Exploring the Effect of Anti-immigration Rhetoric on Emergency Department Use by Undocumented Adults.

An unwelcoming policy climate can create barriers to health care access and produce a 'Chilling Effect' among immigrant communities. For undocumented immigrants, barriers may be unique and have a greater impact. We used administrative emergency department (ED) data from 2015 to 2019 for a Midwestern state provided under a data use agreement with the state hospital association.

Dental Care in Programs of All-Inclusive Care for the Elderly: Organizational Structures and Protocols.

Objectives: This study uses a national model of community-based long-term services and supports, the Program of All-inclusive Care for the Elderly (PACE), to identify organizational structures and protocols that can facilitate the delivery of dental examinations.

Design: We developed an online survey instrument and conceptual model for this study representing 10 domains believed to characterize a quality PACE dental program.

Setting And Participants: The Qualtrics survey was distributed nationally to all 124 PACE programs in the 31 states PACE was available.

Iowa's Medicaid Healthy Behaviors Program Associated With Reduced Hospital-Based Care But Higher Spending, 2012-17.

Health behavior incentive programs are increasingly common in Medicaid programs nationwide. Iowa's Healthy Behaviors Program (HBP) requires Medicaid expansion enrollees to complete an annual wellness exam and health risk assessment or pay monthly premiums to avoid disenrollment. The extent to which the program reduces the use of hospital-based care and lowers health care spending is unknown.

Implementation Matters: Lessons From Iowa Medicaid's Healthy Behaviors Program.

Iowa's Medicaid expansion includes the Healthy Behaviors Program (HBP), which incentivizes enrollees to receive a wellness exam and complete a health risk assessment annually to waive a monthly premium. We conducted a telephone survey with enrollees to examine their awareness and understanding of the HBP, and we then merged the survey data with claims data to examine factors associated with the completion of program requirements. As found in previous research, awareness of the HBP remains low, with approximately half of respondents unaware of the program or the premium requirement.

Setting the PACE for frail older adults in the community: An underused opportunity for furthering medical-dental integration.

Background: The integration of dentistry into comprehensive and long-term care has occurred infrequently and with limited success. The authors aim to describe how the Program of All-Inclusive Care for the Elderly (PACE) has the potential for such incorporation for the growing population of nursing home-appropriate older adults preferring to age in place.

Methods: The authors used a 56-item online survey to explore aspects of oral health care within PACE, including organizational structure, availability and provision of care, preventive protocols, and provider reimbursement.

Purged from the Rolls: A Study of Medicaid Disenrollment in Iowa.

To describe the impact of disenrollment from Medicaid because of failure to pay premiums as part of Iowa's Medicaid program's personal responsibility component. We conducted a mixed method study consisting of in-depth interviews with disenrolled members in 2016 and 2017 (=72) and a survey of disenrolled members in 2017 (=225). Many disenrollees did not know why they were disenrolled, were unaware of the personal responsibility component or premium requirement, and were confused by the disenrollment process.

Disparities in diabetes management among medicaid recipients with intellectual and developmental disabilities (IDD): Evidence from five U.S. states.

Background: Diabetes is one of the most common chronic conditions among adults. Little is known about the quality of diabetes care received by adults with intellectual and developmental disabilities (IDD).

Objective: To determine the extent to which the diabetes care needs are met for a population with both IDD and diabetes who are solely insured by Medicaid in five states (Iowa, Massachusetts, New York, Oregon and South Carolina).

Preventive dental care among Medicaid-enrolled senior adults: from community to nursing facility residence.

Objective: The primary objective of this study was to determine whether the utilization rate of preventive oral health care services while senior adults were community-dwelling differed from the rate after those same senior adults were admitted to nursing facilities. A secondary objective was to evaluate other significant predictors of receipt of preventive oral health procedures after nursing facility entry.

Methods: Iowa Medicaid claims from 2007-2014 were accessed for adults who were 68+ years upon entry to a nursing facility and continuously enrolled in Medicaid for at least three years before and at least two years after admission (n = 874).

Iowa's Medicaid Expansion Promoted Healthy Behaviors But Was Challenging To Implement And Attracted Few Participants.

As part of Iowa's Medicaid expansion, the Healthy Behaviors Program was designed to provide members with incentives to complete specified healthy activities in return for waiving monthly premiums. We used claims data and interviews to document the first year (2014) of the program's implementation. Healthy activities completion rates did not exceed 17 percent.

The importance of matching the evaluation population to the intervention population: Using Medicaid data to reach hard-to-reach intervention populations.

Subject recruitment is a challenge for researchers and evaluators, particularly with populations that are traditionally hard to reach and involve in research, such as low-income and minority groups. However, when the evaluation sample does not reflect a program's intended audience, the discrepancy may lead to evaluation results that are not valid for that audience. We conducted evaluation activities for a state Supplemental Nutrition Assistance Program-Education (SNAP-Ed) intervention that promotes consumption of fruits and vegetables (F&V) in low-income areas.

Understanding Clinic Practices for Human Papilloma Virus Vaccination Series Completion in Clinics That Provide Primary Care: Survey of Clinic Managers in Iowa.

Background: Rates for human papilloma virus (HPV) vaccination are low across the United States. Evidence-based-practices to increase immunization coverage have been recommended by public health organizations, yet many primary care clinics do not follow these practices. The purpose of this study was to examine if primary care clinics use these best practices to promote completion of the HPV vaccine series for their adolescent patients.

Medicaid Health Home Reducing Costs and Reliance on Emergency Department: Evidence From Iowa.

Background: The Affordable Care Act allowed an optional Medicaid State Plan benefit for states to establish Health Homes coordinating care for people who have chronic conditions. Differences in medical home program incentives and implementation styles are important to understand in evaluating effects on key outcomes such as cost and acute care. In Iowa, a Medicaid Health Home (MHH) program was developed targeting Medicaid members with multiple chronic conditions.

Dental Visits by Age One: General Dentist Availability for Privately Insured Children in a Rural State.

Purpose: To evaluate the availability of general dentists who treat very young children with private insurance in the context of recommendations for age one dental visit.

Methods: Administrative data from Delta Dental of Iowa were analyzed to identify general dentists providing care to children younger than 18 years old in 2005 and 2012. Characteristics of dentists providing care to children younger than two years old were compared, examining changes over time.

Travel burden and dentist bypass among dentally insured children.

Objectives: Using administrative data from Iowa Medicaid and a large private dental insurer, we compared distance to the nearest primary care dentist for children ages 6-15 in 2012. Additionally, we examined rates of provider bypass in both populations as an indicator of spatial accessibility to dental care.

Methods: We calculated measures of travel burden, including distance to the nearest primary care dentist and distance to current primary care dentist.

Dental care after an emergency department visit for dental problems among adults enrolled in Medicaid.

Background: Dental emergency department (ED) visits are increasing nationally, but EDs provide only palliative care. The authors examine time to subsequent dentist visit within 6 months after the ED visit, as well as the effect of having a dentist visit in the prior year.

Methods: Using 2010-2012 Iowa Medicaid claims data, the authors identified adults with an index dental ED visit.

Dental Homes for Children With Autism: A Longitudinal Analysis of Iowa Medicaid's I-Smile Program.

Introduction: Medicaid-enrolled children with autism spectrum disorder (ASD) encounter significant barriers to dental care. Iowa's I-Smile Program was implemented in 2006 to improve dental use for all children in Medicaid. This study compared dental home and preventive dental utilization rates for Medicaid-enrolled children by ASD status and within three time periods (pre-implementation, initial implementation, maturation) and determined I-Smile's longitudinal influence on ASD-related dental use disparities.

Parental perceptions of avoidability of their child's emergency department visit.

Objectives: To identify the factors associated with paediatric emergency department (ED) visits and parental perceptions of the avoidability of their child's ED visit.

Design: Cross-sectional study by performing secondary analysis of 2010-2011 Iowa Child and Family Household Health Survey data.

Setting: State-wide representative population-based sample of families with at least one child in the state of Iowa in the USA.

Geographic variation of dental utilization among low income children.

Spatial accessibility of dental care is mediated by dentist workforce availability and travel costs. In this study, we generated dental service areas through small area analysis of Medicaid administrative data and claims. Service areas were then used to assess dimensions of spatial accessibility, including dentist-to-population ratios, and examine relationships in geographic variation of routine dental care among Medicaid-enrolled children.

Eliminating Medicaid adult dental coverage in California led to increased dental emergency visits and associated costs.

Dental coverage for adults is an elective benefit under Medicaid. As a result of budget constraints, California Medicaid eliminated its comprehensive adult dental coverage in July 2009. We examined the impact of this policy change on emergency department (ED) visits by Medicaid-enrolled adults for dental problems in the period 2006-11.

The Importance of Efficacy: Using the Extended Parallel Process Model to Examine Factors Related to Preschool-Age Children Enrolled in Medicaid Receiving Preventive Dental Visits.

Early preventive dental visits are vital to the oral health of children. Yet many children, especially preschool-age children enrolled in Medicaid, do not receive early visits. This study attempts to uncover factors that can be used to encourage parents to seek preventive dental care for preschool-age children enrolled in Medicaid.

The relationship between altruistic attitudes and dentists' Medicaid participation.

Background: The authors investigated the role of private practitioners in the dental safety net, including the provision of care for Medicaid enrollees and attitudinal factors that affect participation.

Methods: In 2013, the authors sent a mixed-mode survey to all general dentists in Iowa assessing their current Medicaid participation and factors affecting participation, including attitudinal statements about altruism, the Medicaid program, and the government's role in providing access to dental care.

Results: Fifty-six percent of responding dentists accepted new Medicaid-enrolled patients; dentists living in nonmetropolitan areas were significantly more likely to accept Medicaid than were those in metropolitan areas.

An explanatory model of factors related to well baby visits by age three years for Medicaid-enrolled infants: a retrospective cohort study.

Background: Well baby visits (WBVs) are a cornerstone of early childhood health, but few studies have examined the correlates of WBVs for socioeconomically vulnerable infants. The study objective was to identify factors related to the number of WBVs received by Medicaid-enrolled infants in the first three years of life and to present a preliminary explanatory model.

Methods: We analyzed Iowa Medicaid claims files and birth certificate data for infants born in calendar year 2000 (N = 6,085).

Factors affecting age at first dental exam for Medicaid-enrolled children seen at Federally Qualified Health Centers.

Purpose: The purpose of this study was to estimate age at first dental visit (FDV) and identify variables predicting earlier visits for Medicaid-enrolled children at Iowa Federally Qualified Health Centers (FQHC).

Methods: Statewide Medicaid claims data were used to draw a random sample of children who received their FDV prior to six years old at a FQHC, were Medicaid-enrolled within the first two months of life, and remained continuously enrolled over the study period. Forty children from each of five FQHCs had their dental charts abstracted and merged with other Medicaid records and birth certificate data.

Periodicity of dental recall visits for young children first seen in community health centers.

Objectives: To study the factors associated with young children who had their first dental visit (FDV) at a Federally Qualified Health Center (FQHC) and returned within 12 months for a second dental episode.

Methods: Two hundred Medicaid-enrolled children who were less than 6 years old were randomly selected from five Iowa FQHCs. Dental utilization was followed for 36 months using dental charts and Medicaid medical and dental claims data, regardless of provider.