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

Thesis (Ph. D.)--University of Washington, 1998. / Vita. Includes bibliographical references (leaves [141]-150).

Thesis (Ph. D.)--Rutgers University, 2008. / "Graduate Program in Social Work." Includes bibliographical references (p. 177-188).

Thesis (Ph. D.)--University of Hawaii at Manoa, 2004. / Includes bibliographical references (leaves 82-87).

Thesis (Ph. D.)--University of Texas at Austin, 2005. / Supervisor: Marvin D. Shepherd. Vita. Includes bibliographical references.

Thesis (Ph. D. )--Dept. of Political Science and School of Business and Public Administration. University of Missouri--Kansas City, 2004. / "A dissertation in political science and public affairs and administration." Advisor: Max J. Skidmore. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed Feb. 28, 2006. Includes bibliographical references (leaves 435-458). Online version of the print edition.

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As Medicaid moves toward a system of managed care, Aid for Families with Dependent Children (AFDC) recipients often are assigned to an organization that assumes responsibility for managing their annual receipt of health care. This study reports the results of an investigation into the patterns of medical care utilization by AFDC recipients and their children under reformed Medicaid. The issues explored include whether or not medical care utilization patterns vary by race, and if there are identifiable factors that determine the utilization patterns of AFDC recipients and their children. We conclude that racial differences in medical care utilization do exist for AFDC recipients, but not for their children. Policy makers involved in reforming Medicaid should recognize that certain cohorts continue to exhibit undesirable medical care utilization patterns, and implement measures to rectify this situation.

Medicaid is a complicated system for educators to access. LEAs can access Medicaid funds by: billing through a contracted service, establishing their own billing system, or may choose not billing Medicaid. The purpose of this study was to investigate the Medicaid billing processes used in Arkansas public schools. The study considers processes some LEAs use to bill Medicaid for related services, and reasons why other LEAs do not access Medicaid. All LEA supervisors of special education in the state of Arkansas were sent a survey regarding Medicaid billing practices. A total of 87 supervisors responded to all or part of the survey (80%). The survey included three major parts. All supervisors were asked to complete the first section, which asked demographic information. Supervisors who currently bill Medicaid were asked to respond to the second section of the questionnaire, which sought information about the billing process. The third section of the survey was completed by supervisors of nonbilling LEAs. These supervisors were asked to rate a series of possible reasons LEAs do not bill as each pertained to their decision. They were also asked to list and rate any other reasons why they do not bill Medicaid. The respondents worked in systems where attendances usually ranged between 500 and 5,000 students with 106-525 of those students receiving special education. Most school systems in the sample have participated in Medicaid billing (80%). Most (76%) prefer billing Medicaid directly rather than using a billing service. Ninety-seven percent bill Medicaid for speech therapy, 72% for occupational therapy, and 79% for physical therapy. In addition, 31% bill Medicaid for Early Periodic Screening Diagnosis and Treatment (EPSDT). The data suggest that the billing procedures can be incorporated with relative ease into a clerical/secretarial assignment, taking less than four hours per week to transact. Various technologies were utilized for processing, but the most popular was the AEVCS machine. Almost half of the supervisors billing Medicaid experienced problems with other agencies. Suggestions for improvements fell into four categories. These were providing ongoing training for billing districts, simplifying billing requirements and paperwork, improving the software used to submit information, and dealing with DHS and Medicaid agency representatives. For the LEAs responding to the survey, total Medicaid reimbursement was $2,237,006.55. This is 78% of the statewide total. Nonbilling districts indicated that the complexity of the billing process, and personnel factors were reasons they decided against seeking Medicaid reimbursement. The findings of the study lead to recommendations for access to billing information, training, and communication with others involved in the process. / Ed. D.

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.