Health Policy Center Authors
Publications by Stacey McMorrow for Health Policy Center
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More about Stacey McMorrow's areas of expertise can be found on this Urban Institute expert's page.
Risk-Based Managed Care in New Hampshire's Medicaid Program (Research Report)
Ashley Palmer, Stacey McMorrow, Genevieve M. Kenney
In December 2013, New Hampshire began the statewide transition to risk-based managed care in its Medicaid program. This report provides an overview of managed care implementation for Medicaid acute care services, drawing upon a case study conducted in July 2014. We found that initial implementation of managed care went relatively smoothly, due in part to the state’s active oversight role. However, both providers and Medicaid beneficiaries reported significant problems with prior authorization processes. As Medicaid managed care continues to evolve in New Hampshire, we will continue monitoring these and other issues as part of an ongoing evaluation.
CHIPRA Mandated Evaluation of the Children's Health Insurance Program: Final Findings (Research Report)
Genevieve M. Kenney, Lisa Clemans-Cope, Ian Hill, Stacey McMorrow, Jennifer M. Haley, Timothy Waidmann, Sarah Benatar, Matthew Buettgens, Victoria Lynch, Nathaniel Anderson, Additional Authors
This report presents findings from an evaluation of CHIP mandated by CHIPRA and patterned after an earlier evaluation. Some of the evaluation findings are at the national level, while others focus on the 10 states selected for more intensive study: Alabama, California, Florida, Louisiana, Michigan, New York, Ohio, Texas, Utah, and Virginia. The evaluation included a large survey conducted in 2012 of CHIP enrollees and disenrollees in the 10 states, and Medicaid enrollees and disenrollees in three of these states. It also included case studies conducted in each of the 10 survey states in 2012 and a national telephone survey of CHIP administrators conducted in early 2013.
Taking Stock: Health Insurance Coverage for Parents under the ACA in 2014 (Policy Briefs/Health Policy Briefs)
Genevieve M. Kenney, Nathaniel Anderson, Sharon K. Long, Lisa Dubay, Stacey McMorrow, Lisa Clemans-Cope, Michael Karpman, Douglas A. Wissoker
In this brief, we use data from the June 2014 Health Reform Monitoring Survey (HRMS) to examine changes in health insurance coverage for parents since September 2013. The HRMS was designed to provide early feedback on ACA implementation to complement the more robust assessments that will be possible when the federal surveys release their estimates of changes in health insurance coverage later in 2014 and in 2015. We find that the uninsurance rate declined by 14.4 percent for parents nationally between September 2013 and June 2014 and by 33.3 percent for parents in states that expanded Medicaid. As the ACA moves forward, it will be important to assess (1) whether these coverage gains translate into improvements in access to care, health status, and financial well-being for parents and (2) the extent of positive spillover effects on parents' children.
A First Look at Children's Health Insurance Coverage under the ACA in 2014 (Policy Briefs/Health Policy Briefs)
Genevieve M. Kenney, Joan Alker, Nathaniel Anderson, Stacey McMorrow, Sharon K. Long, Douglas A. Wissoker, Lisa Clemans-Cope, Lisa Dubay, Michael Karpman, Tricia Brooks
Beginning in June 2013, the Urban Institute's Health Reform Monitoring Survey (HRMS), which was designed to provide early feedback on implementation of the Affordable Care Act (ACA), has been tracking changes in health insurance coverage and other outcomes for children under the ACA. In contrast to adults, uninsured rates for children had been declining in the decade before the ACA's passage, largely because of the expansion of public coverage (Medicaid and the Children's Health Insurance Program) which is substantially generous and draws high participation among children. Estimates derived from HRMS children's supplement suggest that uninsured rates for children had not changed by June 2014 from their pre-ACA levels, though there are reasons to expect that children's coverage will grow in future years.
How are States and Evaluators Measuring Medical Homeness in the CHIPRA Quality Demonstration Grant Program? (Research Report)
Stacey McMorrow, Anna Christensen, Brenda Natzke, Kelly J. Devers, Rebecca Peters
Many Medicaid and CHIP programs and private health plans are pursuing medical home initiatives aimed at improving the quality of health care, but varying conceptual definitions and measurement goals have led to the development of a number of different medical home measurement tools. This Evaluation Highlight, funded by the U.S. Department of Health and Human Services, examines the measurement of "medical homeness" in selected CHIPRA Quality Demonstration projects, describes the development of the Medical Home Index-Revised Short Form (an adaptation of the Medical Home Index survey), and presents preliminary statistics on medical homeness for demonstration practices in six States.
What Drove the Recent Slowdown in Health Spending Growth and Can It Continue? (Research Report)
John Holahan, Stacey McMorrow
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.
Medicare and Medicaid Spending Trends and the Deficit Debate (Research Report)
John Holahan, Stacey McMorrow
Understanding what is driving the spending growth in Medicare and Medicaid is important for identifying appropriate policies to address it. This paper finds that spending in both programs has been and will continue to be significantly affected by growth in enrollment. Over the next decade, projections suggest that annual growth in spending per enrollee in both programs will be close to growth in GDP per capita, a target often advocated by those concerned with the nation's deficit. These findings suggest a need for continued vigilance in monitoring Medicare and Medicaid spending levels and growth, but do not support an argument for major restructuring of either program.
Virtually Every State Experienced Deteriorating Access to Care for Adults over the Past Decade (Research Report)
Genevieve M. Kenney, Stephen Zuckerman, Dana Goin, Stacey McMorrow
We use the Behavioral Risk Factor Surveillance System (BRFSS) to explore state-level changes in access to care over the past for all nonelderly adults and for uninsured adults. Deterioration in access to care was evident in virtually every state and the situation was worse for the uninsured than for other adults in most states. At the end of the decade, the uninsured were at a dramatic disadvantage relative to the insured. This analysis suggests that the potential benefits of the coverage expansion in the Affordable Care Act (ACA) are large and exist in every state.
Addressing Barriers to Health Insurance Coverage Among Children: New Estimates for the Nation, California, New York, and Texas (Research Report)
Stacey McMorrow, Genevieve M. Kenney, Christine Coyer
Maximizing health insurance coverage for children under the ACA will require addressing the complex scenarios that prevent some children from obtaining or retaining coverage. These scenarios include situations where children are eligible for Medicaid or CHIP but their parents are not, as well as those where children are living without at least one of their parents. We provide national estimates of the number of children in these complex coverage scenarios and find that children facing at least one complex scenario are more likely to be uninsured than other children. In addition to national estimates, we present state-level estimates for California, New York, and Texas.
Decade of Health Care Access Declines For Adults Hold Implications For Changes In The Affordable Care Act (Research Report)
Genevieve M. Kenney, Stacey McMorrow, Stephen Zuckerman, Dana Goin
The pending Supreme Court decision and next fall's election raise concerns about what would happen if the insurance expansion in the Affordable Care Act is curtailed. The National Health Interview Surveys for 2000 to 2010 show that access and use for non-elderly adults - the primary targets of the ACA - deteriorated throughout the decade, particularly among those who are uninsured. Children – many of whom qualify for Medicaid and CHIP - generally maintained or improved their access to care. This provides a reason for optimism about the ability of the ACA to improve access for adults, but suggests that eliminating the ACA would likely result in continued erosion of adults’ access to care.