Research by Author & Topic

Publications by Teresa A. Coughlin on Medicaid

Using state survey data, researchers examined Medicaid supplemental payments, including disproportionate share hospital and upper payment limit payments in 2005 and changes in these payments between 2001 and 2005. The researchers found that states increased their use of general funds in financing Medicaid DSH payments while expanding the size and scope of other supplemental payments considerably. Although the federal government has made some headway in reforming state Medicaid financing in recent years, the paper concludes that problems persist and more work remains.

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)

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.

In a Health Affairs web exclusive, Terri Coughlin and Stephen Zuckerman examined budget decisions in eight states over the 2003-05 time period when states faced some of their largest budget shortfalls since World War II. Coughlin and Zuckerman report that, on balance, states were reluctant to raise taxes or reduce either benefits or eligibility for Medicaid and SCHIP. Instead, they frequently relied on one-time actions such as shifting money from surplus accounts into general funds, changing accounting rules or delaying payments from one fiscal year into the next. The authors concluded that by taking this approach, however, some states have created structural deficits that will profoundly influence state policy making for many years to come. (Health Affairs Web Exclusive, August 16, 2005)

This study examined how the Medicaid program is providing access to beneficiaries, using the level of access available to low-income privately insured people in the local health care market as the benchmark. The analysis, which focused on ambulatory care measures, was done for the nation as a whole and for thirteen individual states. The researchers concluded that, on balance, Medicaid beneficiaries fared no worse than their low-income privately insured peers in most of the states examined. (Coughlin, Teresa A., Long, Sharon K., Shen, Yu-Chu. July/August 2005. "Assessing Access to Care Under Medicaid: Evidence for the Nation and Thirteen States." Health Affairs 24(4): 1073-1083.)

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 examines differences in access and use of care among children on Medicaid with physical disabilities, mental illness, and mental retardation or developmental disabilities in New York City. Using 1999 and 2000 survey data for a random sample of disabled children, we find that the Medicaid program has been successful at linking disabled children to health care providers. However, there is evidence of access problems for all disabled children, with access worse for some subgroups of disabled children. (Health Care Financing Review 26(2): 89–103.)

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.)

In this report we examine how New York responded to its budget crisis in fiscal year 2004. While states vary in the depth of the budget pressures they faced, all were required to make difficult choices among spending reductions, tax increases, or other revenue measures.