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Cholera R, Anderson D, Raman SR, Hammill BG, DiPrete B, Breskin A, Wiener C, Rathnayaka N, Landi S, Brookhart MA, Whitaker RG, Bettger JP, Wong CA. Medicaid Coverage Disruptions Among Children Enrolled in North Carolina Medicaid From 2016 to 2018. JAMA HEALTH FORUM 2021; 2:e214283. [PMID: 35977295 PMCID: PMC8796937 DOI: 10.1001/jamahealthforum.2021.4283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/23/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rushina Cholera
- Duke Margolis Center for Health Policy, Durham, North Carolina
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - David Anderson
- Duke Margolis Center for Health Policy, Durham, North Carolina
| | - Sudha R. Raman
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Bradley G. Hammill
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Bethany DiPrete
- NoviSci, Durham, North Carolina
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | | | | | | | | | - M. Alan Brookhart
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- NoviSci, Durham, North Carolina
| | | | - Janet Prvu Bettger
- Duke Margolis Center for Health Policy, Durham, North Carolina
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Charlene A. Wong
- Duke Margolis Center for Health Policy, Durham, North Carolina
- Department of Pediatrics, Duke University, Durham, North Carolina
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2
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Fife Donney J, Mitchell SJ, Lewin A. Medicaid Instability and Mental Health of Teen Parent Families. FAMILY & COMMUNITY HEALTH 2020; 43:10-16. [PMID: 31764302 DOI: 10.1097/fch.0000000000000240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study examines the effect of inconsistent Medicaid coverage on parenting stress, maternal depression, and child behavior in a sample of teen mothers and their children. The majority (54%) of mothers experienced inconsistent coverage. After 24 months, mothers experiencing inconsistent coverage had significantly higher parenting stress and depressive symptoms, and their children had more internalizing behaviors than families with consistent Medicaid. These differences existed despite no initial differences and controlling for numerous covariates. Policies and practices that stabilize Medicaid coverage for teen parent families may reduce unnecessary stress, depressive symptoms, and early childhood behavior problems.
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Affiliation(s)
- Julie Fife Donney
- Department of Family Science, School of Public Health, University of Maryland, College Park (Drs Donney and Lewin). Dr Mitchell is an Independent Research Consultant, Nashville, Tennessee
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Silber JH, Zeigler AE, Reiter JG, Hochman LL, Ludwig JM, Wang W, Calhoun SR, Pati S. Using Appendicitis to Improve Estimates of Childhood Medicaid Participation Rates. Acad Pediatr 2018; 18:593-600. [PMID: 29581042 DOI: 10.1016/j.acap.2018.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/23/2018] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Administrative data are often used to estimate state Medicaid/Children's Health Insurance Program duration of enrollment and insurance continuity, but they are generally not used to estimate participation (the fraction of eligible children enrolled) because administrative data do not include reasons for disenrollment and cannot observe eligible never-enrolled children, causing estimates of eligible unenrolled to be inaccurate. Analysts are therefore forced to either utilize survey information that is not generally linkable to administrative claims or rely on duration and continuity measures derived from administrative data and forgo estimating claims-based participation. We introduce appendectomy-based participation (ABP) to estimate statewide participation rates using claims by taking advantage of a natural experiment around statewide appendicitis admissions to improve the accuracy of participation rate estimates. METHODS We used Medicaid Analytic eXtract (MAX) for 2008-2010; and the American Community Survey for 2008-2010 from 43 states to calculate ABP, continuity ratio, duration, and participation based on the American Community Survey (ACS). RESULTS In the validation study, median participation rate using ABP was 86% versus 87% for ACS-based participation estimates using logical edits and 84% without logical edits. Correlations between ABP and ACS with or without logical edits was 0.86 (P < .0001). Using regression analysis, ABP alone was a significant predictor of ACS (P < .0001) with or without logical edits, and adding duration and/or the continuity ratio did not significantly improve the model. CONCLUSION Using the ABP rate derived from administrative claims (MAX) is a valid method to estimate statewide public insurance participation rates in children.
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Affiliation(s)
- Jeffrey H Silber
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa; Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, Pa; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa.
| | - Ashley E Zeigler
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Joseph G Reiter
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Lauren L Hochman
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Justin M Ludwig
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Wei Wang
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Shawna R Calhoun
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Susmita Pati
- Division of Primary Care Pediatrics, Stony Brook University School of Medicine & Stony Brook Children's Hospital, Stony Brook, NY
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Williams AA, Searcy LF. Policy Campaign: One State's Journey to Influence the Reauthorization of the Children's Health Insurance Program. J Pediatr Health Care 2016; 30:396-403. [PMID: 26810854 DOI: 10.1016/j.pedhc.2015.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 11/26/2015] [Accepted: 11/29/2015] [Indexed: 11/19/2022]
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5
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Jimenez N, Symons RG, Wang J, Ebel BH, Vavilala MS, Buchwald D, Temkin N, Jaffe KM, Rivara FP. Outpatient Rehabilitation for Medicaid-Insured Children Hospitalized With Traumatic Brain Injury. Pediatrics 2016; 137:e20153500. [PMID: 27244850 PMCID: PMC4891290 DOI: 10.1542/peds.2015-3500] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe the prevalence of postdischarge outpatient rehabilitation among Medicaid-insured children hospitalized with a traumatic brain injury (TBI) and to identify factors associated with receipt of services. METHODS Retrospective cohort of children <21 years, hospitalized for a TBI between 2007 and 2012, from a national Medicaid claims database. Outcome measures were receipt of outpatient rehabilitation (physical, occupational, or speech therapies or physician visits to a rehabilitation provider) 1 and 3 years after discharge. Multivariable regression analyses determined the association of demographic variables, injury severity, and receipt of inpatient services with receipt of outpatient rehabilitation at 1 and 3 years. The mean number of services was compared between racial/ethnic groups. RESULTS Among 9361 children, only 29% received any type of outpatient rehabilitation therapy during the first year after injury, although 62% sustained a moderate to severe TBI. The proportion of children receiving outpatient therapies declined to 12% in the second and third years. The most important predictor of receipt of outpatient rehabilitation was receipt of inpatient therapies or consultation with a rehabilitation physician during acute care. Compared with children of other racial/ethnic groups, Hispanic children had lower rates of receipt of outpatient speech therapy. CONCLUSIONS Hospitalized children who received inpatient assessment of rehabilitation needs were more likely to continue outpatient rehabilitation care. Hispanic children with TBI were less likely than non-Hispanics to receive speech therapy. Interventions to increase inpatient rehabilitation during acute care might increase outpatient rehabilitation and improve outcomes for all children.
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Affiliation(s)
- Nathalia Jimenez
- Departments of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center,
| | | | - Jin Wang
- Harborview Injury Prevention and Research Center
| | - Beth H Ebel
- Harborview Injury Prevention and Research Center, Pediatrics, Epidemiology
| | - Monica S Vavilala
- Departments of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Pediatrics
| | | | | | - Kenneth M Jaffe
- Harborview Injury Prevention and Research Center, Pediatrics, Neurologic Surgery, Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, Pediatrics, Epidemiology
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The Association Between Medicaid Coverage for Children and Parents Persists: 2002-2010. Matern Child Health J 2016; 19:1766-74. [PMID: 25874876 DOI: 10.1007/s10995-015-1690-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To assess the association between a child's and their parent's public health insurance status during a time when children had access to coverage independent of policies that impacted adults' access. Secondary data from the Oregon Health Plan (OHP) [Oregon's Medicaid and Children's Health Insurance Programs] for families with at least one parent and one child with OHP coverage at any time during the study period (2002-2010). We linked children to their parents in the OHP data set and examined longitudinal associations between the coverage patterns for children and their parents, controlling for several demographic and economic confounders. We tested for differences in the strength of associations in monthly coverage status in five time periods throughout the nine-year study period. The odds of a child being insured by the OHP in months in which at least one parent had OHP coverage were significantly higher than among children whose parents were not enrolled at that time. Children with at least one parent who maintained or gained OHP coverage in a given month had a much higher probability of being enrolled in the OHP in that month, compared to children who had no covered parents in the given month or the month prior. Despite implementation of policies that differentially affected eligibility requirements for children and adults, strong associations persisted between coverage continuity for parents and children enrolled in Oregon public health insurance programs.
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DeVoe JE, Tillotson CJ, Angier H, Wallace LS. Predictors of children's health insurance coverage discontinuity in 1998 versus 2009: parental coverage continuity plays a major role. Matern Child Health J 2015; 19:889-96. [PMID: 25070735 DOI: 10.1007/s10995-014-1590-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To identify predictors of coverage continuity for United States children and assess how they have changed in the first 12 years since implementation of the Children's Health Insurance Program in 1997. Using data from the nationally-representative Medical Expenditure Panel Survey, we used logistic regression to identify predictors of discontinuity in 1998 and 2009 and compared differences between the 2 years. Having parents without continuous coverage was the greatest predictor of a child's coverage gap in both 1998 and 2009. Compared to children with at least one parent continuously covered, children whose parents did not have continuous coverage had a significantly higher relative risk (RR) of a coverage gap [RR 17.96, 95 % confidence interval (CI) 14.48-22.29 in 1998; RR 12.88, 95 % CI 10.41-15.93 in 2009]. In adjusted models, parental continuous coverage was the only significant predictor of discontinuous coverage for children (with one exception in 2009). The magnitude of the pattern was higher for privately-insured children [adjusted relative risk (aRR) 29.17, 95 % CI 20.99-40.53 in 1998; aRR 25.54, 95 % CI 19.41-33.61 in 2009] than publicly-insured children (aRR 5.72, 95 % CI 4.06-8.06 in 1998; aRR 4.53, 95 % CI 3.40-6.04 in 2009). Parental coverage continuity has a major influence on children's coverage continuity; this association remained even after public health insurance expansions for children. The Affordable Care Act will increase coverage for many adults; however, 'churning' on and off programs due to income fluctuations could result in coverage discontinuities for parents. If parental coverage instability persists, these discontinuities may continue to have a negative impact on children's coverage stability as well.
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Affiliation(s)
- Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode FM, Portland, OR, 97239, USA,
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Hartman L, Espinoza GA, Fried B, Sonier J. Millions of Americans may be eligible for Marketplace coverage outside open enrollment as a result of qualifying life events. Health Aff (Millwood) 2015; 34:857-63. [PMID: 25926592 DOI: 10.1377/hlthaff.2014.0932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Federal regulations establish special enrollment periods--times outside of open enrollment periods--during which people may enroll in or change their health insurance plans offered through the federal and state-based exchanges, or Marketplaces. To be eligible, a person must experience a shift in income or another "qualifying life event," such as a change in marital status or the number of dependents, or the loss of minimum essential health coverage. We produced an upper-bound estimate that 3.7 million nonelderly adults with coverage through a federal or state Marketplace could have experienced a qualifying life event and become eligible for a special enrollment period because of income shifts. In addition, more than 8.4 million nonelderly adults who did not have Marketplace coverage--three-quarters of whom had no insurance--became eligible for a special enrollment period as a result of other qualifying life events. Many if not most of these people may be unaware of their eligibility. In states that did not expand Medicaid eligibility, we estimated that 1.9 million people experienced income shifts outside of the open enrollment period that would make them eligible for Marketplace subsidies. However, because they were uninsured or had nongroup coverage (instead of Medicaid) during the most recent open enrollment period, they had to wait until the next period to enroll in a Marketplace plan.
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Affiliation(s)
- Lacey Hartman
- Lacey Hartman is a senior research fellow at the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota, in Minneapolis
| | | | - Brett Fried
- Brett Fried is a senior research fellow at SHADAC
| | - Julie Sonier
- Julie Sonier is director of the Employee Insurance Division at Minnesota Management and Budget, in St. Paul. At the time this article was written, she was deputy director of SHADAC
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Pati S, Wong AT, Calixte RE, Ludwig J, Zeigler A, Localio AR, Moon J, Silber JH. Medicaid and CHIP retention among children in 12 states. Acad Pediatr 2015; 15:249-57. [PMID: 25454028 DOI: 10.1016/j.acap.2014.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 09/26/2014] [Accepted: 09/28/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Though stable insurance is important to support optimal child health, the reproducibility of metrics to assess child health insurance retention at the state and county level has not been examined. We sought to determine reproducibility of public insurance retention rates for children using 3 different metrics at the state and county level. METHODS Public health insurance retention for children was assessed using 3 different metrics calculated from 2006-2009 Medicaid Analytic Extract data from 12 selected states. The metrics were: 1) Duration: a prospective metric that quantifies the number of newly enrolled children continuously enrolled in public insurance 6, 12, and 18 months after initial enrollment during a selected period; (2) Infant Duration: assesses Duration only among infants born during a selected period; (3) Coverage: a prospective metric that quantifies the average percentage of time a selected population is enrolled over an 18-month interval. Reproducibility of the metrics was assessed using a range of sample sizes with resampling and determining changes in relative rankings of states/counties by retention rate. RESULTS All 3 metrics demonstrated reproducible estimates at the state level with sample sizes of 2000, 5000, and 10,000. Reproducibility of relative rankings for child health insurance retention of counties within states were sensitive to county child population size and the amount of variability in retention rates within the county and at the state level. CONCLUSIONS As health care reform unfolds, the complete set of these 3 reproducible metrics can be used to evaluate multipronged and multilevel strategies to retain eligible children in public health insurance.
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Affiliation(s)
- Susmita Pati
- Division of Primary Care Pediatrics, Stony Brook University School of Medicine, Stony Brook, NY; Pediatric Quality Measures Program Center of Excellence, Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Angie T Wong
- Division of Primary Care Pediatrics, Stony Brook University School of Medicine, Stony Brook, NY; Pediatric Quality Measures Program Center of Excellence, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Rose E Calixte
- Division of Primary Care Pediatrics, Stony Brook University School of Medicine, Stony Brook, NY; Pediatric Quality Measures Program Center of Excellence, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Justin Ludwig
- Pediatric Quality Measures Program Center of Excellence, Children's Hospital of Philadelphia, Philadelphia, Pa; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Ashley Zeigler
- Pediatric Quality Measures Program Center of Excellence, Children's Hospital of Philadelphia, Philadelphia, Pa; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - A Russell Localio
- Pediatric Quality Measures Program Center of Excellence, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - JeanHee Moon
- Pediatric Quality Measures Program Center of Excellence, Children's Hospital of Philadelphia, Philadelphia, Pa; Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Jeffrey H Silber
- Pediatric Quality Measures Program Center of Excellence, Children's Hospital of Philadelphia, Philadelphia, Pa; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pa; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
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10
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Understanding sexual activity and Chlamydia testing rate based on linked national survey and Medicaid claims data. PLoS One 2015; 10:e0122927. [PMID: 25875858 PMCID: PMC4395296 DOI: 10.1371/journal.pone.0122927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/24/2015] [Indexed: 12/05/2022] Open
Abstract
Background Monitoring adherence to national recommendations for annual chlamydia screening of female adolescents and young adult women is important for targeting quality improvement interventions to improve low screening rates. However, accurate measurement of rates may vary depending on the data source used to determine eligible sexually-active women. Methods The 2001–2004 NHANES data linked with Medicaid administrative data by respondent’s unique identifier, the 2011–2012 NHANES data, and the 2004 and 2010 Medicaid data were used in this cross-sectional analysis. We defined self-reported sexual activity by self-reported sexual behaviors, claim-identified sexual activity by reproductive-related claims among women who had ≥ one healthcare claim, HEDIS-defined sexual activity by reproductive-related claims among women who were enrolled in Medicaid for ≥330 days and had ≥ one healthcare claim, and chlamydia tests by claims submitted in the 12 months prior to the survey interview. Results Of Medicaid women aged 18–25 years, 91.5% self-reported to be sexually-active. Of self-reported sexually-active women aged 18–25 years, 92.0% had ≥ one healthcare claim in the 12 months prior to the survey interview; of this subpopulation, only 58.8% were enrolled in Medicaid for ≥ 330 days in the 12 months prior to the survey interview; of this further subpopulation, 74.1% had healthcare claims identifying them as sexually-active in the 12 months prior to the survey interview. Of HEDIS-defined sexually-active women, 42.4% had chlamydia testing. Conclusion Our study suggests that the number of sexually-active women aged 18–25 years used as the denominator in the chlamydia testing measure could be significantly different, depending upon the definition applied and the data used. Our data highlight the limited representativeness of Medicaid population in the current HEDIS measure on chlamydia testing when a high proportion of women who were enrolled in Medicaid for <330 days had been excluded from the measure. The interventions that can improve the proportion of women who were enrolled in Medicaid for ≥ 330 days among all young Medicaid women are needed not only for improving health care services, but also for measuring quality of healthcare.
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DeVoe JE, Marino M, Angier H, O’Malley JP, Crawford C, Nelson C, Tillotson CJ, Bailey SR, Gallia C, Gold R. Effect of expanding medicaid for parents on children's health insurance coverage: lessons from the Oregon experiment. JAMA Pediatr 2015; 169:e143145. [PMID: 25561041 PMCID: PMC4918752 DOI: 10.1001/jamapediatrics.2014.3145] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE In the United States, health insurance is not universal. Observational studies show an association between uninsured parents and children. This association persisted even after expansions in child-only public health insurance. Oregon's randomized Medicaid expansion for adults, known as the Oregon Experiment, created a rare opportunity to assess causality between parent and child coverage. OBJECTIVE To estimate the effect on a child's health insurance coverage status when (1) a parent randomly gains access to health insurance and (2) a parent obtains coverage. DESIGN, SETTING, AND PARTICIPANTS Oregon Experiment randomized natural experiment assessing the results of Oregon's 2008 Medicaid expansion. We used generalized estimating equation models to examine the longitudinal effect of a parent randomly selected to apply for Medicaid on their child's Medicaid or Children's Health Insurance Program (CHIP) coverage (intent-to-treat analyses). We used per-protocol analyses to understand the impact on children's coverage when a parent was randomly selected to apply for and obtained Medicaid. Participants included 14409 children aged 2 to 18 years whose parents participated in the Oregon Experiment. EXPOSURES For intent-to-treat analyses, the date a parent was selected to apply for Medicaid was considered the date the child was exposed to the intervention. In per-protocol analyses, exposure was defined as whether a selected parent obtained Medicaid. MAIN OUTCOMES AND MEASURES Children's Medicaid or CHIP coverage, assessed monthly and in 6-month intervals relative to their parent's selection date. RESULTS In the immediate period after selection, children whose parents were selected to apply significantly increased from 3830 (61.4%) to 4152 (66.6%) compared with a nonsignificant change from 5049 (61.8%) to 5044 (61.7%) for children whose parents were not selected to apply. Children whose parents were randomly selected to apply for Medicaid had 18% higher odds of being covered in the first 6 months after parent's selection compared with children whose parents were not selected (adjusted odds ratio [AOR]=1.18; 95% CI, 1.10-1.27). The effect remained significant during months 7 to 12 (AOR=1.11; 95% CI, 1.03-1.19); months 13 to 18 showed a positive but not significant effect (AOR=1.07; 95% CI, 0.99-1.14). Children whose parents were selected and obtained coverage had more than double the odds of having coverage compared with children whose parents were not selected and did not gain coverage (AOR=2.37; 95% CI, 2.14-2.64). CONCLUSIONS AND RELEVANCE Children's odds of having Medicaid or CHIP coverage increased when their parents were randomly selected to apply for Medicaid. Children whose parents were selected and subsequently obtained coverage benefited most. This study demonstrates a causal link between parents' access to Medicaid coverage and their children's coverage.
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Affiliation(s)
- Jennifer E. DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland2OCHIN, Inc, Portland, Oregon
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Jean P. O’Malley
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
| | - Courtney Crawford
- Department of Family Medicine, Oregon Health & Science University, Portland
| | | | - Carrie J. Tillotson
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
| | - Steffani R. Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Charles Gallia
- Office of Health Analytics, Oregon Health Authority, Portland
| | - Rachel Gold
- OCHIN, Inc, Portland, Oregon5Kaiser Permanente Center for Health Research, Portland, Oregon
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Lee JY, Divaris K, DeWalt DA, Baker AD, Gizlice Z, Rozier RG, Vann WF. Caregivers' health literacy and gaps in children's Medicaid enrollment: findings from the Carolina Oral Health Literacy Study. PLoS One 2014; 9:e110178. [PMID: 25303271 PMCID: PMC4193870 DOI: 10.1371/journal.pone.0110178] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/18/2014] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives Recent evidence supports a link between caregivers’ health literacy and their children’s health and use of health services. Disruptions in children’s health insurance coverage have been linked to poor health care and outcomes. We examined young children’s Medicaid enrollment patterns in a well-characterized cohort of child/caregivers dyads and investigated the association of caregivers’ low health literacy with the incidence of enrollment gaps. Methods We relied upon Medicaid enrollment data for 1208 children (mean age = 19 months) enrolled in the Carolina Oral Health Literacy project during 2008–09. The median follow-up was 25 months. Health literacy was measured using the Newest Vital Sign (NVS). Analyses relied on descriptive, bivariate, and multivariate methods based on Poisson modeling. Findings One-third of children experienced one or more enrollment gaps; most were short in duration (median = 5 months). The risk of gaps was inversely associated with caregivers’ age, with a 2% relative risk decrease for each added year. Low health literacy was associated with a modestly elevated risk increase [Incidence Rate Ratio (IRR) = 1.17 (95% confidence interval (CI) 0.88–1.57)] for enrollment disruptions; however, this estimate was substantially elevated among caregivers with less than a high school education [IRR = 1.52 (95% CI 0.99–2.35); homogeneity p<0.2]. Conclusions Our findings provide initial support for a possible role of caregivers’ health literacy as a determinant of children’s Medicaid enrollment gaps. Although the association between health literacy and enrollment gaps was not confirmed statistically, we found that it was markedly stronger among caregivers with low educational attainment. This population, as well as young caregivers, may be the most vulnerable to the negative effects of low health literacy.
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Affiliation(s)
- Jessica Y. Lee
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- * E-mail:
| | - Kimon Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Darren A. DeWalt
- School of Medicine and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - A. Diane Baker
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - R. Gary Rozier
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - William F. Vann
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Guevara JP, Moon J, Hines EM, Fremont E, Wong A, Forrest CB, Silber JH, Pati S. Continuity of Public Insurance Coverage. Med Care Res Rev 2013; 71:115-37. [DOI: 10.1177/1077558713504245] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Publicly financed insurance programs are tasked with maintaining coverage for eligible children, but published measures to assess coverage have not been evaluated. Therefore, we sought to identify and categorize measures of health insurance continuity for children and adolescents. We conducted a systematic review of Medline and HealthStar databases, review of reference lists of eligible articles, and contact with experts. We categorized measures into 8 domains based on a conceptual framework. We identified 147 measures from 84 eligible articles. Most measures evaluated the following domains: always insured (41%), repeatedly uninsured (36%), and transition out of coverage (29%), while fewer assessed single gap in coverage, always uninsured, transition into coverage, change in coverage, and eligibility. Only 18% of measures assessed associations between continuity of coverage and child and adolescent health outcomes. These results suggest that a number of measures of continuity of coverage exist, but few measures have assessed impact on outcomes.
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Affiliation(s)
| | - Jeanhee Moon
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Ettya Fremont
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Angie Wong
- Stony Brook Long Island Children’s Hospital, Stony Brook, NY, USA
| | | | | | - Susmita Pati
- Stony Brook Long Island Children’s Hospital, Stony Brook, NY, USA
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Lopez MA, Cruz AT, Kowalkowski MA, Raphael JL. Factors associated with high resource utilization in pediatric skin and soft tissue infection hospitalizations. Hosp Pediatr 2013; 3. [PMID: 24377057 DOI: 10.1542/hpeds.2013-0013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe factors associated with prolonged lengths of stay (LOS) and increased charges for pediatric skin and soft tissue infection (SSTI) hospitalizations. METHODS This study was a cross-sectional analysis of pediatric SSTI hospital discharges in 2009 within the Healthcare Cost and Utilization Project Kids' Inpatient Database. Outcomes were prolonged LOS (>75th percentile) and increased hospital charges (>75th percentile). Multivariate logistic regression controlling for patient and hospital level factors was conducted for 2009 data to assess associations among variables. RESULTS The 75th percentile for LOS was 3 days. Infants had higher odds of prolonged LOS than other age groups (<1 year: 1; 1-4 years: 0.70 [95% confidence interval (CI): 0.64-0.76]; 5-12 years: 0.69 [95% CI: 0.63-0.76]; 13-18 years: 1.01 [95% CI: 0.91-1.10]), as did all minority groups compared with white subjects (black subjects: 1.23 [95% CI: 1.09-1.38]; Hispanic subjects: 1.33 [95% CI: 1.20-1.47]; and other races: 1.30 [95% CI: 1.12-1.50]). Public payers compared with private payers (odds ratio: 1.17 [95% CI: 1.10-1.26]) also had increased odds of prolonged LOS. The 75th percentile for charges was $14 317. The adolescent-aged category had higher odds of charges >75th percentile compared with the age category <1 year (odds ratio: 1.54 [95% CI: 1.36-1.74]). All racial/ethnic minorities had higher odds of charges >75th percentile compared with white subjects (black subjects: 1.38 [95% CI: 1.17-1.62]; Hispanic subjects: 1.90 [95% CI: 1.59-2.26]; and other races: 1.26 [95% CI: 1.06-1.50]). CONCLUSIONS Vulnerable populations, including infants, racial/ethnic minorities, and publicly insured children, had higher odds of increased resource utilization during hospitalizations for SSTIs. The findings of this study provide potential targets for future preventive and public health interventions.
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Affiliation(s)
- Michelle A Lopez
- Sections of Hospital Medicine, Baylor College of Medicine, Houston, Texas
| | - Andrea T Cruz
- Emergency Medicine, Baylor College of Medicine, Houston, Texas ; Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | | | - Jean L Raphael
- Academic General Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Abstract
BACKGROUND Adolescents comprise one-third of pediatric tuberculosis (TB) cases in the United States, but there are few specific data on the epidemiology and clinical course in this population. METHODS This was a retrospective review of adolescents (12-18 years old) seen at a Children's Tuberculosis Clinic in Houston, TX, from 1987 to 2012. RESULTS One hundred forty-five adolescents were identified; median age was 15.4 years: 50% female, 55% were Hispanic, 26% black, 13% Asian and 1% white; 54 were born abroad. Diagnoses were made after symptomatic presentation in 79%, during contact investigations in 14% and after screening tuberculin skin testing in the remainder. The most common symptoms were fever (63%), cough (60%) and weight loss (30%), but 21% were asymptomatic at diagnosis. Only 8% of adolescents with intrathoracic TB had hemoptysis. One hundred fourteen (78.6%) had isolated intrathoracic TB, 4 (2.8%) had intra- and extrathoracic TB and 27 (18.6%) had extrathoracic TB. The most common sites of extrathoracic TB were peripheral lymphadenopathy (10) and meningitis (6). The most common radiographic findings were infiltrates (34%), lymphadenopathy (27%), cavitary lesions (26%), pleural effusions (19%) and miliary disease (10%). Acid-fast bacillus smears and mycobacterial cultures were attempted for 97 of 118 adolescents with intrathoracic and 22 of 27 with extrathoracic disease, respectively, resulting in smear/culture positivity in 25% and 54% and 18% and 45%, respectively. Two patients died, 2 had relapse, 7 had significant sequelae and 92% recovered without complication. Seventy three percent of cases potentially were preventable. CONCLUSIONS The clinical, radiologic and microbiologic findings in adolescents with TB have features seen in both younger children and adults; most cases were preventable.
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Cousineau MR, Tsai KY, Kahn HA. Two Responses To A Premium Hike In A Program For Uninsured Kids: 4 In 5 Families Stay In As Enrollment Shrinks By A Fifth. Health Aff (Millwood) 2012; 31:360-6. [DOI: 10.1377/hlthaff.2011.0734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Michael R. Cousineau
- Michael R. Cousineau ( ) is an associate professor of research in the Departments of Family Medicine and Preventive Medicine at the Keck School of Medicine, University of Southern California, in Los Angeles
| | - Kai-Ya Tsai
- Kai-Ya Tsai is a statistician and data manager in the Departments of Family Medicine and Preventive Medicine at the Keck School of Medicine
| | - Howard A. Kahn
- Howard A. Kahn is CEO of the L.A. Care Health Plan, in Los Angeles, California
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