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  • Individual Author: Zogg, Cheryl K.; Scott, John W.; Metcalfe, David; Gluck, Abbe R.; Curfman, Gregory D.; Davis, Kimberly A.; Dimick, Justin B.; Haider, Adil H.
    Reference Type: Journal Article
    Year: 2019

    Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

    Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

    Design, Setting, and Participants Quasi-experimental, difference-in-difference analysis assessed adult trauma in patients aged 19 to 64 years in 5 Medicaid expansion (Colorado,...

    Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

    Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

    Design, Setting, and Participants Quasi-experimental, difference-in-difference analysis assessed adult trauma in patients aged 19 to 64 years in 5 Medicaid expansion (Colorado, Illinois, Minnesota, New Jersey, and New Mexico) and 4 nonexpansion (Florida, Nebraska, North Carolina, and Texas) states.

    Interventions/Exposure Policy implementation in January 2014.

    Main Outcomes and Measures Changes in insurance coverage, outcomes (mortality, morbidity, failure to rescue, and length of stay), and discharge to rehabilitation.

    Results A total of 283 878 patients from Medicaid expansion states and 285 851 patients from nonexpansion states were included (mean age [SD], 41.9 [14.1] years; 206 698 [36.3%] women). Adults with injuries in expansion states experienced a 13.7 percentage point increase in discharge to rehabilitation (95% CI, 7.0-7.8; baseline: 14.7%) that persisted across inpatient rehabilitation facilities (4.5 percentage points), home health agencies (2.9 percentage points), and skilled nursing facilities (1.0 percentage points). There was also a 2.6 percentage point drop in failure to rescue and a 0.84-day increase in length of stay. Rehabilitation changes were most pronounced among patients eligible for rehabilitation coverage under the 2-midnight (8.4 percentage points) and 60% (10.2 percentage points) Medicaid payment rules. Medicaid expansion increased rehabilitation access for patients with the most severe injuries and conditions requiring postdischarge care (eg, pelvic fracture). It mitigated race/ethnicity-, age-, and sex-based disparities in which patients use rehabilitation.

    Conclusions and relevance This multistate assessment demonstrated significant changes in insurance coverage and discharge to rehabilitation among adult trauma patients that were greater in Medicaid expansion than nonexpansion states. By targeting subgroups of the trauma population most likely to be uninsured, rehabilitation gains associated with Medicaid have the potential to improve survival and functional outcomes for more than 60 000 additional adult trauma patients nationally in expansion states. (Author abstract)

  • Individual Author: Weigensberg, Elizabeth; Cornwell, Derekh; Leininger, Lindsey; Stagner, Matthew; LeBarron, Sarah; Gellar, Jonathan; MacIntyre, Sophie; Chapman, Richard; Maher, Erin J.; Pecora, Peter J.; O'Brien, Kirk
    Reference Type: Report
    Year: 2018

    Mathematica and Casey Family Programs have published the final report from a project linking child welfare and Medicaid data to conduct analyses to understand types of high service use and to identify factors predictive of high service use among children in foster care. The study identifies distinct types of high service users and how both child welfare and Medicaid data can be used to predict which children may be likely to experience high degrees of placement instability. The study was conducted in partnership with partners in two states—Tennessee’s Department of Children’s Services and TennCare, and Florida’s Department of Children and Families, Agency for Health Care Administration, and Eckerd Kids. The goal of the project is to help child welfare, Medicaid and other service providing agencies better coordinate service delivery to prevent undesirable outcomes for children and to improve effectiveness and efficiency. (Author abstract) 

    Mathematica and Casey Family Programs have published the final report from a project linking child welfare and Medicaid data to conduct analyses to understand types of high service use and to identify factors predictive of high service use among children in foster care. The study identifies distinct types of high service users and how both child welfare and Medicaid data can be used to predict which children may be likely to experience high degrees of placement instability. The study was conducted in partnership with partners in two states—Tennessee’s Department of Children’s Services and TennCare, and Florida’s Department of Children and Families, Agency for Health Care Administration, and Eckerd Kids. The goal of the project is to help child welfare, Medicaid and other service providing agencies better coordinate service delivery to prevent undesirable outcomes for children and to improve effectiveness and efficiency. (Author abstract) 

  • Individual Author: Hartig, Seth; Skinner, Curtis
    Reference Type: Report
    Year: 2016

    In Florida and across the nation, there is much debate about the adequacy of the minimum wage. The federal minimum wage of $7.25 has not increased since July 2009, and has fallen by more than fifty cents in real terms since then. Adjusted for inflation, the current minimum wage is far below the federal minimum wage in effect from the late 1950s through the 1970s. Recognizing the inadequacy of the federal minimum wage, numerous states—including Florida—have set higher minimum wages for their residents.

    In the past year, Florida state legislators have advanced legislation or promoted ballot initiatives that would raise the state’s minimum wage, now set at $8.05. To help inform the policy debate, this brief advances three arguments for raising the Florida minimum wage. First, the current wage is not high enough to lift many families with working parents out of poverty. Because of this, parents in Florida working at the current minimum wage and with incomes below the poverty line cannot access federal healthcare subsidies under the Affordable Care Act, leaving them without...

    In Florida and across the nation, there is much debate about the adequacy of the minimum wage. The federal minimum wage of $7.25 has not increased since July 2009, and has fallen by more than fifty cents in real terms since then. Adjusted for inflation, the current minimum wage is far below the federal minimum wage in effect from the late 1950s through the 1970s. Recognizing the inadequacy of the federal minimum wage, numerous states—including Florida—have set higher minimum wages for their residents.

    In the past year, Florida state legislators have advanced legislation or promoted ballot initiatives that would raise the state’s minimum wage, now set at $8.05. To help inform the policy debate, this brief advances three arguments for raising the Florida minimum wage. First, the current wage is not high enough to lift many families with working parents out of poverty. Because of this, parents in Florida working at the current minimum wage and with incomes below the poverty line cannot access federal healthcare subsidies under the Affordable Care Act, leaving them without affordable health insurance if they lack employer-provided coverage. Finally, the state minimum wage is also far too low to offset important work-related expenses such as child care, serving as a disincentive for a second parent in a two-parent family to increase his or her working hours. (Author abstract)

     

  • Individual Author: Kneipp, Shawn ; Kairalla, John ; Lutz, Barbara; Pereira, Deidre; Hall, Allyson ; Flocks, Joan; Beeber, Linda; Schwartz, Todd
    Reference Type: Journal Article
    Year: 2011

    We evaluated the effectiveness of a community-based participatory research-grounded intervention among women receiving Temporary Assistance for Needy Families (TANF) with chronic health conditions in increasing (1) health care visits, (2) Medicaid knowledge and skills, and (3) health and functional status. We used a randomized controlled trial design to assign 432 women to a public health nurse case management plus Medicaid intervention or a wait-control group. We assessed Medicaid outcomes pre- and post-training; other outcomes were assessed at 3, 6, and 9 months. Medicaid knowledge and skills improved. Intervention group participants were more likely to have a new mental health visit, and this likelihood increased in higher-risk subgroups. Depression and functional status improved in the intervention group over time. No differences were found in routine or preventive care, or general health. Health outcomes among women receiving TANF can be improved with public health interventions. Additional strategies are needed to further reduce health disparities in this population. (...

    We evaluated the effectiveness of a community-based participatory research-grounded intervention among women receiving Temporary Assistance for Needy Families (TANF) with chronic health conditions in increasing (1) health care visits, (2) Medicaid knowledge and skills, and (3) health and functional status. We used a randomized controlled trial design to assign 432 women to a public health nurse case management plus Medicaid intervention or a wait-control group. We assessed Medicaid outcomes pre- and post-training; other outcomes were assessed at 3, 6, and 9 months. Medicaid knowledge and skills improved. Intervention group participants were more likely to have a new mental health visit, and this likelihood increased in higher-risk subgroups. Depression and functional status improved in the intervention group over time. No differences were found in routine or preventive care, or general health. Health outcomes among women receiving TANF can be improved with public health interventions. Additional strategies are needed to further reduce health disparities in this population. (author abstract) 

    Additional information can be found at the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality's Innovations Exchange web site: https://innovations.ahrq.gov/profiles/public-health-nurses-provide-case-...

  • Individual Author: Quint, Janet; Widom, Rebecca; Moore, Lindsay
    Reference Type: Report
    Year: 2001

    Medicaid and food stamps are important potential sources of support for low-wage workers, including those who have recently received Temporary Assistance for Needy Families (TANF) welfare. Yet many former welfare recipients are not getting these benefits, despite the fact that the vast majority of TANF recipients who find employment are eligible for transitional Medicaid and that, depending on their income, they may be eligible for food stamps as well. While many explanations for declines in the Medicaid and food stamp rolls have been offered, this report focuses on what happens in welfare offices as eligibility workers put policies into practice and interact with agency clients. This report is part of the Project on Devolution and Urban Change (“Urban Change” for short), which is being undertaken by the Manpower Demonstration Research Corporation (MDRC). The report is based on research conducted in early 2000 in welfare offices located in the four large urban counties participating in the project: Cuyahoga County (Cleveland, Ohio); Los Angeles County (California); Miami-Dade...

    Medicaid and food stamps are important potential sources of support for low-wage workers, including those who have recently received Temporary Assistance for Needy Families (TANF) welfare. Yet many former welfare recipients are not getting these benefits, despite the fact that the vast majority of TANF recipients who find employment are eligible for transitional Medicaid and that, depending on their income, they may be eligible for food stamps as well. While many explanations for declines in the Medicaid and food stamp rolls have been offered, this report focuses on what happens in welfare offices as eligibility workers put policies into practice and interact with agency clients. This report is part of the Project on Devolution and Urban Change (“Urban Change” for short), which is being undertaken by the Manpower Demonstration Research Corporation (MDRC). The report is based on research conducted in early 2000 in welfare offices located in the four large urban counties participating in the project: Cuyahoga County (Cleveland, Ohio); Los Angeles County (California); Miami-Dade County (Florida); and Philadelphia County (Pennsylvania). The findings are based primarily on 67 interviews with line staff members (referred to here as “workers”) and their supervisors, and on 28 observations of worker-client meetings. The authors drew also on quantitative data from surveys administered to 615 line staff members at all sites except Los Angeles (where the surveys were fielded too late for the data to be included here). Finally, they analyzed the contents of in-depth interviews with 50 welfare recipients in Cuyahoga and Los Angeles Counties that were conducted as part of the Urban Change project’s ethnographic study. This report contains the findings of that research and, based on those findings, recommendations to state and local welfare agencies and to the Food and Nutrition Service (FNS, the agency within the U.S. Department of Agriculture that administers the Food Stamp Program). The authors shared a draft of the report with FNS as well. On November 18, 2000, as the report was made into its final form, President Clinton announced new rules governing the administration of food stamps that could substantially address some of the problems observed. (Author abstract)

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