Thesis advisor: Richard McGowan / Vermont had 13.9 overdose deaths per 100,000 people in 2014, almost 2.5 times less than New Hampshire in the same year (Rudd 2016). Much of this has been attributed to the framework Vermont has in place for treatment of Opioid Use Disorder (OUD), specifically the “Hub and Spoke” model of treatment. This model has been highly praised due to the continuity of care waivered spoke physicians are able to provide, and the overall success the program has had in reducing overdoses and addiction as a whole, typically through the “gold standard” of Medication Assisted Treatment (MAT). “The Doorway” as the hub and spoke system is called in New Hampshire, is realistically a referral framework that links people seeking treatment with OUD to a provider, which is very different from the structure in Vermont. Vermont is predicted to spend about $85 million of Medicaid money on treatment for people with OUD in 2019 (Table 1). Meanwhile, New Hampshire, a state with over double the population, is projected to spend $52 million in 2019 (Table 2). This is likely due to differences in Medicaid payment structure and MAT-waivered physician availability; Vermont has a larger rate of MAT providers per 10000 population of 2.71 compared to 2.05 in New Hampshire. New Hampshire Medicaid reimburses behavioral health providers poorly, providing an indexed reimbursement rate of 0.83 in comparison to 1.11 in Vermont (Kaiser Family Foundation 2019). To initiate change and create a treatment utilization rate equivalent to Vermont, it is estimated New Hampshire would have to spend $133 million to $150 million in 2019, which is not possible given the taxation structure in place. / Thesis (BA) — Boston College, 2019. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Economics.

Source: Masters Abstracts International, Volume: 47-06, page: 3543. Adviser: Patrice Vaeth. Includes bibliographical references.

Thesis advisor: Andrew Beauchamp / Thesis advisor: Mathis Wagner / This dissertation considers changes of health insurance system of United States that affect health outcomes and labor market outcomes of population. The first chapter examines how Medicaid policy aimed to improve health status of low-income parents affects the health outcomes of young children. Estimates from variations in Medicaid rules across states and over time, show that there exist positive spillover effects on children from Medicaid expansions targeting parents. The child mortality declines more in states with higher level of generosity in Medicaid policy and the effect is larger among black children. Simulations indicate that recent Medicaid expansion under Affordable Care Act Reform can deepen the existing child mortality disparity across states due to different adoption of Medicaid expansion for low income adult population. The second chapter examines Massachusetts health care reform and its impact on labor market outcomes of older males approaching retirement. I find that older males are more likely to remain in full-time employed status rather to choose early retirement, and part-time employment increased only among low-income population who are eligible for subsidized health insurance. The results suggests that there exists employment-lock effect from increase of employers providing employersponsored health insurances following the reform. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Economics.

archives@tulane.edu / Research has shown that populations with mental illness tend to have higher rates of obesity, diabetes, and other chronic conditions. This can be due in part to the medication treatment as anti-psychotic and anti-depressant medications have been shown to be major contributors to elevated rates of obesity, diabetes, dyslipidemia, and metabolic disorders that have the potential to lead to cardiovascular disease. Existing literature has identified many barriers that contribute to low preventive care utilization and screenings for metabolic risk factors. Consequently, national policy initiatives, such as the 2010 Affordable Care Act’s (ACA) Medicaid expansion, have aimed to improve access to care impacting adults with mental illness and expand coverage for more preventive and mental health services. Thus, this project: (1) examined longitudinal trends in diabetes preventive screenings and healthcare utilization associated with the 2016 Louisiana Medicaid expansion for a traditionally enrolled Severe Mentally Ill (SMI) Medicaid insured population, (2) assessed differences in racial and other socio-demographic characteristics associated with receiving diabetes preventive care and utilizing health care services amongst a traditionally enrolled SMI Medicaid insured population, and (3) assessed if Medicaid expansion was associated with better access to care and increased utilization of preventive care for diabetes-related complications in adults with diabetes and depression. To address these aims, adults ages 18 to 64 were analyzed through two data sources. The first is Louisiana Medicaid claims data; a longitudinal assessment of screening rates over a five-year period was used in an interrupted time series analysis to look at the change in screening rates for preventive care services and health care utilization before and after expansion for adults with SMI. Next, we used multivariable logit regression modeling, to examine the likelihood of receiving preventive care and utilizing health care services based on sociodemographic characteristics. Results from these analyses showed there was a total of 53,926 adults with a diagnosed SMI who had continuous enrollment in Medicaid between January 1st, 2014 – December 31st, 2018. Medicaid expansion was associated with significant increases in ED utilization and average inpatient length of stay for traditionally enrolled SMI adults. Racial differences in the likelihood of going to the ED were also apparent as blacks were more likely to go to the ED and for reasons that could have been prevented. For the third aim, data were extracted from the Behavioral Risk Factor Surveillance System survey for the years 2010 to 2017 for all adults with a self-reported diagnoses of depression and diabetes by a health professional. A retrospective cross-sectional study design using difference-in-differences analysis assessed relationship between Medicaid expansion and access to care and preventive care utilization for Medicaid eligible respondents in expansion states, compared to Medicaid eligible respondents in non-expansion states. Medicaid expansion significantly increased insurance coverage and the likelihood of having a personal doctor for eligible respondents in expansion states. / 1 / Alisha Monnette

Thesis (Ph. D.)--University of Rhode Island, 2005. / Typescript. Includes bibliographical references (leaves 113-116).

From Policy to Practice: Implementation of Georgia’s Medicaid Family Planning Waiver Program Sarah C. Blake, MA 282 pages Directed by Dr. John Thomas The purpose of this research was to examine the implementation of Georgia’s Medicaid family planning program, known as Planning for Healthy Babies® or P4HB®. This program is the first such program to provide both family planning services and inter-pregnancy care services through a Medicaid expansion to low-income, uninsured women. An evaluative case study design was employed using mixed methods. These methods incorporated process measures to study the implementation of P4HB® and to assess whether P4HB® was implemented as planned We incorporated theory from the policy implementation and health care access literatures to understand what served as facilitators or barriers to successful implementation. Findings suggest that despite precise goals and objectives, formal guidance about the program did not incorporate clear implementation planning. Many stakeholders, including advocates, providers, and representatives from implementing agencies felt left out of the implementation process and did not feel invested in the program. Considerable confusion existed among eligible clients and providers about the nature and scope of the P4HB® program. This lack of awareness and understanding about P4HB® likely contributed to the program’s low enrollment and participation in the first year of its implementation. As many states prepare to expand their Medicaid programs under the Patient Protection and Affordable Care Act (ACA), this study provides important lessons for policy planning and implementation.

Thesis (Ph. D.)--University of Texas at Austin, 2002. / Vita. Includes bibliographical references. Available also from UMI Company.

Traditionally, the compliance rates with preventive care services for members in the Medicaid Program are significantly lower than their peers enrolled in a commercial health insurance plan even when there are no financial costs for those services to Medicaid members. Start of life services which include prenatal care for pregnant mothers and well-child visits for newborns and infants are used to focus the research. Non-compliance, defined as not receiving recommended preventive services within the timeframe expected, has large financial and societal costs. Women who receive only the minimal prenatal care are at high risk for developing pregnancy complications and having negative birth outcomes while those that failed to receive prenatal care were three times more likely to have a low-birth weight infant. Within the first 6 months of life, children with incomplete visits are 60 percent more likely to visit the emergency room. They may have untreated development delays and disabilities, which occur in approximately 13 percent of children and are estimated to cost $417,000 in direct medical costs and indirect lost productivity per child. This thesis looks at motivational theories and economic incentives in practice in the health care industry to address the lack of compliance of services. It will analyze the problem from the perspective of how does a business, the State Medicaid Program or Medicaid Managed Care Organization (MCO), get a customer, the Medicaid population, to perform a specific behavior, receive preventive care services using motivational theories. / text

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This paper details several factors that affect Medicaid, the federal program that provides health care reimbursement for millions of low-income Americans. The research presents many challenges to sustaining an equitable welfare system that also produces positive health outcomes. Growing levels of poverty have resulted in increased enrollment in the Medicaid program and projections indicate a continuation of this trend. A decrease in the supply of physicians along with an aging population creates new obstacles to health care access. The Patient Protection and Affordable Care Act (PPACA) introduces additional complexities by expanding Medicaid enrollment, increasing regulatory requirements and reducing payments to health care providers through rate cuts and penalties. / Medicaid -- Health care -- Structures and organizations -- Administrative law and regulation -- Reports and projections -- Expectations and challenges. / Department of Political Science