Institute for Health and Disability Policy Studies
https://hdl.handle.net/1808/10789
2024-03-28T15:05:45ZPoor oral health as an obstacle to employment for Medicaid beneficiaries with disabilities
https://hdl.handle.net/1808/16664
Poor oral health as an obstacle to employment for Medicaid beneficiaries with disabilities
Hall, Jean P.; Kurth, Noelle K.; Chapman, Shawna L. C.
Objectives: To inform policy with better information about the oral health-care
needs of aMedicaid population that engages in employment, that is, people ages 16
to 64 with Social Security-determined disabilities enrolled in a Medicaid Buy-In
program.
Methods: Statistically test for significant differences among responses to aMedicaid
Buy-In program satisfaction survey that included oral health questions from the
Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance
System and the Oral Health Impact Profile (OHIP) to results for the state’s general
population and the US general population.
Results: All measures of dental care access and oral health were significantly worse
for the study population as comparedwith a state general population or aUS general
population. Differences were particularly pronounced for the OHIP measure for
difficulty doing one’s job due to dental problems, which was almost five times higher
for the study population.
Conclusions: More comprehensive dental benefits for the study population could
result in increased oral and overall health, and eventual cost savings to Medicaid as
more people work, have improved health, and pay premiums for coverage.
2012-01-01T00:00:00ZThe Validity of Claims-Based Risk Estimation in Underinsured Populations
https://hdl.handle.net/1808/16663
The Validity of Claims-Based Risk Estimation in Underinsured Populations
Hall, Jean P.; Moore, Janice M.
Objectives: To demonstrate a threat to validity in using claims-based risk tools with chronically ill, underinsured populations. Study Design: We tracked disease burden of highrisk pool beneficiaries with potentially disabling health conditions receiving enhanced health insurance benefits through a federally funded research demonstration. At baseline, beneficiaries paid high premiums and cost sharing for risk pool coverage, and most met common criteria for underinsurance. Study benefits provided intervention group members premium and cost-sharing subsidies and additional coverage; control group members paid usual premiums and coinsurance and received usual benefits. We hypothesized that enhanced benefits for the intervention group would increase or stabilize health status measures and decrease case-mix weights, reflecting stabilized or reduced disease burden. Methods: The SF-12v2 health survey was used to measure health status and the Johns Hopkins Adjusted Clinical Groups (ACGs), Version 8.2 with DX-PM model and prior cost for a non-elderly population, was used to measure disease burden. Findings: Over a 3-year period, SF-12v2 scores showed stable health status for the intervention group and significant decline for the control group, while ACG case-mix weights, major illnesses, and chronic condition counts rose significantly for the intervention group but remained stable for the control group. Increased resource utilization for the intervention group appears to have driven increases in ACG measures. Conclusions: When high cost-sharing constrains access to care, risk tools that rely on medical claims may not provide an accurate measure of disease burden. - See more at: http://www.ajmc.com/articles/The-Validity-of-Claims-Based-Risk-Estimation-in-Underinsured-Populations/#sthash.Px74PGmZ.dpuf
2012-12-01T00:00:00ZMedicaid managed care: Issues for beneficiaries with disabilities
https://hdl.handle.net/1808/16662
Medicaid managed care: Issues for beneficiaries with disabilities
Hall, Jean P.; Kurth, Noelle K.; Chapman, Shawna L. C.; Shireman, Theresa I.
Background: States are increasingly turning to managed care arrangements to control costs in their Medicaid programs. Historically,
such arrangements have excluded people with disabilities who use long-term services and supports (LTSS) due to their complex needs.
Now, however, some states are also moving this population to managed care. Little is known about the experiences of people with disabilities
during and after this transition.
Objective: To document experiences of Medicaid enrollees with disabilities using long-term services and supports during transition to
Medicaid managed care in Kansas.
Methods: During the spring of 2013, 105 Kansans with disabilities using Medicaid long-term services and supports (LTSS) were
surveyed via telephone or in-person as they transitioned to managed care. Qualitative data analysis of survey responses was conducted
to learn more about the issues encountered by people with disabilities under Medicaid managed care.
Results: Respondents encountered numerous disability-related difficulties, particularly with transportation, durable medical equipment,
care coordination, communication, increased out of pocket costs, and access to care.
Conclusions: As more states move people with disabilities to Medicaid managed care, it is critically important to address these identified
issues for a population that often experiences substantial health disparities and a smaller margin of health. It is hoped that the early
experiences reported here can inform policy-makers in other states as they contemplate and design similar programs.
2015-01-01T00:00:00ZRealizing Health Reform’s Potential: Why a National High-Risk Insurance Pool Is Not a Workable Alternative to the Marketplace
https://hdl.handle.net/1808/16661
Realizing Health Reform’s Potential: Why a National High-Risk Insurance Pool Is Not a Workable Alternative to the Marketplace
Hall, Jean P.
The Pre-Existing Condition Insurance Plan (PCIP) was a national
high-risk pool established under the Affordable Care Act (ACA) to provide
coverage for individuals with preexisting conditions who had been uninsured for
at least six months. It was intended to be a temporary program: PCIPs opened in
2010 and closed in April 2014. At that point, those with preexisting conditions
could shop for health insurance in the marketplaces, where plans are prevented
from using applicants’ health status to deny coverage or charge more. This issue
brief draws on the PCIP experience to outline why national high-risk pools,
which continue to be proposed as policy alternatives to ACA coverage expansions,
are expensive to enrollees as well as their administrators and ultimately
unsustainable. The key lesson—and the principle on which the ACA is built—is
that insurance works best when risk is evenly spread across a broad population.
2014-12-01T00:00:00Z