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The Centers for Medicare and Medicaid Services (CMS) implemented the Medicare durable medical equipment (DME) Competitive Bidding Program (CBP) in 2011. Since then, concerns have been raised regarding access to equipment and adverse health outcomes.The aim was to evaluate whether the CBP was associated with changes in spending, utilization, and adverse health events (emergency department visits, hospitalizations, and falls).A comparative interrupted time series over 8 years was used to compare Round1 and Round2 bidding to nonbidding areas. Medicare fee for services claims were aggregated at the quarterly Metropolitan Statistical Area (MSA) level from 2009 to 2016.For the 3 evaluated DME (continuous positive airway pressure machines, oxygen supplies, and walkers), we found that implementation of the Medicare CBP was associated with reductions in per capita spending without changes in DME utilization or adverse health outcomes in CBP areas compared with nonbidding areas. For example, the slope change in the proportion of oxygen supplies purchasers in Round1 areas after implementation of Round1 was similar to the slope change in nonbidding areas (-0.0002; 95% CI: -0.0004, 0.0001; P=0.189). The difference in slope changes of emergency department visits and hospitalization in Round1 areas for oxygen supplies were (-0.0004; 95% CI: -0.0016, 0.0008; P=0.514) and (0.0002; 95% CI: -0.0010, 0.0014; P=0.757), respectively. Findings in Round2 areas after implementation of Round2 were similar to findings in Round1 areas.The Medicare DME CBP lowered Medicare expenditures while not reducing beneficiary access or increasing adverse outcomes.

Millions of Americans have been infected with SARS-CoV-2, and more than 575,000 had died as of early May 2021. Understanding who are the most vulnerable populations for COVID-19 mortality and excess deaths is critical, especially as the US prioritizes vaccine distribution. Using Medicare administrative data, we found that beneficiaries residing in nursing homes, the oldest beneficiaries, members of racial/ethnic minority groups, beneficiaries with multiple comorbid conditions, and beneficiaries who are dually eligible for Medicare and Medicaid were disproportionately likely to die after infection with SARS-CoV-2. As the pandemic developed, Medicare data were quickly adapted to provide analyses and inform the nation's response to COVID-19. Similar data for the rest of the population, however, are not readily available. Developing policies and methods around data collection and access will be important to address the consequences of future pandemics and other health emergencies.

Millions of Americans have been infected with SARS-CoV-2, and more than 575,000 had died as of early May 2021. Understanding who are the most vulnerable populations for COVID-19 mortality and excess deaths is critical, especially as the US prioritizes vaccine distribution. Using Medicare administrative data, we found that beneficiaries residing in nursing homes, the oldest beneficiaries, members of racial/ethnic minority groups, beneficiaries with multiple comorbid conditions, and beneficiaries who are dually eligible for Medicare and Medicaid were disproportionately likely to die after infection with SARS-CoV-2. As the pandemic developed, Medicare data were quickly adapted to provide analyses and inform the nation's response to COVID-19. Similar data for the rest of the population, however, are not readily available. Developing policies and methods around data collection and access will be important to address the consequences of future pandemics and other health emergencies.

OBJECTIVE: To examine the associations between Medicaid expansion and nurse staffing ratios and hospital‐wide readmission rates. DATA SOURCES: Secondary data from the 2011‐2016 Healthcare Cost Report Information System, the American Hospital Association Annual Survey, and the Hospital Compare data. STUDY DESIGN: Difference‐in‐difference models are used to compare outcomes in hospitals located in states that expanded Medicaid with those located in nonexpansion states. The changes in nurse staffing ratios and hospital‐wide readmission rates are calculated in each one of the postexpansion years (2014, 2015, and 2016), compared to pre‐expansion. PRINCIPAL FINDINGS: Results indicate that nurse staffing ratios increased, whereas hospital‐wide readmission rates declined in expansion states relative to nonexpansion states. Nurse staffing ratios increased by 0.33, 0.42, and 0.46 registered nurses hours per adjusted patient days in 2014, 2015, and 2016 in hospitals located in expansion states, compared with hospitals in nonexpansion states after expansion. This increase was statistically significant (P

Prior to expansion of Medicaid under the Affordable Care Act, some states obtained Section 1115 waivers from the federal government that allowed them to expand eligibility for Medicaid to adult populations that were not covered previously. Expansion waivers in these states differed in their generosity and year of implementation, creating variation in coverage availability and program longevity across states. This study examined the association between generosity and duration of Medicaid expansion waivers and access to preventive services.The 2012 Medical Expenditure Panel Survey data were used to estimate adjusted logistic models in 2016, comparing outcomes among low-income non-elderly adults living in generous (Medicaid eligibility threshold ≥138% federal poverty level) and moderate (Medicaid eligibility threshold138% federal poverty level) waiver states, relative to no-waiver states.Moderate and generous waivers were associated with statistically significant (p0.001) increases in probabilities of having a usual source of care and a blood pressure check, relative to states without a waiver to expand. Low-income individuals living in states with longer waiver durations had better access to healthcare services than a similar group living in comparison states.Not only is Medicaid waiver generosity associated with improving access to healthcare services, but the combination of generosity and longer duration of a waiver also intensifies the association. As states gain flexibility in designing their Medicaid programs, the healthcare benefits associated with both generosity and duration of waivers are important considerations for policy makers.

Objective Medicaid coverage for low-income women may play an important role in ensuring access to preventive care. This study examines how Medicaid eligibility expansions to nonelderly adults impact cervical cancer screening among low-income women. Data Sources We use data from the Behavioral Risk Factor Surveillance System from 2000 to 2010. The primary outcome of interest is whether women in the relevant guideline consistent age range reported having a Pap test in the previous year. Study Design We use a difference-in-differences approach with matched treatment and comparison states and a simulated eligibility approach based on a continuous measure of Medicaid generosity. Principal Findings Our results indicate that cervical cancer screening increased among low-income women in expansion states relative to comparison states. Increases in screening rates are largest among low-income Hispanic women. Conclusions Medicaid expansions during the period from 2000 to 2010 were associated with improved cervical cancer screening rates, which is critical for early cervical cancer detection and prevention of cancer morbidity and mortality in women. The results suggest that more widespread Medicaid expansions may have positive effects on preventive health care for women.

BACKGROUND States routinely may consider rollbacks of Medicaid expansions to address statewide economic conditions. To the authors' knowledge, little is known regarding the effects of public insurance contractions on health outcomes. The current study examined the effects of the 2005 Medicaid disenrollment in Tennessee on breast cancer stage at the time of diagnosis and delays in treatment among nonelderly women. METHODS The authors used Tennessee Cancer Registry data from 2002 through 2008 and estimated a difference-in-difference model comparing women diagnosed with breast cancer who lived in low-income zip codes (and therefore were more likely to be subject to disenrollment) with a similar group of women who lived in high-income zip codes before and after the 2005 Medicaid disenrollment. The study outcomes were changes in stage of disease at the time of diagnosis and delays in treatment of >60 days and >90 days. RESULTS Overall, nonelderly women in Tennessee were diagnosed at later stages of disease and experienced more delays in treatment in the period after disenrollment. Disenrollment was found to be associated with a 3.3-percentage point increase in late stage of disease at the time of diagnosis (P = .024), a 1.9-percentage point decrease in having a delay of >60 days in surgery (P = .024), and a 1.4-percentage point decrease in having a delay of >90 days in treatment (P = .054) for women living in low-income zip codes compared with women residing in high-income zip codes. CONCLUSIONS The results of the current study indicate that Medicaid disenrollment is associated with a later stage of disease at the time of breast cancer diagnosis, thereby providing evidence of the potential negative health impacts of Medicaid contractions. Cancer 2017;123:3312-9. © 2017 American Cancer Society.

Medicaid expansion under the Affordable Care Act facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Medicaid expansions may provide increased access to care for cancer survivors, a growing population with chronic conditions. We compare access to health care services among cancer survivors living in non-expansion states to those living in expansion states, prior to Medicaid expansion under the Affordable Care Act. We use the 2012 and 2013 Behavioral Risk Factor Surveillance System to estimate multiple logistic regression models to compare inability to see a doctor because of cost, having a personal doctor, and receiving an annual checkup in the past year between cancer survivors who lived in non-expansion states and survivors who lived in expansion states. Cancer survivors in non-expansion states had statistically significantly lower odds of having a personal doctor (adjusted odds ratio [AOR] 0.76, 95 % confidence interval [CI] 0.63–0.92, p

Background There are substantial disparities in breast and cervical cancer screening that stem from lack of health insurance. Although the Affordable Care Act (ACA) expands insurance coverage to many Americans, there are differences in availability of Medicaid coverage across states. Purpose To understand the potential impact of Medicaid expansions on disparities in preventive care for low-income women by assessing pre-ACA breast and cervical cancer screening across states currently expanding and not expanding Medicaid to low-income adults. Methods Data from the 2012 Behavioral Risk Factor Surveillance System (analyzed in 2014) were used to consider differences in demographics among women for whom screening is recommended, including income and race/ethnicity, across expansion and nonexpansion states. Self-reported screening was compared by state expansion status overall, for the uninsured, and for low-income women. Logistic regressions were estimated to assess differences in self-reported screening across expansion and nonexpansion states controlling for demographics. Results Women in states that are not expanding Medicaid had significantly lower odds of receiving recommended mammograms (OR=0.87, 95% CI=0.79, 0.95) or Pap tests (OR=0.87, 95% CI=0.79, 0.95). The difference was larger among the uninsured (OR=0.72, 95% CI=0.56, 0.91 for mammography; OR=0.78, 95% CI=0.65, 0.94 for Pap tests). Conclusions As women in nonexpansion states remain uninsured and others gain coverage, existing disparities in cancer screening by race and socioeconomic status are likely to widen. Health risks and associated costs to underserved populations must be taken into account in ongoing debates over expansion.

States routinely may consider rollbacks of Medicaid expansions to address statewide economic conditions. To the authors' knowledge, little is known regarding the effects of public insurance contractions on health outcomes. The current study examined the effects of the 2005 Medicaid disenrollment in Tennessee on breast cancer stage at the time of diagnosis and delays in treatment among nonelderly women.The authors used Tennessee Cancer Registry data from 2002 through 2008 and estimated a difference-in-difference model comparing women diagnosed with breast cancer who lived in low-income zip codes (and therefore were more likely to be subject to disenrollment) with a similar group of women who lived in high-income zip codes before and after the 2005 Medicaid disenrollment. The study outcomes were changes in stage of disease at the time of diagnosis and delays in treatment of60 days and90 days.Overall, nonelderly women in Tennessee were diagnosed at later stages of disease and experienced more delays in treatment in the period after disenrollment. Disenrollment was found to be associated with a 3.3-percentage point increase in late stage of disease at the time of diagnosis (P = .024), a 1.9-percentage point decrease in having a delay of60 days in surgery (P = .024), and a 1.4-percentage point decrease in having a delay of90 days in treatment (P = .054) for women living in low-income zip codes compared with women residing in high-income zip codes.The results of the current study indicate that Medicaid disenrollment is associated with a later stage of disease at the time of breast cancer diagnosis, thereby providing evidence of the potential negative health impacts of Medicaid contractions. Cancer 2017;123:3312-9. © 2017 American Cancer Society.

Objective To assess the effects of Tennessee's 2005 Medicaid disenrollment on access to health care among low-income nonelderly adults. Data Source/Study Setting We use data from the 2003–2008 Behavioral Risk Factor Surveillance System. Study Design We examined the effects of Medicaid disenrollment on access to care among adults living in Tennessee compared with neighboring states, using difference-in-difference models. Principal Findings Evidence suggests that Medicaid disenrollment resulted in significant decreases in health insurance and increases in cost-related barriers to care for low-income adults living in Tennessee. Statistically significant changes were not observed for having a personal doctor. Conclusions Medicaid disenrollment is associated with reduced access to care. This finding is relevant for states considering expansions or contractions of Medicaid under the Affordable Care Act.

Purpose: To assess the effects of Medicaid disenrollment on stage at diagnosis and delay in surgery for female breast cancer among nonelderly women. Background: Although Medicaid expansions have received considerable attention in the literature, Medicaid contractions have received much less attention. Tennessee's Medicaid program experienced a dramatic Medicaid contraction when the program disenrolled approximately 170,000 nonelderly adults after implementing a new benefit policy in 2005. Despite the fact that this was the largest disenrollment in the history of Medicaid, little is known about the effects of this policy change on access to care and health outcomes. This is the first study, to our knowledge, to consider the effect of disenrollment on stage at diagnosis and delay in surgery for breast cancer. Methods: We use 2002-2008 data from Tennessee Cancer Registry which collects data on newly diagnosed cases of malignant disease that occur to Tennessee residents from all hospitals, laboratories, facilities and healthcare practitioners. The sample used for this study consists of women aged 21 to 64 who were diagnosed with breast cancer and living in Tennessee during the period of study. We merge data on zip code median income with the Tennessee Cancer Registry data and estimate a difference-in-differences model. We calculate the changes in stage at diagnosis, more than 60-days delay in surgery, and more than 90-days delay in surgery for female breast cancer among women who were diagnosed with breast cancer and had surgery as the first-line treatment. The difference-in-differences model compares women who were living in low-income zip codes (and thus more likely to be subject to disenrollment) with women who lived in high-income zip codes before and after Tennessee's 2005 Medicaid disenrollment. We control for age, race/ethnicity, marital status, insurance coverage, and year fixed effects. Results: Preliminary results suggest that nonelderly women who lived in low-income zip codes were 2.8 percentage points (p < 0.1) more likely to be diagnosed with late stage (regional or distant) breast cancer, compared to women living in high-income zip codes, after Tennessee's Medicaid disenrollment. In addition, nonelderly women who lived in low-income zip codes were 1.9 percentage points (p < 0.05) less likely to have more than 60-days delay in surgery than women living in high-income zip codes, after the disenrollment. Women who lived in low-income zip codes were also more likely to have more than 90-days delay in surgery, but this difference was not significant. Conclusions: While many states are expanding Medicaid eligibility under the Affordable Care Act, there has been discussion among policymakers in some states to reduce eligibility once full federal funding expires. This study provides evidence on the potential impact of Medicaid disenrollment on delays in diagnosis and performing urgent surgeries to treat late stages of breast cancer among low-income women in states that may consider future changes to Medicaid eligibility. Citation Format: Wafa W. Tarazi, Cathy J. Bradley, Harry D. Bear, David W. Harless, Lindsay M. Sabik. Medicaid disenrollment in Tennessee and disparities in stage at diagnosis and surgery for female breast cancer. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A82.