Thesis (Ph.D.)--University of Wisconsin--Madison, 2006. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (p. 155-163).

This study assesses cost savings associated with specific contraceptive methods provided to beneficiaries enrolled in South Carolina Medicaid between 2012 and 2018. Incremental cost-effectiveness ratios, defined as the additional cost of contraception provision per live birth averted, were estimated for 4 contraceptive methods (intrauterine devices [IUDs], implants, injectable contraceptives, and pills), relative to no prescription method provision, and savings per dollar spent on method provision were calculated. Costs associated with publicly funded live births were derived from published sources. The analysis was conducted for the entire Medicaid sample and separately for individuals enrolled under low-income families (LIFs), family planning, and partners for healthy children (PHC) eligibility programs. Sensitivity analysis was performed on contraceptive method costs. IUDs and implants were the most cost-effective with cost savings of up to $14.4 and $7.2 for every dollar spent in method provision, respectively. Injectable contraceptives and pills each yielded up to $4.8 per dollar spent. However, IUDs and implants were less cost-effective than injectable contraceptives and pills if the average length of use was less than 2 years. Medicaid's savings varied across Medicaid eligibility programs, with the highest and lowest savings from contraceptive provision to women in the LIFs and PHC eligibility programs, respectively. The results suggest the need to account for unique needs and preferences of beneficiaries in different Medicaid eligibility categories during contraception provision. The findings also inform program administration and provide evidence to justify legislative appropriations for Medicaid reproductive health care services.

The coronavirus pandemic exposed the systemic issues faced by nursing homes with a higher percentage of Medicaid residents. By using the Brown University's Long-Term Care focus facility-level data and the Centers for Medicare and Medicaid Services data, the study examines the association between the nursing home and resident characteristics with Covid-19 cases in high-Medicaid nursing homes. Fifty-eight facilities in Florida were identified as having residents whose primary support was Medicaid. The findings from the study suggest a higher proportion of Medicaid residents, for-profit status, and chain affiliation status, were associated with a higher prevalence of Covid-19 cases among nursing home residents. Further research on related health policies is necessary to resolve the current disparities in nursing home care serving a higher proportion of Medicaid residents.

No description available.

Source: Masters Abstracts International, Volume: 46-05, page: 2667. Advisers: David P. Cappelli; Benjamin S. Bradshaw. Includes bibliographical references.

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2006. / Title from first page of PDF document. Includes bibliographical references (p. 104-110).

Asthma is a prevalent chronic disease with high health care utilization and excessive costs. Adherence to asthma long-term controller medications is one of the key drivers to improve asthma management. The purpose of this study was to investigate how patient characteristics and medication regimens, including adherence, impact asthma-related outcomes, which was represented by the use of quick-relief medications: oral corticosteroids (OCSs) and short-acting [beta]2-agonists (SABAs). Texas Medicaid prescription claims from July 1, 2008 to August 31, 2010 were retrospectively analyzed. Patients aged 5-63 years with a primary diagnosis of asthma (ICD-9 code 493) and four or more prescription claims for any asthma medication in one year (persistent asthma) were included. The primary outcomes were adherence to asthma long-term controller medications estimated by Proportion of Days Covered (PDC) and asthma control defined by the number of OCS and SABA claims. A total of 32,172 patients were included in the study. The majority of the patients were on monotherapy (58.9%), with leukotriene receptor antagonists (LTRAs) being most commonly prescribed (65.6%). Among patients on combination therapy (41.1%), fixed dose combinations of inhaled corticosteroids (ICSs) plus long-acting β-agonists (LABAs) were most commonly prescribed (51.9%). Mean (±SD) adherence to controller therapy was 32.2% (±19.7). Patients on LTRAs were 7.7% more adherent compared to patients on ICS therapy, and patients on fixed dose combination therapy were 4.5% more adherent compared to patients on concurrent therapy, while controlling for covariates (age, gender, race, number of non-study medications) (p<0.0001). The likelihood of having 6 or more claims for SABA in one year was significantly higher for adherent (PDC≥50%) patients (p<0.0001). However, the likelihood of OCS use was significantly higher for nonadherent (PDC<50%) patients compared to those who were adherent (p<0.0001). In conclusion, adherence to long-term controller medications was low among patients with asthma. Healthcare providers should emphasize adherence to controller therapy among patients with asthma. Being adherent is critical in prevention of asthma exacerbations requiring OCS use. As frequent SABA use signals poor asthma control, healthcare providers and patients (both adherent and nonadherent) should be educated/re-educated about SABA inhaler use. / text

Purpose: To assess the effect of dental Medicaid reforms in the state of Virginia on dental plan performance. Methods: This project is a retrospective cohort study of 825,000 dental claims obtained from the Virginia Department of Medical Assistance Services. This cohort includes dental claims for children enrolled in Virginia’s Medicaid program from July 1, 2002 through June 30, 2008. The independent variable was enrollment pre or post policy reform with July 1, 2005 as the period dividing date. The dependent variable was dental benefit utilization measured as the average number of restorative, preventative, and total procedures. Statistical methods include Welch’s t-test and repeated measures mixed model ANOVA controlling for gender, race, age, length of enrollment, gaps in patient enrollment, citizenship status, and geographic location. Results: This cohort of data showed a significant increase in the total number of procedures utilized by enrolled children (P value < 0.001). There were also significant increases in restorative services across all periods of enrollment. Conclusion: The consolidation of Virginia’s multiple managed care programs into a single vendor with increased reimbursement levels resulted in increased in access to care and improved utilization of dental services for children enrolled in Medicaid.

Medicaid orthodontic patients have been shown to miss more appointments and break more appliances than self-pay patients, indicating a greater tendency toward non-compliance. Lack of compliance during the post-treatment phase can be detrimental to retention. The purpose of this study was to determine whether there is a difference in PAR score changes between Medicaid and non-Medicaid patients during and after orthodontic treatment. PAR scores were determined using study models of 43 Medicaid and 39 non-Medicaid patients before and at the end of active treatment, and 24 Medicaid and 42 non-Medicaid patients at the end of treatment and at an average of 13 months post-treatment. PAR scores generally reduce during treatment and will increase if relapse occurs. Rates of PAR score change during and after treatment were compared between Medicaid and non-Medicaid patients using the Mann-Whitney U-test. The mean initial PAR score was greater in the Medicaid group (31.95 versus 23.28; p=0.003) while there was no significant difference found between the two groups for the end of treatment PAR scores (3.22 versus 2.93; p=0.451). The rates of PAR score improvement during treatment (14.07/year versus 12.14/year; p=0.203) and worsening after the removal of orthodontic appliances (2.04/year versus 2.91/year; p=0.872) were found not to differ between the two groups. It was found that the rate of PAR score improvement during treatment did not differ between Medicaid and non-Medicaid patients. During the post-treatment period, the rate of PAR score worsening was also found not to differ.

Background: The percentage of overweight children has tripled in the last thirty years. Inconsistent findings are published regarding the relationship between socioeconomic variables and being overweight in childhood.Objective: To determine whether socioeconomic variables are associated with risk of being overweight among six year olds. Methods: Six year olds with BMI data were selected from the National Survey of Children's Health (n=4,362). Variables were coded and a low socioeconomic index was created. Using population weights, descriptive statistics were generated and regression was utilized to assess the relationship between socioeconomic variables and being 'at risk' for overweight. Socioeconomic variables were also compared by risk status.Results: Approximately 47% of the sample was 'at risk' of overweight (BMI ≥ 85th percentile). Males and nonwhites were more likely to be 'at risk' than their counterparts. After adjustment, the proportion of those with Medicaid was greater among the 'at risk' group compared to those who were 'not at risk' (38.3% vs. 35.3%' p-value=0.010). Those 'at risk' were also more likely to have free/reduced-cost breakfast/lunch (60.3% vs. 51.8%, p-value=Conclusion: Several low socioeconomic indicators as well as a composite index were associated with being 'at risk' for childhood overweight. With the current obesity epidemic, governmental agencies should identify low socioeconomic groups and target interventions specific to these vulnerable populations.