Citation URL: http://www.urban.org/JenniferKing

This study uses survey data linked with claims data to examine the consequences of unmet need for future health care use for a sample of disabled Medicaid beneficiaries. The findings show that self-reported unmet need is a strong predictor of future health care use for disabled Medicaid beneficiaries, including a greater reliance on emergency rooms and hospital care for conditions that potentially could be handled in less expensive settings. Addressing the barriers to care that underlie unmet need could generate cost savings to Medicaid and provide better health outcomes for program beneficiaries. (Inquiry, 42, 4, Winter 2005/2006. pp. 413-420)

Produced under the State Planning Grant project of the DC Department of Health, this report provides details on the characteristics of the uninsured in the District. It first presents data on the variation in insurance coverage by sociodemographic characteristics. It then presents data on the reasons that people are uninsured. Finally, it looks at the cost of uninsurance, presenting estimates of current expenditures by and for the uninsured. Data sources include the Current Population Survey, the Kaiser Family Foundation's DC Health Care Access Survey, and the Medical Expenditure Panel Survey.

This study assesses how well the Medicaid program is working at improving access to and use of health care for low-income mothers. Using data from the National Survey of America's Families, we estimate the effects of Medicaid on access and use relative to private coverage and being uninsured, using instrumental variables to control for selection into insurance status. We find that the Medicaid program improved access to care relative to uninsurance, achieving access and use levels comparable to those of the privately insured. (Health Services Research 40(1): 39–58.)

This study addresses the impacts of Medicaid managed care in rural Minnesota. Using difference-in-differences methods, the study compares access to care for Medicaid beneficiaries in rural counties that implemented Medicaid managed care between 1998 and 2000 with Medicaid beneficiaries in rural counties that continued to operate fee-for-service Medicaid over the period. We find that Medicaid managed care in rural areas neither positively nor negatively affected beneficiaries' access to care. With the cost savings under managed care reported by the state, it appears that Minnesota was able to reduce the costs of its Medicaid program without worsening access to care. (Journal of Rural Health 21(1): 12–20.)

Using data from a 2002 survey, the authors look at the design and operation of Medicaid disproportionate share hospital (DSH) and upper payment limit (UPL) programs in thirty-four states. The authors find that more available DSH gains were paid to hospitals in 2001 than occurred in the late 1990s. By contrast, survey data suggest that the bulk of available UPL gains in 2001 were kept by states and not by providers. Using simulation analyses, the authors estimate that because of DSH and UPL practices, the effective 2001 federal Medicaid match rate in the survey states was about three percentage points higher on average than it would have been otherwise.

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