State Medicaid programs were established to care for the poor by eliminating financial barriers and increasing their ability to be treated within the mainstream of the heath care system. The number of children eligible for Medicaid services is increasing, yet the number of Medicaid providers remains low. Health care providers cite failed appointments as being a major problem with Medicaid patients and one of the largest deterrents to participating. The purpose of this study was to determine whether a difference in appointment keeping behavior exists between Medicaid and non-Medicaid orthodontic patients. During a twelve-month period, a tally of appointments was kept for 707 active patients at Virginia Commonwealth University's Department of Orthodontics. Patients were categorized as either Medicaid or non-Medicaid and their appointment keeping behavior was evaluated. The results revealed that a significant difference does exist in the number of failed appointments between the groups (P<0.0001). The Medicaid patients failed 247(15.4%) of 1609 appointments and non-Medicaid patients failed 367(8.3%) of 4438 appointments. Additionally, these data show that although Medicaid patients accounted for only 26.6% of all appointments, they were responsible for about 40% of all appointment failures. The findings from this study support the concern among dental practitioners that Medicaid patients have higher rate of appointment failures than non-Medicaid patients.

Master of Public Health / Department of Human Nutrition / Sandra B. Procter / Nutritionally vulnerable women are more apt to give birth to low birth weight, small for gestational babies who have increased medical complications and higher risk of mortality. Participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) prenatally has been found to enhance positive pregnancy outcomes for women; reduced risk of low birth weights and nutrient deficiencies thus reducing the costs associated with medical care for infants covered by Medicaid, the joint federal and state insurance program for low income women, which covers 40% of infants in the United States. Pregnant women covered by Medicaid insurance are normally at the most risk but are adjunct eligible for the WIC program. This descriptive cross-sectional research study determined the demographic and nutritional characteristics of Medicaid births in the WIC program compared to non-Medicaid births for the 2009 WIC program year, using the Kansas birth certificate, WIC program data linked to the birth certificate by unique identifying code. Results from the study show that the Kansas WIC and Medicaid programs are serving the target population for the objectives of the programs. Mothers of Medicaid births who received WIC food during pregnancy and those in the WIC program are of low socioeconomic status and they are more likely to be younger in age, of minority racial group, less educated, never married and less likely to breastfeed infants at discharge and high likelihood of smoking. Compared to Medicaid births that did not participate in the WIC program, women at the lower margins of low socioeconomic status participated in WIC, signaling that the most vulnerable were getting the needed services. Distinct findings from the Kansas WIC program reveal that Medicaid births in the WIC program were more likely to be breastfed at discharge, compared to Medicaid births not in the WIC program, even though WIC recipients had demographic characteristics associated with low breastfeeding patterns. A study investigating the reasons for not enrolling in WIC by Kansas Department of Health would be beneficial to the WIC program’s goal to provide nutrition support to low income eligible women, infants and children in Kansas.

The objective of this study was to explore a possible association between infant mortality rate (IMR) and Medicaid dental benefit payouts per state, as well as propose an expansion of the dental benefits provided through Medicaid. Data was obtained from the Vital Statistics report 2012 and the Center for Medicare & Medicaid Services (CMS) Medicaid coverage database for fiscal year 2011. Population and demographic data was also collected for further comparison. The states observed were Alabama, Georgia, Kentucky, Louisiana, North Carolina, South Carolina, and Tennessee. The IMR data was ranked in ascending order and then the dental payments were compared between the seven southern states. There did not appear to be an association between the two variables. It was hypothesized that the state with the highest IMR would have the least amount of Medicaid dental payments; possibly indicating limited benefits and a need for expansion. The data did not support the hypothesis. Although Mississippi had the highest IMR at 9.9 per 1,000 live births, the amount dental benefits paid through Medicaid was not the lowest. Kentucky had the lowest IMR at 6.9 per 1,000 live births, and North Carolina had the highest amount of dental payments with $352,602 being paid by the state. However, the comparing variable in each state did not reflect an association. Limitations of the study were addressed and suggested improvements were made for future studies that would possibly yield significant findings. In conclusion, the data collected and observed did not provide evidence that the expansion of Medicaid dental benefits would combat infant mortality rates across the country.

A steady increase of new immigrants to the United States has sparked a great debate on the financial impact the foreign born population has on public services. While the United States government has an extensive history on exclusions for potential public charges, the impact of negative attitudes towards immigrants has caused substantial changes in eligibility criteria for legal permanent residents and ultimately immigration policy at large. This report uses group threat theory, which predicts a punitive response from a dominant group when these individuals perceive a threat to their group interests to explain shifts in attitudes and corresponding changes in eligibility criteria for public benefit programs for immigrants. Additionally, this study examines how U.S. citizens’ misinformed perceptions of immigrants’ utilization of public programs may negatively influence public support for increased government spending on public health care programs. To quantify the implications of public attitudes, the study uses repeat crosssectional data on attitudes towards immigration from the General Social Survey (GSS) from 1994 (N=578), prior to Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. The responses are compared to a similar survey conducted by GSS in 2004 (N=365) an era of steep economic growth and substantially higher health care costs.

Thesis (Ph. D.)--University of Chicago, School of Social Service Administration, August, 2001. / Includes bibliographical references. Also available on the Internet.

A steady increase of new immigrants to the United States has sparked a great debate on the financial impact the foreign born population has on public services. While the United States government has an extensive history on exclusions for potential public charges, the impact of negative attitudes towards immigrants has caused substantial changes in eligibility criteria for legal permanent residents and ultimately immigration policy at large. This report uses group threat theory, which predicts a punitive response from a dominant group when these individuals perceive a threat to their group interests to explain shifts in attitudes and corresponding changes in eligibility criteria for public benefit programs for immigrants. Additionally, this study examines how U.S. citizens’ misinformed perceptions of immigrants’ utilization of public programs may negatively influence public support for increased government spending on public health care programs. To quantify the implications of public attitudes, the study uses repeat crosssectional data on attitudes towards immigration from the General Social Survey (GSS) from 1994 (N=578), prior to Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. The responses are compared to a similar survey conducted by GSS in 2004 (N=365) an era of steep economic growth and substantially higher health care costs. / text

Although bevacizumab is one of the most commonly used treatments for DME and AMD, there are concerns regarding safety and effectiveness due to its off-label use. The study objectives were to determine if: 1) the risk of cardiovascular/ hemorrhagic events (safety) and visual impairment (effectiveness) differed by bevacizumab use (i.e., use vs. non-use and number of treatments) among DME and AMD patients; and 2) direct medical costs differed between DME and DME control patients. A retrospective cohort analysis was conducted with Texas Medicaid medical and prescription data (9/1/07-12/31/12) for patients: 18- 63 years, continuously enrolled 1-year pre- and post-index, and diagnosed with DME or AMD. The index date was the first date of diagnosis. The dependent variables were: 1) cardiovascular/hemorrhagic risk; 2) visual impairment; 3) direct medical costs. The independent variables were bevacizumab use and number of bevacizumab treatments. Covariates were disease state, Charlson Comorbidity Index (CCI) score, total medication use, number of laser treatments, and demographics. Propensity scoring technique was used to match: 1) bevacizumab users and non-users; and 2) DME and DME control cohorts. Descriptive analyses, logistic regression, Cox-regression, and generalized linear models were employed. A final cohort of 3,647 DME, 297 AMD, and 57,897 DME control patients were included. The majority (DME and AMD) was between 45-63 years of age (86.6%), Hispanic (54.0%), and female (65.1%). The mean total number of unique medications and mean CCI were 2.7 ± 3.4 and 6.0 ± 3.3, respectively. Total direct medical costs/person (Mean (±SD)) incurred by DME, DME control, and AMD subjects in the post-index period were $6,704(±9,338), $5,495(±10,153), and $4,935(±12,702), respectively. No differences in cardiovascular/ hemorrhagic risk were found between bevacizumab users and non-users. The claims data lacks the detail to determine the effectiveness of bevacizumab. DME control patients had lower overall direct medical costs than DME patients (p<0.0001). In conclusion, although bevacizumab is a less expensive off-label alternative of ranibizumab, the choice between bevacizumab and ranibizumab should be made through careful consideration. However, as the use of anti-VEGF agent increases, further research should be conducted to determine if any changes in cardiovascular adverse events occur. / text

The primary goals of the National Health Planning and Resources Development Act (P.L. 93-641) of 1974 were to (1) contain health care costs and (2) increase the accessibility and quality of health services. Certificate of need (CON) regulation is one attempt to constrain health care costs by limiting the supply of certain medical care facilities. With respect to the nursing home industry, prospective nursing home owners/operators are required to demonstrate that a "need" exists for more nursing home beds. Some States also imposed a construction moratorium that prevented any expansion of existing facilities or construction of new facilities regardless of whether or not a "need" existed. These CON/moratorium programs impose a supply side constraint that creates a potential barrier to entry and in the presence of excess demand may cause a nursing home bed shortage for those residents covered by Medicaid. Even though the Federal CON requirement lapsed in 1986, forty-two St ates and the District of Columbia continue to have a CON, a construction moratorium, or both for nursing home facilities. Yet maintaining these regulations comes with a cost.This paper investigates if differences exist in the quality of care and the access to care between nursing homes in those States without CON and/or construction moratorium and those States that still have such policies. Using data for the years 1991 through 2003 for all freestanding Medicaid-/Medicare-certified nursing home facilities in the United States and employing state and facility fixed effects models we find that Medicaid-eligible residents in those states without CON and/or construction moratorium policies have more access to a nursing home bed than those individuals in states with these policies. With respect to quality of care the results are mixed depending on the measure of quality that is employed. With the risk of becoming a nursing home resident at the age of 65 at 44 percent and at the age of 8 5 at 53 percent (Spillman and Lubitz 2002) coupled with the aging of the current population, the areas of quality of care and access to care remain important policy issues in the nursing home industry.

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Numbers of caesarean sections, epidurals, and other forms of medical interventions for birthing are rising in the United States healthcare industry. One possible reason is the medicalization of birthing and labor techniques. Another potential reason is the increasing distinction between laboring in a hospital versus laboring in the home or an independent birthing center. The dominance of the medical model of birthing has led to social constructions of birthing that divide women by diagnosis, into either high-risk or low-risk prenatal categories, further perpetuating the medical model’s power to marginalize the midwifery model. Forty percent of U.S. births are financed by Medicaid insurance. Because Medicaid insurance is based on the technocratic medical model, birthing providers that accept Medicaid insurance may be pressured, directly and indirectly, to adopt the medical model as the most appropriate birthing option, decentering the midwifery model. Inevitably, this potentially shifts birthing options and experiences for low-income women in the U.S. In order to understand how low-income women experience birthing in U.S birthing institutions, we first need to take a closer look at how birthing facilities socially construct birthing. Among many areas of influence for the social construction of birthing, website content has been neglected as a form of primary data. Using content analysis, this study investigates how web content aids in the social stock of knowledge on labor and delivery. Analyzing the websites of three birthing centers and two public hospitals that accept Medicaid insurance in Miami, Florida, this study’s findings indicate that the language used on birthing center websites aligns with the midwifery model, but reverts to the medical model used by hospitals, in language and policy, when discussing cases of emergency birthing. The public hospital websites, meanwhile, appropriate the language and procedures of the midwifery model without providing the practical benefits of natural birthing. Findings in this study also capture a snapshot of birthing models used by providers in Miami, Florida ahead of its 2016 transition from the Florida Medicaid system to the Federally-Funded Marketplace, as per the Affordable Care Act of 2009. By assessing how birthing providers socially construct birthing, we could reduce the underrepresentation of natural birthing, exposing low-income women to more balanced depictions of both the medical and midwifery models of birthing, possibly reducing negative socio-emotional outcomes during birthing, postpartum depression and maternity-mortality rates among the poor.