Participants: A total of 3260 new Medicare enrollees aged 65 years or older were interviewed in person between June and December 1997 (853 in Cleveland, 498 in Houston, 975 in south Florida, 934 in Tampa); 2956 spoke English and 304 spoke Spanish as their native language. MAIN OUTCOME MEASURE; Functional health literacy as measured by the Short Test of Functional Health Literacy in Adults.
Results: Overall, 33.9% of English-speaking and 53.9% of Spanish-speaking respondents had inadequate or marginal health literacy. The prevalence of inadequate or marginal functional health literacy among English speakers ranged from 26.8% to 44.0%. In multivariate analysis, study location, race/language, age, years of school completed, occupation, and cognitive impairment were significantly associated with inadequate or marginal literacy. Reading ability declined dramatically with age, even after adjusting for years of school completed and cognitive impairment. The adjusted odds ratio for having inadequate or marginal health literacy was 8.62 (95% confidence interval, 5.55-13.38) for enrollees aged 85 years or older compared with individuals aged 65 to 69 years.
Conclusions: Elderly managed care enrollees may not have the literacy skills necessary to function adequately in the health care environment. Low health literacy may impair elderly patients' understanding of health messages and limit their ability to care for their medical problems.
Medicaid enrollment has risen to unprecedented levels since the start of the COVID-19 pandemic. In an earlier analysis, we showed that most of this new Medicaid enrollment was from the continuous coverage requirement of the Families First Coronavirus Response Act. One of the most urgent issues for policymakers this year is what will happen to the health coverage of these millions of new enrollees after the HHS Public Health Emergency (PHE) ends. It is probable that the PHE will be extended through the first half of 2022, and further extension is possible. In this brief, we project Medicaid enrollment for the population under age 65 and federal and state Medicaid spending for 2022 and 2023, assuming the PHE is extended through the first, second, or third quarters of 2022. We find that the longer the PHE lasts, the greater the potential number of people losing Medicaid coverage over the 14 months after the PHE ends: 12.9 million if it expires after the first quarter of 2022, 14.4 million if it expires after the second quarter, and 15.8 million if it expires after the third quarter.
The percentage of Medicaid enrollees in managed care in fiscal year 2020 are broken out by comprehensive managed care, limited-benefit plans, and primary care case management, and again by eligibility group and state.
Of the 83.5 million total Medicaid enrollees in fiscal year 2020, 70.4 percent were enrolled in comprehensive care, ranging from 36.5 percent for individuals age 65 and older to 81.8 percent for the new adult group.
Our recently published study in JAMA Health Forum used administrative data from three state Medicaid programs to explore racial inequities in Medicaid. We found that Black enrollees generated lower spending and had lower utilization, including of primary care services and recommended care for acute and chronic conditions, than white enrollees. Black enrollees were more likely than white enrollees to use the emergency department for avoidable reasons, which suggests they may have worse access to ambulatory care.
While Black enrollees used fewer services overall, they had higher rates than white enrollees of preventive screenings for conditions such as breast and cervical cancer that are assessed by the Healthcare Effectiveness Data and Information Set (HEDIS) measures. This finding is consistent with recent evidence on disparities from California.
Prior studies have explored features of the health care system that may contribute to racial and ethnic disparities in access to care, provider participation, and health outcomes for Medicaid enrollees. For example, enrollees who identify as members of racial and ethnic minority groups are less likely to report having a usual source of care, and providers are less likely to accept Medicaid patients in areas where a greater share of the population identifies as being part of a historically disadvantaged group. In addition to facing these structural barriers to accessing care, racial and ethnic minority groups face well-documented barriers to care because of interpersonal and structural racism.
During 1999--2006, the number of poisoning deaths in the United States nearly doubled, from approximately 20,000 to 37,000, largely because of overdose deaths involving prescription opioid painkillers (1). This increase coincided with a nearly fourfold increase in the use of prescription opioids nationally (2). In Washington, in 2006, the rate of poisoning involving opioid painkillers was significantly higher than the national rate (1). To better characterize the prescription opioids associated with these deaths and to reexamine previously published results indicating higher drug overdose rates in lower-income populations (3), health and human services agencies in Washington analyzed overdose deaths involving prescription opioids during 2004--2007. This report describes the results of that analysis, which found that 1,668 persons died from prescription opioid-related overdoses during the period (6.4 deaths per 100,000 per year); 58.9% of decedents were male, the highest percentage of deaths (34.4%) was among persons aged 45--54 years, and 45.4% of deaths were among persons enrolled in Medicaid. The age-adjusted rate of death was 30.8 per 100,000 in the Medicaid-enrolled population, compared with 4.0 per 100,000 in the non-Medicaid population, an age-adjusted relative risk of 5.7. Methadone, oxycodone, and hydrocodone were involved in 64.0%, 22.9%, and 13.9% of deaths, respectively. These findings highlight the prominence of methadone in prescription opioid--related overdose deaths and indicate that the Medicaid population is at high risk. Efforts to minimize this risk should focus on assessing the patterns of opioid prescribing to Medicaid enrollees and intervening with Medicaid enrollees who appear to be misusing these drugs.
The cause of the higher death rate in Washington's Medicaid enrolled population might be related, in part, to differences in opioid prescribing in the Medicaid population. Although comparable prescribing data for Medicaid and non-Medicaid populations are not available for Washington, studies indicate that opioid prescribing rates among Medicaid enrollees are at least twofold higher than rates for persons with private insurance (6,7). In one of these studies, both the percentage of patients with pain being treated with opioids and the opioid dose per prescription were higher in Medicaid patients than in non-Medicaid patients (6). The higher death rate among Medicaid enrollees in Washington also might be related to a higher prevalence of substance abuse and other mental health problems, which has been found in other Medicaid populations (8). In this analysis, medical examiners and coroners reported the presence of an illegal drug (e.g., cocaine, methamphetamine, and heroin) in nearly a fifth of deaths, and psychotherapeutic drugs such as benzodiazepines and antidepressants were reported in a high proportion of deaths.
But the impact on employment was even more surprising, she says, and has implications for current debates in state and federal public policy, including proposals to require Medicaid enrollees to work or actively seek work.
Tipirneni and her colleagues performed the survey of a representative sample of Healthy Michigan Plan enrollees, and detailed structured interviews with 67 participants, in 2015 and 2016 as part of the official federally mandated evaluation of the program. They communicated with participants in their choice of English, Spanish or Arabic.
The findings from focus groups conducted in February 2022, which were featured during our 10th Unwinding Webinar in September, provide additional insight on communicating about the unwinding. These findings conclude that associating the resumption of renewals with the public health emergency was not only confusing but it was particularly frightening terminology for Spanish-speakers. Focus group participants also confirmed that they see the state agency as the official information source but want to hear about renewal from other sources. To that end, Medicaid health plans, health care providers, navigators and assisters, and policy and advocacy organizations should all take steps to reinforce messages coming from the state and fill in gaps where the state may not be reaching enrollees.
The COVID-19 pandemic and federal mitigation efforts led to unprecedented Medicaid enrollment, largely thanks to the Medicaid continues coverage requirement, which prevents state Medicaid agencies from disenrolling beneficiaries during the PHE. One of the most urgent issues facing policymakers is what happens to the health coverage of these millions of new enrollees after the PHE ends.
The ACA requires insurers to provide cost-sharing reductions (CSRs) to low-income consumers on the marketplaces. We link 2013-2015 All-Payer Claims Data to 2004-2013 administrative hospital discharge data from Utah and exploit policy-driven differences in the value of CSRs that are solely determined by income. We find that enrollees with lower cost sharing have higher levels of health care spending, controlling for past health care use. We estimate the demand elasticity of total health care spending to be -0.10, but find larger elasticities for emergency room care, lifestyle drugs, and low-value care. We also find positive cross-price elasticities between outpatient and inpatient care.
Some employers not only cover telemedicine, but also provide a financial incentive to encourage enrollees to use telemedicine instead of visiting a brick and mortar facility. Among large employers offering telemedicine services in their largest plans, 53% have an incentive, such as lower cost sharing to encourage employees to use these services. 2b1af7f3a8