workers' jobs, while the drop in ESI take-up was driven largely by rising premiums. Health Services Research, Vol. 41, No. 6, 2006, pp. 2074-2096.