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Medicaid managed care network adequacy standards and mental health care access.
Am J Manag Care
January 2025
Department of Population Health Sciences, Weill Cornell Medicine, 575 Lexington Ave, 6th Floor, New York, NY 10022. Email:
Objectives: Medicaid is the largest payer of mental health (MH) services in the US, and more than 80% of its enrollees are covered by Medicaid managed care (MMC). States are required to establish quantitative network adequacy standards (NAS) to regulate MMC plans' MH care access. We examined the association between quantitative NAS and MH care access among Medicaid-enrolled adults and among those with MH conditions.
View Article and Find Full Text PDFCharacterizing the Impact of Race and Contemporary Redlining on Receipt of Guideline-Concordant Locoregional Therapy Among Older Women With Breast Cancer.
Adv Radiat Oncol
February 2025
Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin.
Purpose: Improving locoregional control for breast cancer (BC) results in better overall survival. Contemporary redlining is associated with worse BC survival in older patients. Self-reported race is associated with survival, redlining, and access to care.
View Article and Find Full Text PDFMedicaid Spending in Coordination-Only Dual-Eligible Special Needs Plans.
JAMA Netw Open
January 2025
Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.
Importance: More than 4 million Medicare beneficiaries have enrolled in dual-eligible Special Needs Plans (D-SNPs), and coordination-only D-SNPs are common. Little is known about the impact of coordination-only D-SNPs on Medicaid-covered services and spending, including long-term services and supports, which are financed primarily by Medicaid.
Objective: To evaluate changes in Medicaid fee-for-service (FFS) spending before and after new enrollment in coordination-only D-SNPs vs new enrollment in non-D-SNP Medicare Advantage (MA) plans among community-living beneficiaries enrolled in both Medicare and North Carolina Medicaid.
Hospital Safety-Net Burden is Associated with Perioperative Outcomes in Primary Total Hip Arthroplasty: A Multistate Retrospective Analysis, 2015-2020.
Popul Health Manag
January 2025
Department of Anesthesiology, New York Presbyterian/Weill Cornell Hospital, New York, USA.
Total hip arthroplasty (THA) is a widely performed surgical procedure in the United States, but disparities in THA outcomes related to hospital-level factors, such as safety-net burden, are underexplored. This study expands on previous research by analyzing multicenter, multistate data from 2015 to 2020 to investigate the impact of hospital safety-net burden-defined as the proportion of services billed to Medicaid and uninsured patients-on THA outcomes. This study is a retrospective analysis using data from the State Inpatient Databases for Florida, Kentucky, Maryland, New York, Washington, New Jersey, and North Carolina.
View Article and Find Full Text PDF"Where There's a Will There's a Way": The Impact of State Variations in the Implementation of Continuous Coverage on Access to Postpartum Care During the Pandemic Emergency.
Health Serv Res
January 2025
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.
Objectives: To explore how the Medicaid continuous coverage requirement and unwinding process was implemented in three states with diverse existing policy environments and implications for the implementation of post-emergency 12-month postpartum extensions.
Data Sources: State data on unwinding performance and qualitative in-depth interviews with 48 stakeholders and patient-facing healthcare workers in Texas, New York and New Jersey.
Study Design: State Medicaid stakeholders and patient-facing healthcare workers in each state were interviewed with the goal of gaining insights into: (1) How the continuous coverage requirement was implemented; (2) What effects continuous coverage had on access to care for postpartum mothers; (3) How states are implementing the pandemic unwinding and postpartum extensions.
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