Uninsured/Uncompensated Care

National health expenditures have grown at record-low rates for the past three years. The recession has been cited as an important driver of recent trends leading many to wonder if slower spending growth will continue as the economy recovers. We review the trends in health spending growth over the last decade and show that growth began to slow well before the most recent recession. We also consider trends in incomes and insurance coverage and suggest that declines in real incomes and a shift towards less generous insurance arrangements have slowed the growth in provider revenues and forced cost containment efforts. The question remains, however, as to whether the changes that slowed health spending growth over the last decade will be maintained or extended as the economy recovers and the Affordable Care Act expands health insurance coverage.

This report presents data on changes in Medicaid's enrollment and spending between federal fiscal year 2007 and federal fiscal year 2011, a period which includes the worst economic downturn in the United States since the Great Depression of the 1930s. The paper also examines what factors drove Medicaid spending over the period, and concludes that overall spending growth from 2007 to 2011 was driven largely by the enrollment growth that resulted from many people losing jobs and income during the recession. However, on a per enrollee basis, Medicaid spending has grown more slowly than other sectors of the health system.

Maternal depression can have severe and lasting consequences for both a mother and her child. This brief uses the National Survey of Drug Use and Health to estimate the prevalence, severity, and treatment of major depression among low-income mothers with young children (ages 0-5). We find that one out of eleven low-income mothers with young children had a major depressive episode in the past year, and nearly one-third did not report receiving any treatment. While uninsured low-income mothers had much lower treatment rates than insured low-income mothers, rates were comparable across treatment providers, suggesting that Medicaid fills an important gap.

Following the introduction of a question on health insurance coverage in 2008, the American Community Survey (ACS) has increasingly been used as a source for state-level health insurance estimates. This reflects a number of key advantages of the ACS, including a survey design that supports state representative estimates for all states and the large size of its sample. As a result, the ACS yields relatively precise state-level estimates of annual health insurance coverage. This paper explores the feasibility of expanding the value of the ACS for tracking health insurance coverage by generating subannual estimates.

Policy experts predict that small employers, especially those with younger and healthier employees, will increasingly establish “self-funded” health plans, leaving the traditional fully insured market to obtain lower premiums and avoid market reforms under the Affordable Care Act. Through interviews with stakeholders in 10 study states, this paper describes factors that may in¬fluence whether and how extensively this change occurs. It also shows that states have minimal data on this potentially growing market, but they would be well served to improve their monitoring efforts so they can identify any increases in small group self-funding and resulting adverse selection, and respond appropriately.

Work Support Strategies (WSS) is a multiyear, multi-state initiative to implement reforms that help eligible low-income families get and keep a full package of work support benefits, including Medicaid, nutrition assistance (SNAP), and child care assistance. This report summarizes the lessons learned from the nine planning grant states (Colorado, Idaho, Illinois, Kentucky, New Mexico, North Carolina, Oregon, Rhode Island, South Carolina), just one year into a four-year project. The report includes what the states did, how they overcame challenges, and how the planning year changed their strategies and capacities for the future.

Work Support Strategies (WSS) is a multiyear, multi-state initiative to implement reforms that help eligible low-income families get and keep a full package of work support benefits, including Medicaid, nutrition assistance (SNAP), and child care assistance. This report describes Colorado's accomplishments and lessons learned during the initiative’s first year. In this planning year, Colorado improved collaboration between the state human services and health agencies, and between the state and counties. Improved collaboration led to a shortened joint benefit application, quicker processing of SNAP applications and recertifications, cohesive plans for implementing health reform, and supplemental budget funds to improve the statewide automated benefits system.

Work Support Strategies (WSS) is a multiyear, multi-state initiative to implement reforms that help eligible low-income families get and keep a full package of work support benefits, including Medicaid, nutrition assistance (SNAP), and child care assistance. This report describes Idaho's accomplishments and lessons learned during the initiative's first year. In this planning year, Idaho implemented policy and process improvements, including improving the redetermination process by aligning redetermination dates and further implementing the universal workforce case management approach. The state also implemented child care assistance program reforms including aligning policy with other work support programs and simplifying eligibility requirements.

Work Support Strategies (WSS) is a multiyear, multi-state initiative to implement reforms that help eligible low-income families get and keep a full package of work support benefits, including Medicaid, nutrition assistance (SNAP), and child care assistance. This report describes Illinois' accomplishments and lessons learned during the initiative's first year. In this planning year, the state identified how and where to best align programs to simplify eligibility processes, including an assessment of child care assistance policies and development of a key performance measures report for local office managers. The state designed and piloted a new task-based model to improve benefit field office efficiency.

Work Support Strategies (WSS) is a multiyear, multi-state initiative to implement reforms that help eligible low-income families get and keep a full package of work support benefits, including Medicaid, nutrition assistance (SNAP), and child care assistance. This report describes North Carolina's accomplishments and lessons learned during the initiative's first year. In this planning year, North Carolina broke down state program silos and instituted a review board to assure cross-program input to policy changes. The state engaged with counties around the implementation of a new benefits eligibility system and encouraging innovation in business processes and piloted alignment of program certification dates.