scholarly journals Medicaid enrollment after liver transplantation: Effects of medicaid expansion

2016 ◽  
Vol 22 (8) ◽  
pp. 1075-1084 ◽  
Author(s):  
Dmitry Tumin ◽  
Don Hayes ◽  
W. Kenneth Washburn ◽  
Joseph D. Tobias ◽  
Sylvester M. Black
Keyword(s):  
Liver Transplantation ◽  
Medicaid Expansion ◽  
Medicaid Enrollment

Impact of Medicaid expansion on diagnosis and management of patients with testicular cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 551-551
Author(s):  
Xinglei Shen ◽  
Mindi TenNapel
Keyword(s):  
Testicular Cancer ◽  
Stage I ◽  
Stage Iii ◽  
Medicaid Expansion ◽  
Chi Square ◽  
Medicaid Enrollment ◽  
Chi Square Test ◽  
Reduced Rate ◽  
New Diagnosis ◽  
Insured Patients

551 Background: One crucial aspect of the Affordable Care Act is the optional Medicaid expansion, which started in 2014. Patients with testicular cancer may derive particular benefit from Medicaid expansion due to demographics overlap. We hypothesize that Medicaid expansion would improve outcome in these patients. Methods: We reviewed the Surveillance Epidemiology and End Results (SEER) database for testicular cancer diagnosed from 2010 to 2014. Among the SEER regions, we separated in to states that did (CA, CT, HI, IA, KY, MI, NJ, NM, WA) or did not (AK, GA, LA, UT) undertake expansion. Medicaid data from CMMS were used to measure the degree of Medicaid expansion (EXP). Data from 2010-2013 was used as baseline, and 2014 as the effect of EXP. Chi-square test was used to compare between groups. Results: We identified 12731 cases of testicular cancer from 2010 to 2014. Within SEER regions, overall Medicaid enrollment increased by 30.4% from 2013 to 2014 in the EXP states, and by 8.4% in non-EXP states. Expansion did not affect incidence of testicular cancer. In the EXP states, Medicaid coverage for testicular cancer increased from 14.8% to 19.4% in 2014 (p < 0.001) and uninsured decreased from 8.7% to 4.3% (p < 0.001). In non-EXP states, coverage with Medicaid (9.7% to 8.8%, p = 0.60) and uninsured (13.6% to 12.9%, p = 0.68) did not change. Within individual states, we noted a linear correlation between % increase in Medicaid enrollment and % decrease in uninsured cases (R = 0.58). Among Medicaid patients in EXP states, stage I cases increased (52% to 60%), stage III cases decreased (27% to 20%). There was no change among insured patients (70.6% to 73.3% for stage I, and 10.9% to 9.1% for stage III). In contrast, in non-EXP states, Medicaid patients had decrease in stage I and increase in stage III cases. Medicaid patients had higher rates of no treatment and lower rates of lymph node assessment for stage II NSGCT compared to insured patients, but this did not vary with EXP. Conclusions: Medicaid expansion reduced rate of uninsured for patients with new diagnosis of testicular cancer. There was a shift to earlier stage of diagnosis in Medicaid patients, but no apparent effect yet on management. Future studies will focus on change over time and effect on survival.

scholarly journals 1030. Medicaid Expansion: How Does it Impact HIV Outcomes in One Non-urban Southeastern Ryan White HIV/AIDS Program Clinic?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S544-S546
Author(s):  
Kathleen A McManus ◽  
Karishma R Srikanth ◽  
Samuel D Powers ◽  
Rebecca Dillingham ◽  
Elizabeth T Rogawski McQuade
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
Baseline Viral Load ◽  
Medicaid Expansion ◽  
Engagement In Care ◽  
Medicaid Enrollment ◽  
Ryan White ◽  
Aids Program ◽  
Research Grant ◽  
Hiv Aids

Abstract Background People living with HIV (PLWH) with Medicaid historically have lower viral suppression (VS) rates than those with other insurance. VS rates with Medicaid expansion (ME) are unknown. We examined HIV outcomes (engagement in care, VS) by insurance status for a non-urban Southeastern Ryan White HIV/AIDS Program (RWHAP) Clinic cohort for year after ME. Methods Participants were PLWH ages 18-63 who attended &gt; 1 HIV medical visit/year in 2018 and 2019. Log-binomial models were used to estimate the association of characteristics with Medicaid enrollment prevalence and one-year risks of engagement in care and VS in 2019. Results Among 577 patients, 241 (42%) were newly eligible for Medicaid due to ME and 79 (33%) enrolled (Figure 1a). For those without Medicare, Medicaid enrollment was higher for those with incomes &lt; 100% FPL (adjusted prevalence ratio [aPR] 1.67; 95% confidence interval [CI] 1.00-1.86) compared to those with incomes &gt; 101% FPL. Those enrolled in Medicaid due to ME had 87% engagement in care compared to 80-92% for other insurance plans (Figure 1b). Controlling for 2018 engagement, older age (adjusted risk ratio [aRR] for 10 years 1.03, 95% CI 1.00-1.05; Table 1) was associated with being engaged in 2019. Engagement was lower for those with employment-based insurance (aRR 0.91, 95% CI 0.83-0.99) and Medicare (aRR 0.87, 95% CI 0.78-0.96). Of those with viral loads in 2018 and 2019 (n=549), those who newly enrolled in Medicaid due to ME had 85% VS compared to 87-99% for other insurance plans (Figure 1c). In univariate analysis, age, income, and baseline viral load status were associated with viral suppression (Table 2), and those with Medicaid due to ME (aRR 0.90, 95% CI 0.81-1.00) were less likely to achieve VS compared with others. Figure 1 Table 1 Table 2 Conclusion The low uptake of ME was likely influenced by many PLWH already having Medicare. While the RWHAP supports high quality HIV care, Medicaid enrollment improves access to non-HIV care and should be supported by RWHAP. Given that engagement in care was high for PLWH who newly enrolled in Medicaid, the finding of lower VS is surprising. The discordance may be due to medication access gaps associated with changes in pharmacy logistics. Future studies with larger cohorts will need to examine how ME contributes to PLWH’s overall health and to ending the HIV epidemic. Disclosures Kathleen A. McManus, MD, MSCR, Gilead Sciences, Inc (Research Grant or Support, Shareholder) Rebecca Dillingham, MD, MPH, Gilead Sciences, Inc (Research Grant or Support)Warm Health Technologies, Inc (Consultant)

scholarly journals The Line Between Medicaid and Marketplace: Coverage Effects from Wisconsin’s Partial Expansion

2021 ◽  
Author(s):  
Laura Dague ◽  
Marguerite Burns ◽  
Donna Friedsam
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Claims Database ◽  
Medicaid Coverage ◽  
Medicaid Enrollment ◽  
Medicaid Eligibility ◽  
Balanced Budget ◽  
Parents And Caregivers

Abstract Context: States have sought to experiment with the income eligibility threshold between Medicaid coverage and access to subsidized Marketplace plans in an effort to increase coverage for low-income adults while meeting other state priorities, particularly a balanced budget. In 2014, Wisconsin opted against adoption of an ACA Medicaid expansion, instead setting the Medicaid eligibility threshold at 100% of the poverty level—a state-funded partial expansion. Childless adults gained new eligibility, while parents and caregivers with incomes between 101–200% of poverty lost existing eligibility. Methods: We use Wisconsin’s all-payer claims database to assess health insurance gains, losses, and transitions among low-income adults affected by this partial expansion. Findings: We find that less than one third of adults who lost Medicaid eligibility definitely took up commercial coverage, and many returned to Medicaid. Among those newly Medicaid eligible, there was little evidence of crowd-out. Both groups experienced limited continuity of coverage. Overall, new Medicaid enrollment of childless adults was offset by coverage losses among parents and caregivers, rendering Wisconsin’s overall coverage gains similar to non-expansion states. Conclusions: Wisconsin’s experience demonstrates the difficulty in relying on the Marketplace to cover the near poor and suggests that full Medicaid expansion more effectively increases coverage.

scholarly journals The differential impact of the COVID-19 epidemic on Medicaid expansion and non-expansion states

2021 ◽  
Author(s):  
Muhammad Ragaa Hussein ◽  
Islam Morsi ◽  
Engy A. Awad ◽  
Dina A. Fayed ◽  
Thamer AlSulaiman ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care Access ◽  
Medicaid Expansion ◽  
Federally Funded ◽  
Differential Impact ◽  
Policy Measure ◽  
Emergency Plans ◽  
Care Access ◽  
Medicaid Enrollment ◽  
The Individual

AbstractMedicaid expansion is a federally-funded program to expand health care access and coverage to economically challenged populations by increasing eligibility to Medicaid enrollment and investing in public health preventive services in the individual states. Yet, when the COVID-19 epidemic plagued the country, fourteen states were practicing their chosen decision not to enact the Medicaid expansion policy. We examined the consequences of this nationwide split in Medicaid design on the spread of the COVID-19 epidemic between the expansion and non-expansion states. Our study shows that, on average, the expansion states had 217.56 fewer confirmed COVID-19 cases per 100,000 residents than the non-expansion states [-210.41; 95%CI (−411.131) - (−2.05); P<0.05]. Also, the doubling time of COVID-19 cases in Medicaid expansion states was longer than that of non-expansion states by an average of 1.68 days [1.6826; 95%CI 0.4035-2.9617; P<0.05]. These findings suggest that proactive investment in public health preparedness was an effective protective policy measure in this crisis, unsurpassed by the benefits of COVID-19 emergency plans and funds. The study findings could be relevant to policymakers and healthcare strategists in non-expansion states considering their states’ preparations for such public health crises.

Risk factors for mortality on the liver waiting list of cirrhotic patients listed for liver transplantation

2001 ◽  
Vol 120 (5) ◽  
pp. A77-A77
Author(s):  
D DELPHINE ◽  
F AGNESE ◽  
B NADINE ◽  
L OLIVIER ◽  
L HUBERT ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Waiting List ◽  
Cirrhotic Patients

Evolution of hepatitis C virus quasispecies after liver transplantation

2001 ◽  
Vol 120 (5) ◽  
pp. A373-A374
Author(s):  
A LYRA ◽  
X FAN ◽  
S RAMRAKHIANI ◽  
A DIBISCEGLIE
Keyword(s):  
Liver Transplantation ◽  
Hepatitis C Virus ◽  
Hepatitis C
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