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Corporate Consolidation And The Youth Mental Health Crisis: Evidence From Medicaid Managed Care In 2022.

Medicaid managed care organizations serve as the primary vehicle for delivering behavioral health services to low-income youth. However, market consolidation has shifted enrollment toward a handful of large national parent firms. Understanding the implications of this shift is critical for identifying and closing gaps in adolescent mental health services. Using national Medicaid claims data from 2022, we examined the associations between managed care organization ownership by five major parent firms and measures of youth mental health service use and provider composition. Managed care organiza…

Barriers to outpatient mental health services experienced by adult Medicaid recipients: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to summarize the evidence on barriers to outpatient mental health services experienced by Medicaid recipients. INTRODUCTION: Medicaid recipients commonly face challenges in accessing outpatient mental health services. This scoping review will categorize existing evidence on barriers to outpatient mental health services experienced by adult Medicaid recipients and identify knowledge gaps that warrant further investigation. ELIGIBILITY CRITERIA: This review will consider studies that address barriers to outpatient mental health service access …

Geographic and racial/ethnic patterns of polysomnography use among children enrolled in Medicaid, 2017-2019.

PURPOSE: The purpose of this cross-sectional observational study was to describe the geographic distribution of utilization of polysomnography (PSG) among children enrolled in Medicaid/Child Health Insurance Program from 2017 to 2019. METHODS: The data source was the Transformed Medicaid Information System (T-MSIS) research analytic files. PSG among children ages 0 to 18 years was identified from the claims data. All children enrolled in Medicaid with at least one service utilization claim formed the denominators for calculation of age-adjusted rates per 10,000 children at the US Census Burea…

Расовые различия в выживании нескольких миелом: ассоциации с трансплантацией стволовых клеток, страхованием и расширением сети медицинских учреждений.

На уровне населения чернокожие пациенты с множественной миеломой (ММ) могут выжить хуже, чем белые. Авторы изучили вопрос о том, как автологическая трансплантация стволовых клеток (ASCT), страхование и расширение сети " Медикэйд " связаны с расовыми различиями в общем уровне выживания (rwOS) в реальном мире. МЕТОДЫ: Данные, полученные 4932 больные MM (MM)24% Блэк) в Флатиронской базе данных исследований в области здравоохранения анализировался с использованием моделей " Кокс регрессиал " (rwOS), " Файн энд срей " (ASCT) и " политомная регрессия " (страхо

Совпадение в аннотации оригинала
BACKGROUND: At the population level, Black patients with multiple myeloma (MM) may experience worse survival than White patients. The authors examined how autologous stem cell transplantation (ASCT), insurance, and Medicaid expansion relate to racial differences in real-world overall survival (rwOS). METHODS: Data from 4932 patients with MM (24% Black) in t…

Effect of Medicaid accountable care on preventable emergency department and hospital admissions: rural-urban heterogeneity.

BACKGROUND: Accountable care organizations provide a framework for collaboration among providers and payers to improve patients' health and care experiences while reducing costs. However, there is limited research on the realization of these benefits for low-income individuals across varying degrees of rurality. This study examined the heterogeneous impact of Coordinated Care Organizations (CCOs), an accountable care model implemented in Oregon Medicaid, on preventable emergency department (ED) and hospital admissions by rurality of residence. METHODS: Using person-month panel data on 131,246…

Child mental health, homelessness, and the shelter system: evidence from Medicaid in New York City.

We identified children who resided in the New York City shelter system during 2015-2020 by matching address histories in Medicaid insurance claims to publicly available homeless shelter addresses, permitting examination of health care use before, during, and after shelter stays. We found that 4.5% of NYC children aged 4-17 with consistent Medicaid coverage entered shelter over a 3-to-5-year period. After shelter entry, children had increased probabilities of receiving mental health services, including therapy and diagnoses of neurodevelopmental disorders but little change in physical health se…

Associations between minimally adequate treatment and clinical outcomes among Medicaid-enrolled youth with bipolar disorder.

OBJECTIVE: To investigate associations between minimally adequate treatment and clinical outcomes among youth with bipolar disorder. METHODS: This study utilized a retrospective cohort of publicly-insured (Medicaid) youth aged 10-18 years with a new bipolar disorder episode between 2009 and 2013 from 15 geographically diverse states. Four minimally adequate treatment measures were evaluated during a 180-day treatment period: 1) Minimally Adequate Pharmacotherapy: medication (mood stabilizer and/or atypical antipsychotic) possession ratio ≥80%; 2) Minimally Adequate Psychotherapy: ≥8 psychothe…

Heterogeneous effects of Medicaid coverage on cardiovascular risk factors: secondary analysis of randomized controlled trial.

OBJECTIVES: To investigate whether health insurance generated improvements in cardiovascular risk factors (blood pressure and hemoglobin A1c (HbA1c) levels) for identifiable subpopulations, and using machine learning to identify characteristics of people predicted to benefit highly. DESIGN: Secondary analysis of randomized controlled trial. SETTING: Medicaid insurance coverage in 2008 for adults on low incomes (defined as lower than the federal-defined poverty line) in Oregon who were uninsured. PARTICIPANTS: 12 134 participants from the Oregon Health Insurance Experiment with in-person dat…

Medicaid Eligibility Loss Among Dual-Eligible Beneficiaries Before and During COVID-19 Public Health Emergency.

IMPORTANCE: Medicaid coverage loss can substantially compromise access to and affordability of health care for dual-eligible beneficiaries. The extent to which this population lost Medicaid coverage before and during the COVID-19 public health emergency (PHE) and the characteristics of beneficiaries more at risk for coverage loss are currently not well known. OBJECTIVE: To assess the loss of Medicaid coverage among dual-eligible beneficiaries before and during the first year of the PHE, and to examine beneficiary-level and plan-level factors associated with heightened likelihood of losing Med…

Neighborhood Socioeconomic Disadvantage and Acute Care Utilization in Washington State Medicaid: A Retrospective Cohort Study.

BACKGROUND: Neighborhood disadvantage has been associated with potentially preventable acute care utilization among Medicare beneficiaries, but this association has not been studied in a Medicaid population, which is important for informing more equitable care and policies for this population. OBJECTIVE: To describe the association between Area Deprivation Index (ADI) and acute care utilization (including potentially preventable utilization) among Medicaid beneficiaries in Washington State. DESIGN: Retrospective cohort study of 100% Medicaid claims. Mixed effects logistic regression was appl…

Continuous Medicaid Eligibility During the COVID-19 Pandemic and Postpartum Coverage, Health Care, and Outcomes.

IMPORTANCE: Pursuant to the Families First Coronavirus Response Act (FFCRA), continuous Medicaid eligibility during the COVID-19 public health emergency (PHE) created a de facto national extension of pregnancy Medicaid eligibility beyond 60 days postpartum. OBJECTIVE: To evaluate the association of continuous Medicaid eligibility with postpartum health insurance, health care use, breastfeeding, and depressive symptoms. DESIGN, SETTING, AND PARTICIPANTS: This cohort study using a generalized difference-in-differences design included 21 states with continuous prepolicy (2017-2019) and postpoli…

Medications For Opioid Use Disorder Increased Among Louisiana Medicaid Enrollees During Policy Reforms, 2018-21.

Increasing access to medications for opioid use disorder (MOUD) is a key strategy in addressing the opioid crisis. To increase MOUD access, state governments have pursued a combination of increased funding for MOUD and requirements that providers offer treatment. Louisiana has pursued multiple strategies, including a requirement that residential treatment programs offer MOUD as part of their licensure. Using Louisiana Medicaid claims data for enrollees with diagnosed OUD from the period 2018-21, we analyzed trends in MOUD between enrollees treated in residential and nonresidential settings and…

Association between prescription drug monitoring programs use mandates and prescription stimulants received by Medicaid enrollees.

INTRODUCTION: Prescription drug monitoring program (PDMP) use mandates are an important policy tool to curb nonmedical opioid use. However, data are scarce about their efficacy on other commonly used prescription drugs such as stimulants. METHODS: We used 2010-2020 state-level secondary data from Medicaid State Drug Utilisation Data and quasi-experimental difference-in-differences research design to estimate the association between PDMP use mandates and population-adjusted stimulants (amphetamines and methylphenidate) prescribing outcomes: (i) number of prescriptions filled; and (ii) total am…

Do Children With Medicaid Insurance Have Increased Revision Rates 5 Years After Posterior Spinal Fusions?

BACKGROUND: Socioeconomic disparities in musculoskeletal care are increasingly recognized, however, no studies to date have investigated the … e identified with 9006 (83.4%) patients with private insurance and 1788 (16.6%) patients insured by Medicaid. The mean follow-up in the database was 5.36±3 years for patients with private insurance and 4.78±2.9 years for patients with Medicaid insurance ( P <0.001). Children with AIS and Medicaid insurance had a significantly higher prevalence of asthma, h …

Performance Metrics of Substance Use Disorder Care Among Medicaid Enrollees in New York, New York.

IMPORTANCE: There is limited evaluation of the performance of Medicaid managed care (MMC) private plans in covering substance use disorder (SUD) treatment. OBJECTIVE: To compare the performance of MMC plans across 19 indicators of access, quality, and outcomes of SUD treatment. DESIGN SETTING AND PARTICIPANTS: This cross-sectional study used administrative claims and mandatory assignment to plans of up to 159 016 adult Medicaid recipients residing in 1 of the 5 counties (boroughs) of New York, New York, from January 2009 to December 2017 to identify differences in SUD treatment access, patte…

Association of polysubstance use disorder with treatment quality among Medicaid beneficiaries with opioid use disorder.

INTRODUCTION: The opioid crisis is transitioning to a polydrug crisis, and individuals with co-occurring substance use disorder (SUDs) often have unique clinical characteristics and contextual barriers that influence treatment needs, engagement in treatment, complexity of treatment planning, and treatment retention. METHODS: Using Medicaid data for 2017-2018 from four states participating in a distributed research network, this retrospective cohort study documents the prevalence of specific types of co-occurring SUD among Medicaid enrollees with an opioid use disorder (OUD) diagnosis, and ass…

Factors associated with Medicaid participation among infants born with birth defects in Texas, 2010-2014.

BACKGROUND: Birth defects are major contributors to healthcare resource use, disability, and mortality, particularly during the perinatal period. As the nation's public insurance program for low-income individuals, Medicaid funds a large proportion of healthcare costs associated with birth defects. Here, we explore birth defect-related factors associated with Medicaid participation in the first year of life. METHODS: Infants born with birth defects between 2010 and 2014 were linked from the Texas Birth Defects Registry to the state's Medicaid claims database. Variation in Medicaid participati…

Racial Differences in Contraception Encounters and Dispensing Among Female Medicaid Beneficiaries With Systemic Lupus Erythematosus.

OBJECTIVE: African American and Hispanic women with systemic lupus erythematosus (SLE) have the highest rates of potentially avoidable pregnancy complications, yet racial disparities in family planning among reproductive-age women with SLE have not been well-studied. Our objective was to examine whether there are racial differences in contraception encounters and dispensing among US Medicaid-insured women with SLE. METHODS: Using Medicaid claims data from 2000-2010, we identified women ages 18-50 years with SLE. We examined contraception encounters and uptake over 24 months. We used multivari…

Association between preexisting mental illnesses and mortality among medicaid-insured women diagnosed with breast cancer.

BACKGROUND: We investigated the impact of preexisting mental illnesses on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer. METHODS: Data from the New York State Cancer Registry for 10,444 women diagnosed with breast cancer from 2004 to 2016 and aged <65 years at diagnosis were linked with Medicaid claims. Women were categorized as having depression or a severe mental illness (SMI) if they had at least three relevant diagnosis claims with at least one claim within three years prior to breast cancer diagnosis. SMI included schizophrenia, bipolar …

Concussion-Related Health Care Utilization Among Medicaid Insured Children in Ohio: Rural and Urban Differences.

PURPOSE: The current study examines rural-urban differences in trends in rates and type of concussion-related health care utilization over time from 2008 to 2016 among Medicaid insured children in Ohio. METHODS: We analyzed Medicaid claims for health care utilization for diagnosed concussions among children aged ≤18 years between April 1, 2008, and December 31, 2016. We compared the trends in rates of concussion-related health care utilization between children who lived in rural and urban areas using Poisson regressions. We examined trends in the type of concussion-related health care utiliza…