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The SSRC Library allows visitors to access materials related to self-sufficiency programs, practice and research. Visitors can view common search terms, conduct a keyword search or create a custom search using any combination of the filters at the left side of this page. To conduct a keyword search, type a term or combination of terms into the search box below, select whether you want to search the exact phrase or the words in any order, and click on the blue button to the right of the search box to view relevant results.

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  • Individual Author: Mueller, Keith J. ; Alfero, Charles ; Coburn, Andrew F. ; Lundblad, Jennifer P. ; MacKinney, A. Clinton; McBride, Timothy D. ; Weigel, Paula
    Reference Type: Report
    Year: 2018

    The U.S. health care system is undergoing significant transformation as a result of Federal, State, and private payer policies designed to improve access to medical care as well as the value and outcomes of health care while attempting to slow cost growth. Some payment innovations, such as accountable care and other risk-based models, drive organizational and delivery changes that have shown evidence of improved quality, reduced care fragmentation, and lowered costs for certain populations. Yet overall, the entire system has not realized substantial cost savings nor has quality improved for everyone. There continue to be gaps between people who live in areas where progress is being made and those who do not, perhaps reflecting symptoms such as rising health insurance premiums, unstable insurance markets with limited plan choice, large variation in uninsured rates and access to care, and continued health professional shortages. It is clear that more changes are required if real progress is to be made toward lowering total health care system costs, improving access and health care...

    The U.S. health care system is undergoing significant transformation as a result of Federal, State, and private payer policies designed to improve access to medical care as well as the value and outcomes of health care while attempting to slow cost growth. Some payment innovations, such as accountable care and other risk-based models, drive organizational and delivery changes that have shown evidence of improved quality, reduced care fragmentation, and lowered costs for certain populations. Yet overall, the entire system has not realized substantial cost savings nor has quality improved for everyone. There continue to be gaps between people who live in areas where progress is being made and those who do not, perhaps reflecting symptoms such as rising health insurance premiums, unstable insurance markets with limited plan choice, large variation in uninsured rates and access to care, and continued health professional shortages. It is clear that more changes are required if real progress is to be made toward lowering total health care system costs, improving access and health care experiences for all individuals, and achieving better population health.

    This paper examines the progress of health system transformation and the gaps that remain as they affect rural people, places, and providers. The health system transformation activities examined here are not limited to the Patient Protection and Affordable Care Act of 2010 (PPACA), but also touch upon activities undertaken by states, insurance plans, and private and public payers.

    The paper is organized into seven chapters covering topic areas that have key implications for rural people and the rural health care delivery system: Medicare, Medicaid and CHIP, Insurance Coverage and Affordability, Quality, Health Care Finance and System Transformation, Workforce, and Population Health. Each chapter begins with a summary of Policy Opportunities, followed by a background section on Rural Trends and Challenges that summarizes rural-related policy advances and continued gaps. We conclude each chapter with a Looking Ahead section that highlights the most pressing issues in today’s rural health care system environment, and we suggest future policy directions related to each issue. (Author abstract)

  • Individual Author: Medicaid and CHIP Payment and Access Commission
    Reference Type: Report
    Year: 2018

    Using data combined from the 2013–2015 National Health Interview Surveys, this brief examines characteristics of individuals with Medicaid coverage—children and adults—in rural areas, as well as their access to care and use of services, comparing their experience to their privately insured and uninsured counterparts. We also compare access and use between Medicaid beneficiaries in urban and rural areas, and by disability. (Edited author introduction)

     

    Using data combined from the 2013–2015 National Health Interview Surveys, this brief examines characteristics of individuals with Medicaid coverage—children and adults—in rural areas, as well as their access to care and use of services, comparing their experience to their privately insured and uninsured counterparts. We also compare access and use between Medicaid beneficiaries in urban and rural areas, and by disability. (Edited author introduction)

     

  • Individual Author: Wheaton, Laura; Lynch, Victoria; Johnson, Martha C.
    Reference Type: Report
    Year: 2017

    This report examines the overlap in eligibility of children and nonelderly adults for Supplemental Nutrition Assistance Program (SNAP) and Medicaid/Children’s Health Insurance Program (CHIP) benefits in 2013, prior to Medicaid expansion under the Affordable Care Act. We find that over half of children eligible for one program were eligible for both, and nearly all of the remaining children were eligible for Medicaid/CHIP. A substantially smaller share of parents and nonparents were eligible for both SNAP and Medicaid/CHIP. The report also provides state-level estimates to allow calculation of state joint program participation rates. (Author abstract)

    This report examines the overlap in eligibility of children and nonelderly adults for Supplemental Nutrition Assistance Program (SNAP) and Medicaid/Children’s Health Insurance Program (CHIP) benefits in 2013, prior to Medicaid expansion under the Affordable Care Act. We find that over half of children eligible for one program were eligible for both, and nearly all of the remaining children were eligible for Medicaid/CHIP. A substantially smaller share of parents and nonparents were eligible for both SNAP and Medicaid/CHIP. The report also provides state-level estimates to allow calculation of state joint program participation rates. (Author abstract)

  • Individual Author: Sparr, Mariel; Joraanstad, Alexandra; Atukpawu-Tipton, Grace; Miller, Nicole; Leis, Julie; Filene, Jill
    Reference Type: Report
    Year: 2017

    Rates of poor birth outcomes remain high in the United States. In 2015, 9.6 percent of U.S. infants were born preterm and 8.1 percent were born with low birth weights. To address poor birth outcomes in the United States, the Centers for Medicare and Medicaid Services (CMS) developed the Strong Start for Mothers and Newborns (Strong Start) initiative. The Strong Start initiative is studying enhanced prenatal care approaches aimed at reducing preterm births among Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries who are at high risk for poor birth outcomes. As part of the Strong Start initiative, CMS, in partnership with the Administration for Children and Families and the Health Resources and Services Administration, established the Mother and Infant Home Visiting Program Evaluation - Strong Start (MIHOPE-Strong Start). MIHOPE-Strong Start is evaluating the effectiveness of evidence-based home visiting for improving birth outcomes, maternal and infant health, health care use, and prenatal care use among women enrolled in Medicaid or CHIP as compared to mothers...

    Rates of poor birth outcomes remain high in the United States. In 2015, 9.6 percent of U.S. infants were born preterm and 8.1 percent were born with low birth weights. To address poor birth outcomes in the United States, the Centers for Medicare and Medicaid Services (CMS) developed the Strong Start for Mothers and Newborns (Strong Start) initiative. The Strong Start initiative is studying enhanced prenatal care approaches aimed at reducing preterm births among Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries who are at high risk for poor birth outcomes. As part of the Strong Start initiative, CMS, in partnership with the Administration for Children and Families and the Health Resources and Services Administration, established the Mother and Infant Home Visiting Program Evaluation - Strong Start (MIHOPE-Strong Start). MIHOPE-Strong Start is evaluating the effectiveness of evidence-based home visiting for improving birth outcomes, maternal and infant health, health care use, and prenatal care use among women enrolled in Medicaid or CHIP as compared to mothers who may receive other services available in the community. To better understand the larger service systems within which prenatal care and home visiting programs operate at the state level, MIHOPE-Strong Start conducted interviews with staff from state agencies and other non-governmental entities working to improve birth outcomes in the states participating in MIHOPE-Strong Start. This report presents the findings from this qualitative substudy, which provides a snapshot of the range of state efforts to promote prenatal health and improve birth outcomes, including home visiting. (Author abstract) 

  • Individual Author: Hoynes, Hilary ; Bronchetti, Erin; Christensen, Garret
    Reference Type: Report
    Year: 2017

    The food stamp program (SNAP) is one of the most important elements of the social safety net and is the second largest anti-poverty program for children in the U.S. (only the EITC raises more children above poverty). The program varies little across states and over time, which creates challenges for quasi-experimental evaluation. Notably, SNAP benefit levels are fixed across 48 states; but local food prices vary widely, leading to substantial variation in the real value of SNAP benefits. In this study, we leverage time variation in the real value of the SNAP benefit across markets to examine the effects of SNAP on child health. We link panel data on regional food prices and the cost of the Thrifty Food Plan, as measured by the USDA’s Quarterly Food at Home Price Database, to restricted-access geo-located National Health Interview Survey data on samples of SNAP-recipient and SNAP-eligible children. We estimate the relationship between the real value of SNAP benefits (i.e., the ratio of the SNAP maximum benefit to the TFP price faced by a household) and children’s health and health...

    The food stamp program (SNAP) is one of the most important elements of the social safety net and is the second largest anti-poverty program for children in the U.S. (only the EITC raises more children above poverty). The program varies little across states and over time, which creates challenges for quasi-experimental evaluation. Notably, SNAP benefit levels are fixed across 48 states; but local food prices vary widely, leading to substantial variation in the real value of SNAP benefits. In this study, we leverage time variation in the real value of the SNAP benefit across markets to examine the effects of SNAP on child health. We link panel data on regional food prices and the cost of the Thrifty Food Plan, as measured by the USDA’s Quarterly Food at Home Price Database, to restricted-access geo-located National Health Interview Survey data on samples of SNAP-recipient and SNAP-eligible children. We estimate the relationship between the real value of SNAP benefits (i.e., the ratio of the SNAP maximum benefit to the TFP price faced by a household) and children’s health and health care utilization, in a fixed effects framework that controls for a number of individual-level and region characteristics, including non-food prices. Our findings indicate that children in market regions with a lower real value of SNAP benefits utilize significantly less health care, and may utilize emergency room care at increased rates. Lower real SNAP benefits also lead to an increase in school absences but we find no effect on reported health status. (Author abstract) 

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