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3. Effects of forced disruption in Medicaid managed care on children with asthma

Author

Piwnica-Worms, Katherine, Staiger, Becky, Ross, Joseph S., Rosenthal, Marjorie S., and Ndumele, Chima D.

Subjects
Asthma in children -- Care and treatment, Medicaid -- Usage, Managed care plans (Medical care) -- Usage, Business, Health care industry
Abstract

Objective: To evaluate the effect of a forced disruption to Medicaid managed care plans and provider networks on health utilization and outcomes for children with persistent asthma. Data Sources: Medicaid managed care administrative claims data from 2013 to 2016, obtained from a southeastern state. Study Design: A difference-in-difference analysis compared patients' outpatient, inpatient, and emergency department (ED) utilization and receipt of recommended services before and after implementation of a statewide redistribution of patients among nine managed care plans. Data Collection/Extraction Methods: Enrollment data for children with asthma were linked to the administrative claims. Children were included if they had a diagnosis of persistent asthma in 2013 and if they were enrolled continuously throughout 2014-2016. Principal Findings: Among the 28 537 children with asthma, 26% were forced to switch their managed care plan after the redistribution. Of these, 67% also switched their primary care provider (PCP). Relative to those who remained in their plan, disruption was associated with an additional 2.1 percentage-point decrease in the number of children who had an outpatient visit per quarter [95%CI -2.8, -1.3], from 71% to 66% (compared to plan stayers: 74% to 71%). Among children experiencing a change to their plan, there was overall a decrease in the proportion of children receiving an asthma-specific visit per quarter, but there was less of a decrease in children that also changed their PCP [1.6 percentage points, 95%CI 0.7, 2.5], from 9.7% to 8.3% (compared to those who did not switch their PCP: 12% to 8.6%). Indicators of asthma care quality and emergent care utilization were not significantly different between the two periods. Conclusions: While there was a decrease in the number of outpatient visits associated with forced disruption of Medicaid managed care plans for children with persistent asthma, there were no consistent associations with worse asthma quality performance or higher emergent health care utilization. KEYWORDS asthma, child, disruptions to care continuity, managed care programs, Medicaid, 1 | INTRODUCTION Managed care is the dominant model of financing and delivery for over 70 million Americans who receive health insurance coverage through Medicaid. (1) In 2016, approximately 70% [...]

Published
2021
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4. The effect of Medicaid expansion on the take‐up of disability benefits by race and ethnicity.

Author

Staiger, Becky, Helfer, Madeline, and Van Parys, Jessica

Abstract

Public disability programs provide financial support to 12 million working‐age individuals per year, though not all eligible individuals take up these programs. Mixed evidence exists regarding the impact of Medicaid eligibility expansion on program take‐up, and even less is known about the relationship between Medicaid expansion and racial and ethnic disparities in take‐up. Using 2009–2020 Current Population Survey data, we compare changes in Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) take‐up among respondents with disabilities living in Medicaid expansion states to respondents with disabilities living in non‐expansion states, before and after Medicaid expansion. We further explore heterogeneity by race/ethnicity. We find that Medicaid expansion reduced SSI take‐up by 10% overall, particularly among White and Hispanic respondents (10% and 21%, respectively). Medicaid expansion increased SSDI take‐up by 8% overall, particularly among White and Black respondents (9% and 11%, respectively). Moreover, we find that Medicaid expansion reduced the probability that respondents with disabilities had employer‐sponsored health insurance by approximately 8%, suggesting that expansion may have reduced job‐lock among the SSDI‐eligible, contributing to the observed increase in SSDI take‐up. [ABSTRACT FROM AUTHOR]

Published
2024
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