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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: 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: Hahn, Heather
    Reference Type: Report
    Year: 2019

    Work-related requirements—such as employment, job search, job training, or community engagement activities—are currently a condition of eligibility for some safety net programs. Temporary Assistance for Needy Families (TANF), the Supplemental Nutrition Assistance Program (SNAP), housing assistance and Medicaid each include work-related requirements in some states or localities for some beneficiaries. Recent proposals would expand or introduce new work requirements in these and other safety net programs, which offer vital supports for families to meet their basic needs.

    For parents, meeting work requirements to gain or maintain eligibility for safety net programs and access to vital supports is not as straightforward as simply engaging in the required work activities. Parents must not only understand what the requirements are, but be able to access the necessary training and supports to meet the requirements and document their compliance. If they qualify for an exemption, they must learn how to document this as well. Agencies administering safety net programs must be able...

    Work-related requirements—such as employment, job search, job training, or community engagement activities—are currently a condition of eligibility for some safety net programs. Temporary Assistance for Needy Families (TANF), the Supplemental Nutrition Assistance Program (SNAP), housing assistance and Medicaid each include work-related requirements in some states or localities for some beneficiaries. Recent proposals would expand or introduce new work requirements in these and other safety net programs, which offer vital supports for families to meet their basic needs.

    For parents, meeting work requirements to gain or maintain eligibility for safety net programs and access to vital supports is not as straightforward as simply engaging in the required work activities. Parents must not only understand what the requirements are, but be able to access the necessary training and supports to meet the requirements and document their compliance. If they qualify for an exemption, they must learn how to document this as well. Agencies administering safety net programs must be able to efficiently process each case.

    This report illustrates and explores the complex pathways parents who are subject to work requirements must navigate to maintain their access to the safety net. Some pathways may lead families to maintain their access to benefits, while others could lead them to lose access to benefits for which they are still eligible. (Edited author abstract)

     

  • Individual Author: Hartig, Seth
    Reference Type: Conference Paper
    Year: 2019

    This presentation was given at the 57th National Association for Welfare Research and Statistics (NAWRS) Workshop in 2019. The presentation provides an overview of the perils of food assistance and other social services benefits cliffs, as well as the results of a study on the effects of minimum wage and inflation on benefit limits. Discrepencies between market rates and subsidies for food, child care, and other needs can cause families to face severe financial circumstances when they reach sharp benefit limits.

    This presentation was given at the 57th National Association for Welfare Research and Statistics (NAWRS) Workshop in 2019. The presentation provides an overview of the perils of food assistance and other social services benefits cliffs, as well as the results of a study on the effects of minimum wage and inflation on benefit limits. Discrepencies between market rates and subsidies for food, child care, and other needs can cause families to face severe financial circumstances when they reach sharp benefit limits.

  • Individual Author: Bhatt, Chintan B. ; Beck-Sagué, Consuelo M.
    Reference Type: Journal Article
    Year: 2018

    Objectives. To explore the effect of Medicaid expansion on US infant mortality rate.

    Methods. We examined data from 2010 to 2016 and 2014 to 2016 to compare infant mortality rates in states and Washington, DC, that accepted the Affordable Care Act Medicaid expansion (Medicaid expansion states) and states that did not (non–Medicaid expansion states), stratifying data by race/ethnicity.

    Results. Mean infant mortality rate in non–Medicaid expansion states rose (6.4 to 6.5) from 2014 to 2016 but declined in Medicaid expansion states (5.9 to 5.6). Mean difference in infant mortality rate in Medicaid expansion versus non–Medicaid expansion states increased from 0.573 (P = .08) in 2014 to 0.838 in 2016 (P = .006) because of smaller declines in non–Medicaid expansion (11.0%) than in Medicaid expansion (15.2%) states. The 14.5% infant mortality rate decline from 11.7 to 10.0 in African American infants in Medicaid expansion states was more than twice that in non–Medicaid expansion states (6.6%: 12.2 to 11.4; P = .012).

    Conclusions....

    Objectives. To explore the effect of Medicaid expansion on US infant mortality rate.

    Methods. We examined data from 2010 to 2016 and 2014 to 2016 to compare infant mortality rates in states and Washington, DC, that accepted the Affordable Care Act Medicaid expansion (Medicaid expansion states) and states that did not (non–Medicaid expansion states), stratifying data by race/ethnicity.

    Results. Mean infant mortality rate in non–Medicaid expansion states rose (6.4 to 6.5) from 2014 to 2016 but declined in Medicaid expansion states (5.9 to 5.6). Mean difference in infant mortality rate in Medicaid expansion versus non–Medicaid expansion states increased from 0.573 (P = .08) in 2014 to 0.838 in 2016 (P = .006) because of smaller declines in non–Medicaid expansion (11.0%) than in Medicaid expansion (15.2%) states. The 14.5% infant mortality rate decline from 11.7 to 10.0 in African American infants in Medicaid expansion states was more than twice that in non–Medicaid expansion states (6.6%: 12.2 to 11.4; P = .012).

    Conclusions. Infant mortality rate decline was greater in Medicaid expansion states, with greater declines among African American infants. Future research should explore what aspects of Medicaid expansion may improve infant survival. (Author abstract)

     

  • Individual Author: Hahn, Heather; Rohacek, Monica; Isaacs, Julia
    Reference Type: Report
    Year: 2018

    Child care subsidies are critical for the well-being of low-income families, including parents’ economic success and children’s development. To inform state efforts to simplify access to child care subsidies and improve service delivery, this report highlights steps taken and lessons learned by five states that participated in the Work Support Strategies initiative between 2012 and 2015. These states worked to improve child care subsidy access and retention, efficiency of service delivery, quality of client service, and alignment with other benefit programs. The report also discusses the implications of these findings for implementation of the reauthorized Child Care and Development Fund. (Author abstract)

    Child care subsidies are critical for the well-being of low-income families, including parents’ economic success and children’s development. To inform state efforts to simplify access to child care subsidies and improve service delivery, this report highlights steps taken and lessons learned by five states that participated in the Work Support Strategies initiative between 2012 and 2015. These states worked to improve child care subsidy access and retention, efficiency of service delivery, quality of client service, and alignment with other benefit programs. The report also discusses the implications of these findings for implementation of the reauthorized Child Care and Development Fund. (Author abstract)

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