Publications by Julia F. Costich for Health Policy Center

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Kentucky implemented numerous Medicaid policy changes under authority granted by the Deficit Reduction Act of 2005, which allowed greater flexibility in benefit design and cost-sharing. This case study describes these changes and explores their impacts, along with the political, regulatory, and institutional environments that shaped these impacts. While Kentucky succeeded in meeting some of the original goals of the policy changes, further Medicaid changes would be needed to have major impacts on costs and beneficiary behaviors; however, such changes will likely be heavily dependent on how Kentucky weathers the current economic downturn and on the policy changes the state makes associated with federal health reform efforts.

This study examines the effects of new and higher premiums on SCHIP enrollment in Kansas, Kentucky, and New Hampshire—three states that implemented premium changes in 2003. We used state administrative enrollment records from 2001 to 2004–2005 to track changes in total caseloads, new enrollments, and disenrollment timing in premium-paying categories of SCHIP before and after the premium changes were implemented. Premium hikes were associated with lower caseloads in all three states and with earlier disenrollment in Kentucky and New Hampshire. Premium increases appeared to have greater disenrollment effects for lower-income children in New Hampshire and for nonwhite children in Kentucky.
Inquiry, Volume 43, Number 4 (Winter 2006/2007): 378-392

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