Medicaid and Public Health: Second Edition

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: 31 August 2024 | Viewed by 2912

Special Issue Editor

Division of Hematology and Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
Interests: health policy; epidemiology; health services research; oncology; leukemia; myelodysplastic syndromes
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In this Special Issue, we present reports on Medicaid. This US-based healthcare program was originally instituted in the 1960s for people with low-paid jobs, mothers, babies, children, alternately abled people struggling to find or keep gainful employment, and seniors with meagre resources. This federal program empowers states to administer healthcare coverage to these disadvantaged populations. Since then, healthcare, health, and society have changed. To keep with the times and control costs, the federal government and states have adapted Medicaid in many ways. This Special Issue is intended to house reports of these adaptations and their outcomes.

A lot of what Medicaid pays for is preventable problems. Heart disease and cancers are preventable by not using tobacco. Vaccinations prevent infections and cancers. Clear communication between people and their healthcare providers prevents emergency room visits, hospitalizations, and re-hospitalizations. In this Special Issue, we will report on innovations in prevention for both short-term improvements in care but also long-term improvements. Evidence from this Special Issue is meant to help state Medicaid programs as they research methods for improving their programs.

A common complaint about Medicaid is its high cost. However, its high cost is a direct consequence of social inequities in the US. The basic needs for a good life, such as food, housing, security, and supportive relationships, are variably distributed in the US and sometimes withheld based on the color of one’s skin, spelling of their name, gender, and other types of discrimination. These upstream inequities result in downstream health disparities. The deeper pressure to improve Medicaid is achieving social justice before Medicaid is even needed. This Special Issue will publish manuscripts showing the need and mechanisms of addressing social inequities. These publications will urge Medicaid programs to reach out to other departments for new and stronger partnerships.

Medicaid is critical to states achieving wellbeing for all their people. Because of Medicaid’s eligibility requirements, by definition, it is a healthcare delivery system directly impacted by social determinants of health. Nearly all people depending on Medicaid experience financial hardship, which is causally related to other physical deprivations, such as depression and anxiety. Articles of interest in this Special Issue will be new healthcare delivery innovations that achieve health equity by also addressing an individual’s social and environmental surroundings. These innovations will assist health service researchers looking for inspiration and implementation scientists in search of methods for deployment.

Because Medicaid is dependent on federal and state government cooperation, this program is often politically charged. Thus, this Special Issue is also meant to house Perspective pieces and Editorials that are well referenced.

Ultimately, we strive for a society where all people are healthy, happy, and secure. This Special Issue is meant to demonstrate our progress toward that vision.

Yours in improving health and healthcare,

Prof. Dr. Christopher R. Cogle
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • medicaid
  • health services 
  • healthcare delivery
  • health policy
  • population health
  • public health
  • health equity
  • health disparities

Published Papers (3 papers)

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14 pages, 435 KiB  
Article
Practice Site Heterogeneity within and between Medicaid Accountable Care Organizations
by Zachary Dyer, Matthew Alcusky, Jay Himmelstein, Arlene Ash and Michaela Kerrissey
Healthcare 2024, 12(2), 266; https://doi.org/10.3390/healthcare12020266 - 20 Jan 2024
Viewed by 553
Abstract
The existing literature has considered accountable care organizations (ACOs) as whole entities, neglecting potentially important variations in the characteristics and experiences of the individual practice sites that comprise them. In this observational cross-sectional study, our aim is to characterize the experience, capacity, and [...] Read more.
The existing literature has considered accountable care organizations (ACOs) as whole entities, neglecting potentially important variations in the characteristics and experiences of the individual practice sites that comprise them. In this observational cross-sectional study, our aim is to characterize the experience, capacity, and process heterogeneity at the practice site level within and between Medicaid ACOs, drawing on the Massachusetts Medicaid and Children’s Health Insurance Program (MassHealth), which launched an ACO reform effort in 2018. We used a 2019 survey of a representative sample of administrators from practice sites participating in Medicaid ACOs in Massachusetts (n = 225). We quantified the clustering of responses by practice site within all 17 Medicaid ACOs in Massachusetts for measures of process change, previous experience with alternative payment models, and changes in the practices’ ability to deliver high-quality care. Using multilevel logistic models, we calculated median odds ratios (MORs) and intraclass correlation coefficients (ICCs) to quantify the variation within and between ACOs for each measure. We found greater heterogeneity within the ACOs than between them for all measures, regardless of practice site and ACO characteristics (all ICCs ≤ 0.26). Our research indicates diverse experience with, and capacity for, implementing ACO initiatives across practice sites in Medicaid ACOs. Future research and program design should account for characteristics of practice sites within ACOs. Full article
(This article belongs to the Special Issue Medicaid and Public Health: Second Edition)
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14 pages, 534 KiB  
Article
Relationship between Depression and Anxiety during Pregnancy, Delivery-Related Outcomes, and Healthcare Utilization in Michigan Medicaid, 2012–2021
by Kara Zivin, Xiaosong Zhang, Anca Tilea, Sarah J. Clark and Stephanie V. Hall
Healthcare 2023, 11(22), 2921; https://doi.org/10.3390/healthcare11222921 - 07 Nov 2023
Viewed by 851
Abstract
To evaluate associations between depression and/or anxiety disorders during pregnancy (DAP), delivery-related outcomes, and healthcare utilization among individuals with Michigan Medicaid-funded deliveries. We conducted a retrospective delivery-level analysis comparing delivery-related outcomes and healthcare utilization among individuals with and without DAP between January 2012 [...] Read more.
To evaluate associations between depression and/or anxiety disorders during pregnancy (DAP), delivery-related outcomes, and healthcare utilization among individuals with Michigan Medicaid-funded deliveries. We conducted a retrospective delivery-level analysis comparing delivery-related outcomes and healthcare utilization among individuals with and without DAP between January 2012 and September 2021. We used generalized estimating equation models assessing cesarean and preterm delivery; 30-day readmission after delivery; severe maternal morbidity within 42 days of delivery; and ambulatory, inpatient, emergency department or observation (ED), psychotherapy, or substance use disorders (SUD) visits during pregnancy. We adjusted models for age, race/ethnicity, urbanicity, federal poverty level, and obstetric comorbidities. Among 170,002 Michigan Medicaid enrollees with 218,890 deliveries, 29,665 (13.6%) had diagnoses of DAP. Compared to those without DAP, individuals with DAP were more often White, rural dwelling, had lower income, and had more comorbidities. In adjusted models, deliveries with DAP had higher odds of cesarean and preterm delivery OR = 1.02, 95% CI: [1.00, 1.05] and OR = 1.15, 95% CI: [1.11, 1.19] respectively), readmission within 30 days postpartum (OR = 1.14, 95% CI: [1.07, 1.22]), SMM within 42 days (OR = 1.27, 95% CI: [1.18, 1.38]), and utilization compared to those without DAP diagnoses (ambulatory: OR = 7.75, 95% CI: [6.75, 8.88], inpatient: OR = 1.13, 95% CI: [1.11, 1.15], ED: OR = 1.86, 95% CI: [1.80, 1.92], psychotherapy: OR = 172.8, 95% CI: [160.10, 186.58], and SUD: OR = 5.6, 95% CI: [5.37, 5.85]). Among delivering individuals in Michigan Medicaid, DAP had significant associations with adverse delivery-related outcomes and greater healthcare use. Early detection and intervention to address mental illness during pregnancy may help mitigate burdens of these complex yet treatable disorders. Full article
(This article belongs to the Special Issue Medicaid and Public Health: Second Edition)
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7 pages, 226 KiB  
Brief Report
Inappropriate Prescribing of Antibiotics to Pediatric Patients Receiving Medicaid: Comparison of High-Volume and Non-High-Volume Antibiotic Prescribers—Kentucky, 2019
by Bethany A. Wattles, Michael J. Smith, Yana Feygin, Kahir Jawad, Andrea Flinchum, Brittany Corley and Kevin B. Spicer
Healthcare 2023, 11(16), 2307; https://doi.org/10.3390/healthcare11162307 - 16 Aug 2023
Viewed by 727
Abstract
Inappropriate antibiotic prescribing to pediatric Medicaid patients was compared among high-volume and non-high-volume prescribers. High-volume prescribers had a higher percentage of inappropriate prescriptions than non-high-volume prescribers (17.2% versus 15.8%, p = 0.005). Targeting high-volume prescribers for stewardship efforts is a practical approach to [...] Read more.
Inappropriate antibiotic prescribing to pediatric Medicaid patients was compared among high-volume and non-high-volume prescribers. High-volume prescribers had a higher percentage of inappropriate prescriptions than non-high-volume prescribers (17.2% versus 15.8%, p = 0.005). Targeting high-volume prescribers for stewardship efforts is a practical approach to reducing outpatient antibiotic prescribing that also captures inappropriate use. Full article
(This article belongs to the Special Issue Medicaid and Public Health: Second Edition)
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