Medicaid/SCHIP

Authors: Szilagyi PG, Shenkman E, Brach C, et al.
Date: 2003.
Title: Children with special health care needs enrolled in SCHIP: patient characteristics and health care needs.
Publication: Pediatrics 112(6 Pt. 2):508-20.
Abstract: Available on PubMed®.
Availability: Reprints of this article can be ordered from the AHRQ Publications Clearinghouse (1-800-358-9295, AHRQ Publication No. 04-RO17).

Authors: Shone LP, Dick AW, Brach C, et al.
Date: 2003.
Title: The role of race and ethnicity in SCHIP in four states: are these baseline disparities, and what do they mean for SCHIP?
Publication: Pediatrics 112(6):521-32.
Abstract: Available on PubMed®.
Availability: Reprints of this article can be ordered from the AHRQ Publications Clearinghouse (1-800-358-9295, AHRQ Publication No. 04-RO16).

Authors: Brach C, Lewit EM, VanLandeghem K, et al.
Date: 2003
Title: Who's enrolled in SCHIP? Findings from the Child Health Insurance Research Initiative (CHIRI™).
Publication: Pediatrics 112(6):499-507.
Abstract: Available on PubMed®
Availability: Reprints of this article can be ordered from the AHRQ Publications Clearinghouse (1-800-358-9295, AHRQ Publication No. 04-RO15).

Authors: Dick AW, Allison RA, Haber SG, Brach C, Shenkman B
Title: Consequences of States' Policies for SCHIP Disenrollment.
Publication: Health Care Financing Review 23(3):65-88.
Date: 2002
Abstract: Policymakers are concerned about disenrollment from the State Children's Health Insurance Program (SCHIP). We describe disenrollment in Florida, Kansas, New York, and Oregon and assess the links between disenrollment and states' SCHIP policies. We find that SCHIP is used on a long-term basis (at least 2 years) for a significant group of new enrollees and as temporary coverage (fewer than 12 months) for many others. Recertification generates large disenrollments (about half of children still enrolled at the time), but as many as 25 percent return within 2 months. The increased disenrollment rate at recertification is completely eliminated by a policy of passive re-enrollment.
Availability: AHRQ Publication No. 02-R070 is available from the AHRQ Publications Clearinghouse.

Authors: Spector W., Mukamel D.
Title: Nursing home administrators' perceptions of competition and strategic responses.
Publication: Long Term Care Interface 2001 Mar;2(3):37-41.
Date: 2001
Abstract: This paper presents findings from a 1999 mailed survey of nursing home administrators in New York State, designed to elicit their perceptions of competition in the nursing home market and their strategic plans to cope with changing market conditions. Results show that administrators think that nursing home markets have become more competitive and expect this trend to continue. They perceive differences in the way individual customers choose nursing homes versus the way MCOs and hospitals make such choices. They believe that individual consumers place a higher value on quality of life factors, while aggregate purchasers rate price and the availability of complex sub-acute services higher. Strategic responses by nursing homes varied by ownership type.

Authors: Friedman B, Jee J., Steiner C, et al.
Title: Tracking the State Children's Health Insurance Program with hospital data: National baselines, State variations, and some cautions.
Publication: Med Care Res Rev 56(4):440-55.
Date: 1999
Abstract: State and Federal agencies are concerned with the impact of the State Children's Health Insurance Program (SCHIP) on the health care of enrolled children. As part of a broad program evaluation, and at relatively low cost, analysts can track data on hospital admissions for ambulatory care sensitive (ACS) conditions. This article uses hospital data for 19 states to calculate baseline ACS rates and to discuss trends and cross-state variations just prior to the start of SCHIP. A few cautions and limitations are discussed. An unexpected result in the explorations was a substantial increase in the rate of ACS admissions for self-pay and Medicaid-enrolled children during the period of 1990-1995. During that same period, the admission rate for other insured children fell by more than a third. The comparisons across states are meant to be illustrative; they do reveal a relationship between the rate of asthma admissions and the proportion of self-pay plus Medicaid-enrolled cases.
Availability: AHRQ Pub. No. 00-R009 is available from the AHRQ Publications Clearinghouse.

Authors: Harris-Kojetin L, Fowler F, Schnaier J, et al.
Title: The use of cognitive testing for developing and evaluating CAHPS® survey items.
Publication: Med Care 37(3 Suppl):MS10-MS21.
Date: 1999
Abstract: The main goal of the Consumer Assessments of Health Plans (CAHPS®) survey is to develop an integrated set of tested, standardized surveys to obtain meaningful information from health plan enrollees about their experiences. The CAHPS® project benefits from the complementary strengths of psychometric and cognitive testing. The authors found that cognitive testing was integral in developing and refining the CAHPS® instrument. The cognitive testing findings contributed to an improved instrument that should capture consumers' health care and plan experiences with less response error than one not subjected to such testing.

Authors: Fraser I, Chait E, Brach C.
Title: Promoting choice: Lessons from managed Medicaid programs.
Publication: Health Aff 17(5):165-73.
Date: 1998
Abstract: By examining the experiences of seven States with mandatory managed Medicaid programs, this article seeks to draw some lessons and raise research, policy, and operational questions about enrollee choice of health plans. The article explores the strategies States adopt to inform and facilitate choice, and what methods they use to assign individuals who do not make a choice in the time allotted. Differences are identified in the enrollment and education process that might account for some of the variation among States' rates of enrollees who choose a plan. Use of enrollment brokers and restrictions on marketing is also discussed.
Availability: AHCPR Publication No. 98-R088 is available from the AHRQ Publications Clearinghouse.

Authors: Friedman B, Devers K, Hellinger F, et al.
Title: Carve outs and related models of contracting for speciality care: Framework and highlights of a workshop.
Publication: American Journal of Managed Care 4(Special Issue).
Date: 1998
Abstract: This article provides an overview of papers presented at a workshop sponsored by AHCPR in January, 1998. The papers, published in this special issue of the American Journal of Managed Care, focus on one set of strategies: the use of carve outs and related models of contracting for specialty care. The defining common feature of these contracts is that they engage providers and management entities different from those otherwise available to care for the same patients within a health plan. The other common feature of these arrangements is that they receive significant attention in the marketplace and almost no attention from research. The purpose of the workshop and this special issue of the American Journal of Managed Care is to identify what is known and not known about these arrangements and develop an agenda for future research.
Availability: AHCPR Publication No. 98-R080 is available from the AHRQ Publications Clearinghouse.

Author: Hellinger F.
Title: Regulating the financial incentives facing physicians in managed care plans.
Publication: American Journal of Managed Care 4(5):663-74.
Date: 1998
Abstract: Recent accounts of enrollees in managed care plans being denied access to potentially lifesaving services have heightened public anxiety about the impact of managed care on the accessibility and appropriateness of care, This anxiety has been translated into legislative action. The present review focuses on an area of managed care operations that has received considerable attention in State legislatures and in Congress during the past 2 years: the financial relationship between managed care health plans and physicians. Twelve States now mandate that managed care plans disclose information about their financial relationship with physicians, and 11 States regulate the method used by managed care health plans to compensate physicians. Most laws that regulate methods of compensation prohibit health plans from providing physicians an inducement to reduce or limit the delivery of "medically necessary" services. Moreover, in 1996 the Health Care Financing Administration (HCFA) finalized its regulations governing the financial incentives facing physicians in plans that treat Medicaid or Medicare patients, and these regulations went into effect on January 1, 1997. These regulations are also examined in this study.
Availability: AHCPR Publication No. 98-R064 is available from the AHRQ Publications Clearinghouse.

Authors: Fraser I, Brach C.
Title: Meeting Medicaid's cost and quality challenges: The role of AHRQ research.
Publication: Rockville (MD): AHCPR.
Date: 1997
Abstract: This Program Note describes AHCPR's role in providing research and technical assistance to the Medicaid program in six areas: care for elderly and disabled populations, maternal and child health, HIV and AIDS, drug policy, informing consumers, and system financing and management.
Availability: AHCPR Publication No. 97-0044 is available from the AHRQ Publications Clearinghouse. Online version.

Authors: Robinson G, Brach C.
Title: Managed mental health care and women: Implications of a changing delivery system.
Publication: Paper read at Changes in Mental Health Care: What Might They Mean for Women?
Date: October 2, 1996
Abstract: This article was written to serve as the basis of discussion for the Commonwealth Fund Commission on Women's Health's symposium, Changes in Mental Health Care: What Might They Mean for Women? The public mental health system is now undergoing a radical transformation with the advent of managed care. Over the past two decades Medicaid has grown into a dominant funding source for public mental health services. States, facing budgetary pressures, are increasingly shifting Medicaid programs into managed care.

Author: Spector W, Cohen J.
Title: The effect of Medicaid reimbursement on quality of care in nursing homes.
Publication: Journal of Health Economics 1996;15:23-48.
Date: 1996
Abstract: This study uses a nationally representative sample of nursing homes and nursing home residents to examine the effect of Medicaid reimbursement on quality of care. The analysis shows that both reimbursement approach and level affect nursing home quality, as measured by case-mix adjusted staff to resident ratios. The analysis also shows that staffing ratios have an impact on resident outcomes, and these impacts vary by professional category of staff.
Availability: AHCPR Publication No. 96-R116 is available from the AHRQ Publications Clearinghouse.

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