The Urgent Matters safety net assessment team would like to thank our community partner, the Grea... more The Urgent Matters safety net assessment team would like to thank our community partner, the Greater San Antonio Hospital Council (GSAHC), for its help in identifying key safety net issues in San Antonio and connecting us with stakeholders in the community. At GSAHC, William Rasco was instrumental in coordinating our site visits, interviews and focus groups and an essential resource through the course of the project. The mission of GSAHC is to provide leadership in educating, communicating, and coordinating health care providers to improve the health of the San Antonio and Bexar County region. More information on GSAHC can be found at www.gsahc.org. We would also like to acknowledge David Hnatow, MD, at the University Health System for providing us with important information and resources regarding the emergency department at the University Health System. The Urgent Matters team would also like to recognize the many individuals in the San Antonio health care community, who gave generously of their time and provided important and useful insights into the local safety net system. The San Antonio, Texas, Safety Net Assessment would not have been possible without their participation.
Medicaid has touched the lives of half of all of the low income young adults of prime military se... more Medicaid has touched the lives of half of all of the low income young adults of prime military service age. The roots of Medicaid's unique child health eligibility and coverage policies can be traced to a seminal, 1964 government study entitled One Third of a Nation: A Report on Young Men Found Unqualified for Military Service. This study analyzed the underlying causes of the astounding 50 percent rejection rate among the young men drafted into the military in 1962. It documented pervasive evidence of treatable and correctable physical, mental, and developmental conditions, and its findings influenced the course of Medicaid legislation for children, particularly the comprehensive coverage available to children under the EPSDT program. This 1964 report remains relevant in a modern era of national security concern and serves to underscore Medicaid's ongoing importance to children and adolescents.
In this article we examine the federal freedom-of-choice statute, which was enacted in the mid-19... more In this article we examine the federal freedom-of-choice statute, which was enacted in the mid-1980s to protect Medicaid beneficiaries' access to timely and confidential family planning services. We also examine how these provisions have been implemented in 15 jurisdictions and provide a case study of 5 family planning programs. We found that this attempt to "carve out" family planning services from managed care has led to numerous problems. First, there is virtually no federal guidance concerning to which services and supplies the exemption applies. Second, there are no guidelines as to how carve-outs are to function. Therefore, if managed care systems are inaccessible or nonresponsive to reasonable community care seeking patterns, then a carve-out carve-out may be the only answer. Carve-outs should be used as a last resort, however, because they are so difficult to design.
This study assesses the potential cost savings associated with the use of community health center... more This study assesses the potential cost savings associated with the use of community health centers, based on econometric analyses of the 2006 Medical Expenditure Panel Survey. After controlling for health status, health insurance coverage, income, age, and other factors, this study finds that patients who receive a majority of their ambulatory care at community health centers have significantly lower annual overall medical expenditures (24%) and ambulatory expenditures (25%) than those who do not. These results are consistent with other studies indicating that, by providing good quality primary care, community health centers can reduce the utilization of other medical services.
Background: National health reform is designed to reduce the number of uninsured adults. Currentl... more Background: National health reform is designed to reduce the number of uninsured adults. Currently, many uninsured individuals receive care at safety-net health care providers such as community health centers (CHCs) or safety-net hospitals. This project examined data from Massachusetts to assess how the demand for ambulatory and inpatient care and use changed for safety-net providers after the state's health care reform law was enacted in 2006, which dramatically reduced the number of individuals without health insurance coverage. Methods: Multiple methods were used, including analyses of administrative data reported by CHCs and hospitals, case study interviews, and analyses of data from the 2009 Massachusetts Health Reform Survey, a staterepresentative telephone survey of adults. Results: Between calendar years 2005 and 2009, the number of patients receiving care at Massachusetts CHCs increased by 31.0%, and the share of CHC patients who were uninsured fell from 35.5% to 19.9%. Nonemergency ambulatory care visits to clinics of safety-net hospitals grew twice as fast as visits to non-safety-net hospitals from 2006 to 2009. The number of inpatient admissions was comparable for safety-net and non-safetynet hospitals. Most safety-net patients reported that they used these facilities because they were convenient (79.3%) and affordable (73.8%); only 25.2% reported having had problems getting appointments elsewhere. Conclusions: Despite the significant reduction in uninsurance levels in Massachusetts that occurred with health care reform, the demand for care at safety-net facilities continues to rise. Most safety-net patients do not view these facilities as providers of last resort; rather, they prefer the types of care that are offered there. It will continue to be important to support safety-net providers, even after health care reform programs are established.
In the coming years, the United States must address both an expansion of Medicaid coverage and an... more In the coming years, the United States must address both an expansion of Medicaid coverage and an unexpected shortage of primary care physicians. Under the Patient Protection and Affordable Care Act (ACA), the Medicaid eligibility threshold for nonelderly adults will rise to 133% of the federal poverty level (about $30,000 for a family of four) in 2014. States with restrictive Medicaid eligibility requirements and high rates of uninsured residents will expand coverage substantially, while programs in states with higher current Medicaid eligibility thresholds and fewer uninsured residents will grow less. However, since many of the states with the largest anticipated Medicaid expansions are also the ones that have less primary care capacity, they could face surging demand from the newly insured without having sufficient primary care resources available. These gaps could affect access to care not only for newly eligible Medicaid beneficiaries but also for others who depend on a state’s...
The Urgent Matters safety net assessment team would like to thank our community partner, the Grea... more The Urgent Matters safety net assessment team would like to thank our community partner, the Greater San Antonio Hospital Council (GSAHC), for its help in identifying key safety net issues in San Antonio and connecting us with stakeholders in the community. At GSAHC, William Rasco was instrumental in coordinating our site visits, interviews and focus groups and an essential resource through the course of the project. The mission of GSAHC is to provide leadership in educating, communicating, and coordinating health care providers to improve the health of the San Antonio and Bexar County region. More information on GSAHC can be found at www.gsahc.org. We would also like to acknowledge David Hnatow, MD, at the University Health System for providing us with important information and resources regarding the emergency department at the University Health System. The Urgent Matters team would also like to recognize the many individuals in the San Antonio health care community, who gave generously of their time and provided important and useful insights into the local safety net system. The San Antonio, Texas, Safety Net Assessment would not have been possible without their participation.
Medicaid has touched the lives of half of all of the low income young adults of prime military se... more Medicaid has touched the lives of half of all of the low income young adults of prime military service age. The roots of Medicaid's unique child health eligibility and coverage policies can be traced to a seminal, 1964 government study entitled One Third of a Nation: A Report on Young Men Found Unqualified for Military Service. This study analyzed the underlying causes of the astounding 50 percent rejection rate among the young men drafted into the military in 1962. It documented pervasive evidence of treatable and correctable physical, mental, and developmental conditions, and its findings influenced the course of Medicaid legislation for children, particularly the comprehensive coverage available to children under the EPSDT program. This 1964 report remains relevant in a modern era of national security concern and serves to underscore Medicaid's ongoing importance to children and adolescents.
In this article we examine the federal freedom-of-choice statute, which was enacted in the mid-19... more In this article we examine the federal freedom-of-choice statute, which was enacted in the mid-1980s to protect Medicaid beneficiaries' access to timely and confidential family planning services. We also examine how these provisions have been implemented in 15 jurisdictions and provide a case study of 5 family planning programs. We found that this attempt to "carve out" family planning services from managed care has led to numerous problems. First, there is virtually no federal guidance concerning to which services and supplies the exemption applies. Second, there are no guidelines as to how carve-outs are to function. Therefore, if managed care systems are inaccessible or nonresponsive to reasonable community care seeking patterns, then a carve-out carve-out may be the only answer. Carve-outs should be used as a last resort, however, because they are so difficult to design.
This study assesses the potential cost savings associated with the use of community health center... more This study assesses the potential cost savings associated with the use of community health centers, based on econometric analyses of the 2006 Medical Expenditure Panel Survey. After controlling for health status, health insurance coverage, income, age, and other factors, this study finds that patients who receive a majority of their ambulatory care at community health centers have significantly lower annual overall medical expenditures (24%) and ambulatory expenditures (25%) than those who do not. These results are consistent with other studies indicating that, by providing good quality primary care, community health centers can reduce the utilization of other medical services.
Background: National health reform is designed to reduce the number of uninsured adults. Currentl... more Background: National health reform is designed to reduce the number of uninsured adults. Currently, many uninsured individuals receive care at safety-net health care providers such as community health centers (CHCs) or safety-net hospitals. This project examined data from Massachusetts to assess how the demand for ambulatory and inpatient care and use changed for safety-net providers after the state's health care reform law was enacted in 2006, which dramatically reduced the number of individuals without health insurance coverage. Methods: Multiple methods were used, including analyses of administrative data reported by CHCs and hospitals, case study interviews, and analyses of data from the 2009 Massachusetts Health Reform Survey, a staterepresentative telephone survey of adults. Results: Between calendar years 2005 and 2009, the number of patients receiving care at Massachusetts CHCs increased by 31.0%, and the share of CHC patients who were uninsured fell from 35.5% to 19.9%. Nonemergency ambulatory care visits to clinics of safety-net hospitals grew twice as fast as visits to non-safety-net hospitals from 2006 to 2009. The number of inpatient admissions was comparable for safety-net and non-safetynet hospitals. Most safety-net patients reported that they used these facilities because they were convenient (79.3%) and affordable (73.8%); only 25.2% reported having had problems getting appointments elsewhere. Conclusions: Despite the significant reduction in uninsurance levels in Massachusetts that occurred with health care reform, the demand for care at safety-net facilities continues to rise. Most safety-net patients do not view these facilities as providers of last resort; rather, they prefer the types of care that are offered there. It will continue to be important to support safety-net providers, even after health care reform programs are established.
In the coming years, the United States must address both an expansion of Medicaid coverage and an... more In the coming years, the United States must address both an expansion of Medicaid coverage and an unexpected shortage of primary care physicians. Under the Patient Protection and Affordable Care Act (ACA), the Medicaid eligibility threshold for nonelderly adults will rise to 133% of the federal poverty level (about $30,000 for a family of four) in 2014. States with restrictive Medicaid eligibility requirements and high rates of uninsured residents will expand coverage substantially, while programs in states with higher current Medicaid eligibility thresholds and fewer uninsured residents will grow less. However, since many of the states with the largest anticipated Medicaid expansions are also the ones that have less primary care capacity, they could face surging demand from the newly insured without having sufficient primary care resources available. These gaps could affect access to care not only for newly eligible Medicaid beneficiaries but also for others who depend on a state’s...
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