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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: Adams, Gina; Spaulding, Shayne
    Reference Type: White Papers
    Year: 2018

    Work requirements for key safety net programs are currently being discussed across the country. It is important that this debate be based on an understanding of what recipients need to meet those requirements and to successfully place themselves on a path toward self-sufficiency. Among those potentially subject to work requirements are low-income parents with limited education and low skills who need education and training to find and keep stable jobs. However, a lack of quality, affordable child care often stands in their way. To inform current policy deliberations, we have compiled research insights about meeting the child care needs of low-income parents seeking education and job training from the dozen studies produced under Urban Institute’s “Bridging the Gap: Exploring the Intersection between Child Care and Workforce Development for Low-Income Parents” project. This brief highlights key insights for policymakers and lays out further questions to be explored. (Author abstract)

     

     

     

    Work requirements for key safety net programs are currently being discussed across the country. It is important that this debate be based on an understanding of what recipients need to meet those requirements and to successfully place themselves on a path toward self-sufficiency. Among those potentially subject to work requirements are low-income parents with limited education and low skills who need education and training to find and keep stable jobs. However, a lack of quality, affordable child care often stands in their way. To inform current policy deliberations, we have compiled research insights about meeting the child care needs of low-income parents seeking education and job training from the dozen studies produced under Urban Institute’s “Bridging the Gap: Exploring the Intersection between Child Care and Workforce Development for Low-Income Parents” project. This brief highlights key insights for policymakers and lays out further questions to be explored. (Author abstract)

     

     

     

  • Individual Author: Sherman, Erin ; Secrist, Amy; Gidwani, Suman; Storey, Douglas; Leifer, Jess
    Reference Type: Conference Paper
    Year: 2018

    Motivation: Baltimore City experiences one of the highest infant mortality rates in the country. Although a large percentage of pregnant women in Baltimore are Medicaid recipients, they often do not take-up pregnancy and postpartum support services that are available with an appropriate referral. Particularly for high-risk pregnancies, this can lead to adverse birth outcomes. To begin accessing these services, Medicaid-eligible patients must have a prenatal risk assessment (PRA) form filled out by their provider. Without this form, women with high risk pregnancies may not be referred to services such as insurance assistance, WIC, home visits by social workers, and smoking cessation assistance. Intervention: In collaboration with the Baltimore City Health Department (BCHD), the Johns Hopkins University Center for Communication Programs (CCP) and other partners in the B’more for Healthy Babies (BHB) initiative, a package of behavioral interventions was randomized across prenatal care practices in Baltimore. The set of interventions included the...

    Motivation: Baltimore City experiences one of the highest infant mortality rates in the country. Although a large percentage of pregnant women in Baltimore are Medicaid recipients, they often do not take-up pregnancy and postpartum support services that are available with an appropriate referral. Particularly for high-risk pregnancies, this can lead to adverse birth outcomes. To begin accessing these services, Medicaid-eligible patients must have a prenatal risk assessment (PRA) form filled out by their provider. Without this form, women with high risk pregnancies may not be referred to services such as insurance assistance, WIC, home visits by social workers, and smoking cessation assistance. Intervention: In collaboration with the Baltimore City Health Department (BCHD), the Johns Hopkins University Center for Communication Programs (CCP) and other partners in the B’more for Healthy Babies (BHB) initiative, a package of behavioral interventions was randomized across prenatal care practices in Baltimore. The set of interventions included the following components: 

    • Checklist: The PRA Checklist includes execution notes for the 3 steps required to successfully complete a PRA: talking points for speaking to a patient about the PRA, steps and specific filling number for the PRA, and fax number for faxing the PRA.
    • Feedback: Three quarterly feedback reports were used to compare how many PRAs an office completed in comparison to offices like it. They provided a visual image (smiley face or exclamation point) to indicate whether the office was doing better or worse than its peers. Additionally, practices who had not submitted any PRAs in the previous year received a report indicating that they need to submit PRAs to appropriately serve their patients.
    • Testimonials: Patient testimonials included quotes from mothers who had benefitted from services referred through the PRA. They highlighted stories of mothers and babies with positive health outcomes as a result of services like home visiting and cribs. Testimonials will be sent to all treatment offices via email at intervals of 1-2 months.
    • Information: A website was developed which provides a quiz that allows clinics to see how many of the standard PRA procedures they are/are not following. The website also has a list of behaviorally informed best practices that we developed based on site visits and advice from BHB/BCHD.

    Methodology: Data collection will occur between March-September 2018 with the primary outcome being the number of PRAs submitted by each practice. Cluster randomization is used to identify effects in 25 control clinics compared to 27 treatment clinics throughout the city. Results: The results, available by September 2018, will show whether this combination of peer comparison and informational interventions can impact providers’ PRA submission rates, referral rates to prenatal and postpartum support services, and the rate of accepted services by Medicaid-eligible women. Conclusion: The results of this experiment will determine whether social and informational efforts impact PRA take-up and increase support-service access for pregnant Medicaid-eligible women in Baltimore. (Author abstract)

  • Individual Author: Bauer, Lauren; Schanzenbach, Diane Whitmore; Shambaugh, Jay
    Reference Type: Report
    Year: 2018

    Basic assistance programs such as the Supplemental Nutrition Assistance Program (SNAP, formerly the Food Stamp Program) and Medicaid ensure families have access to food and medical care when they are low-income. Some policymakers at the federal and state levels intend to add new work requirements to SNAP and Medicaid. In this paper, we analyze those who would be impacted by an expansion of work requirements in SNAP and an introduction of work requirements into Medicaid. We characterize the types of individuals who would face work requirements, describe their labor force experience over 24 consecutive months, and identify the reasons why they are not working if they experience a period of unemployment or labor force nonparticipation. We find that the majority of SNAP and Medicaid participants who would be exposed to work requirements are attached to the labor force, but that a substantial share would fail to consistently meet a 20 hours per week–threshold. Among persistent labor force nonparticipants, health issues are the predominant reason given for not working. There may be...

    Basic assistance programs such as the Supplemental Nutrition Assistance Program (SNAP, formerly the Food Stamp Program) and Medicaid ensure families have access to food and medical care when they are low-income. Some policymakers at the federal and state levels intend to add new work requirements to SNAP and Medicaid. In this paper, we analyze those who would be impacted by an expansion of work requirements in SNAP and an introduction of work requirements into Medicaid. We characterize the types of individuals who would face work requirements, describe their labor force experience over 24 consecutive months, and identify the reasons why they are not working if they experience a period of unemployment or labor force nonparticipation. We find that the majority of SNAP and Medicaid participants who would be exposed to work requirements are attached to the labor force, but that a substantial share would fail to consistently meet a 20 hours per week–threshold. Among persistent labor force nonparticipants, health issues are the predominant reason given for not working. There may be some subset of SNAP and Medicaid participants who could work, are not working, and might work if they were threatened with the loss of benefits. This paper adds evidence to a growing body of research that shows that this group is very small relative to those who would be sanctioned under the proposed policies who are already working or are legitimately unable to work. (Author abstract)

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