Research by Author & Topic

Publications by Teresa A. Coughlin on Uninsured/Uncompensated Care

To assess Medicaid’s importance in improving access to care, in this brief we compare health care access of Medicaid beneficiaries to that of the low-income uninsured population. We focus on low-income parents, the group most likely to be affected by the many recent Medicaid changes. We compare the two groups for the nation as a whole, as well as for selected states. While previous research has documented the significant role Medicaid plays in providing access at the national level, only very limited work has examined how the program performs at the state level.

Hurricane Katrina destroyed much of the New Orleans health care system. The devastation was especially profound for the low-income uninsured, most of whom depend heavily on a handful of providers. Focusing on the low-income population, this essay examines some of the early responses to the many health care issues that surfaced in Katrina's wake, and discusses emerging issues that both private and public decisionmakers will face. One potential strategy for rebuilding is a health care safety net based on a continuum of care to low-income residents, integrating a network of community clinics with a new but smaller Charity Hospital.

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.

The Medicare and Medicaid programs distribute extra payments to hospitals that treat a disproportionate share of indigent patients. The disproportionate share hospital (DSH) payment program under Medicare and Medicaid represent an important source of hospital revenues with DSH payments totaled nearly $20 billion in 1998. Yet relatively little is know about the distribution of these payments and how well they are targeted toward safety net hospitals. In a first time national examination of the joint distribution of Medicaid and Medicare DSH funds, we find that the current allocation targets financially vulnerable safety net hospitals at least as well as the alternatives that we examined.

During the late 1990s, New York began to address the state's large and growing uninsured population. The state expanded coverage to children through the Child Health Plus program and Medicaid expansions. More recently, New York expanded coverage to adults through the Family Health Plus and Healthy New York programs. New York has been phasing in enrollment of over two million Medicaid recipients into managed care on a mandatory basis. As of May 2001, approximately 34 percent of those eligible for Medicaid managed care were enrolled. Implementation of mandatory managed care has moved more slowly than anticipated for several reasons. These include: sensitivity around past marketing abuses in New York City, the exit of several Medicaid managed care plans, and lack of support from hospitals-related to plans' and hospitals' perception that the Medicaid capitation rates are too low. New York is faced with the important challenge of enrolling and retaining eligible populations in the new insurance coverage programs. Rising Medicaid expenditures, the current recessionary environment, and the impact of the September 11th attacks on the World Trade Center are likely to complicate this challenge.

With spending totaling more than $15 billion a year, one of the largest public subsidy programs to help pay for health care services for the uninsured is the Medicaid disproportionate share hospital (DSH) program. Although the DSH program sometimes has been highly controversial, this study provides some insights on the experiences of five community programs that have used DSH funds in a positive way: To provide health care services to the uninsured. While each program is unique and faces it own set of circumstances, several lessons are drawn to guide other communities as they search for local solutions to the growing problem of caring for the uninsured.

Paper based on UI survey on the sources of state funds and the uses of DSH expenditures. Paper will also examine how states intend to respond to cuts in federal DHS payments.

The state reports describe the safety net and health care programs in place for low-income people on the eve of welfare reform. The reports also analyze the particular circumstances that are shaping the state's response to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). The state reports are based on case studies in the respective state.