Background—Medicaid and uninsured populations are a significant focus of current healthcare reform. We hypothesized that outcomes after coronary artery bypass grafting (CABG) in the United States is dependent on primary payer status. Methods and Results—From 2003 to 2007, 1 250 619 isolated CABG operations were evaluated using the Nationwide Inpatient Sample (NIS) database. Patients were strati...

Medicaid spending more than doubled from 1958 to 1992, reversing a long trend of cost containment in the program. Reasons for the cost explosion are severalfold. (1) Congress expanded eligibility to more children, pregnant women, and low-income elderly persons. (2) The recession has added more people to the Medicaid rolls. (3) Growing numbers of disabled cash assistance recipients have increase...

The Medicaid program has become increasingly complex as policymakers use it to address various policy objectives, leading to structural tensions that surface with Medicaid managed care. In this article, we illustrate this complexity by focusing on the experience of three States with behavioral health carveouts--Maryland, Oregon, and Tennessee. Converting to Medicaid managed care forces policyma...

Medicaid coverage of children is analyzed in this article, using data from uniform Medicaid files (Tape-to-Tape) for California, Georgia, Michigan, and New York. Results show that Medicaid is a different program to children of different enrollment groups and ages. For children receiving cash assistance through either Aid to Families with Dependent Children or Supplemental Security Income, Medic...

In this analysis, Medicaid cost containment is viewed within the theoretical framework of a price discrimination model. The value of viewing supply decisions made by physicians in terms of the conventional economic laws of supply and demand is demonstrated. Physicians are seen to respond to prices in a predictable way. As private prices increase, physicians are less willing to participate in Me...

The 2014 implementation of key provisions of the Affordable Care Act (ACA) represents one of the largest health insurance expansions since the creation of Medicare and Medicaid in 1965. These provisions include premium tax credits for the purchase of private insurance for lowand middle-income adults and, in participating states, expanded Medicaid eligibility for adults with incomes up to 138 pe...

As State Medicaid programs become increasingly important sources of payment for acquired immunodeficiency syndrome (AIDS)-related care, and drug regimens the major weapons available to fight human immunodeficiency virus (HIV)-related illnesses, Medicaid drug policies will have a substantial impact. State Medicaid programs were surveyed to identify policies on a range of prescription drug polici...

PURPOSE This study compared the expenditure by the state Medicaid program for episodic, nondefinitive care provided through the emergency room (ER) of a children's hospital with the cost to Medicaid of covering that same child with the recommended preventive service calculated on the fee schedule of the state dental Medicaid program. METHODS Records of patients discharged from the ER during 1...

D entistry is in the midst of a major transition. One key driver of change is the Affordable Care Act (ACA), which has many provisions relevant to the dental care sector. A key provision of the ACA is Medicaid expansion, which has the potential to reshape the dental benefits landscape considerably. Let’s first look at trends in Medicaid before ACA. For more than a decade, public health insuranc...

The implementation of the Medicare prospective payment system has sparked the growth of similar Medicaid systems. Eight State Medicaid agencies now employ a system based on diagnosis-related groups (DRG's), and another four State Medicaid agencies are planning to implement such systems in the near future. The eight DRG-based systems in existence in 1986 are examined in this article. Preliminary...