西瓜视频

Object moved to here.

The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity | Health Care Reform | JAMA | 西瓜视频

西瓜视频

[Skip to Navigation]
Sign In
1.
US Government Accountability Office. Federal low-income programs: eligibility and benefits differ for selected programs due to complex and varied rules. June 2017. Accessed September 30, 2021.
2.
Centers for Medicare & Medicaid Services. Monthly Medicaid & CHIP application, eligibility determination, and enrollment reports & data. Accessed July 22, 2022.
3.
Centers for Medicare & Medicaid Services. National health expenditure data, table 19: national health expenditures by type of expenditure and program: calendar year 2020. Accessed July 22, 2022. https://www.cms.gov/files/zip/nhe-tables.zip
4.
Colello 听HJ锘, Morton 听WR锘. Medicaid eligibility: older adults and individuals with disabilities. December 9, 2019. August 26, 2022.
5.
Goodman-Bacon 听A锘. 听Public insurance and mortality: evidence from Medicaid implementation.听锘 听J Polit Econ. 2018;126(1):216-262. doi:锘
6.
Wherry 听LR锘, Miller 听S锘, Kaestner 听R锘, Meyer 听BD锘. 听Childhood Medicaid coverage and later-life health care utilization.听锘 听Rev Econ Stat. 2018;100(2):287-302. doi:锘
7.
Wherry 听LR锘, Meyer 听BD锘. 听Saving teens: using a policy discontinuity to estimate the effects of Medicaid eligibility.听锘 听J Hum Resour. 2016;51(3):556-588. doi:锘
8.
Brown 听CC锘, Moore 听JE锘, Felix 听HC锘, 听et al. 听Association of state Medicaid expansion status with low birth weight and preterm birth.听锘 听闯础惭础. 2019;321(16):1598-1609. doi:锘
9.
Michener 听J锘. 听Fragmented Democracy: Medicaid, Federalism, and Unequal Politics. Cambridge University Press; 2018. doi:锘
10.
Gruber 听J锘, Sommers 听BD锘. 听Paying for Medicaid: state budgets and the case for expansion in the time of coronavirus.听锘 听N Engl J Med. 2020;382(24):2280-2282. doi:锘
11.
Michener 听JD锘. 听Politics, pandemic, and racial justice through the lens of Medicaid.听锘 听Am J Public Health. 2021;111(4):643-646. doi:锘
12.
Centers for Medicare & Medicaid Services. Innovation Center strategic direction. Accessed Feb 2, 2022.
13.
Lanford 听D锘, Quadagno 听J锘. 听Implementing ObamaCare: the politics of Medicaid expansion under the Affordable Care Act of 2010.听锘 听Sociol Perspect. 2016;59(3):619-639. doi:锘
14.
Michener 听J锘. 听Race, politics, and the Affordable Care Act.听锘 听J Health Polit Policy Law. 2020;45(4):547-566. doi:锘
15.
Gee 听RE锘, Shulkin 听D锘, Romm 听I锘. 听A blueprint for comprehensive Medicaid reform.听锘 听闯础惭础. 2021;325(7):619-620. doi:锘
16.
National Association of State Budget Officers. State expenditure report. Accessed July 22, 2022.
17.
US Government Publishing Office. Budget FY 2022: table 15.1: outlays for health programs: 1962-2026. Accessed July 15, 2022.
18.
Medicaid and CHIP Payment and Access Commission. Exhibit 15: Medicaid full-year equivalent enrollment by state and eligibility group, FY 2019 (thousands). Accessed January 15, 2022.
19.
Medicaid and CHIP Payment and Access Commission. MACStats: Medicaid and CHIP data book. December 2015. Accessed October 14, 2021.
20.
Medicaid and CHIP Payment and Access Commission. MACStats: Medicaid and CHIP data book. December 2021. Accessed July 22, 2022.
21.
US Census Bureau. Census Bureau releases analytical report on COVID-19 impact on the 2020 American Community Survey. October 27, 2021. Accessed July 15, 2022.
22.
Kaiser Family Foundation. Medicaid waiver tracker: approved and pending Section 1115 waivers by state. Accessed May 28, 2021.
23.
Primary Care Collaborative. Primary care innovations and PCMH programs by title. Accessed May 28, 2021.
24.
Center for Health Care Strategies Inc. Medicaid accountable care organization programs: state profiles. Accessed February 15, 2022.
25.
Change Healthcare. Value-based care in America: state-by-state. Accessed February 15, 2022.
26.
National Academy for State Health Policy. State delivery system and payment reform map. Accessed May 28, 2021.
27.
Medicaid and CHIP Payment and Access Commission. Delivery System Reform Incentive Payment programs. April 2020. Accessed February 15, 2022.
28.
Centers for Medicare & Medicaid Services. Medicaid.gov. Accessed February 2, 2022.
29.
Perez 听EO锘. 听Diversity鈥檚 Child: People of Color and the Politics of Identity. University of Chicago Press; 2021. doi:锘
30.
Congressional Research Service. Medicaid: an overview. Updated February 22, 2021. Accessed February 15, 2022.
31.
Thompson 听FJ锘, Burke 听C锘. 听Executive federalism and Medicaid demonstration waivers: implications for policy and democratic process.听锘 听J Health Polit Policy Law. 2007;32(6):971-1004. doi:锘
32.
McMorrow 听S锘, Kenney 听GM锘, Long 听SK锘, Goin 听DE锘. 听Medicaid expansions from 1997 to 2009 increased coverage and improved access and mental health outcomes for low-income parents.听锘 听Health Serv Res. 2016;51(4):1347-1367. doi:锘
33.
Jarlenski 听M锘, Rocco 听P锘, Tipirneni 听R锘, Kennedy 听AJ锘, Gunturi 听N锘, Donohue 听J锘. 听Shaping health policy for low-income populations: an assessment of public comments in a new Medicaid waiver process.听锘 听J Health Polit Policy Law. 2017;42(6):1039-1064. doi:锘
34.
Centers for Medicare & Medicaid Services. Federal fiscal year (FFY) 2019 statistical enrollment data system (SEDS) reporting. November 10, 2020. Accessed February 15, 2022.
35.
Medicaid and CHIP Payment and Access Commission. Exhibit 14: Medicaid enrollment by state, eligibility group, and dually eligible status, FY 2019 (thousands). Accessed January 15, 2022.
36.
Medicaid and CHIP Payment and Access Commission. Exhibit 19: Medicaid benefit spending per full-year equivalent (FYE) enrollee by eligibility group and service category, FY 2019. Accessed September 15, 2021.
37.
Medicaid and CHIP Payment and Access Commission. Nursing facilities. Accessed September 15, 2021.
38.
Medicaid and CHIP Payment and Access Commission. Medicaid 101 financing. Accessed September 15, 2021.
39.
Medicaid and CHIP Payment and Access Commission. Exhibit 1: Medicaid and CHIP enrollment as a percentage of the US population. Accessed September 15, 2021.
40.
Clemans-Cope 听L锘, Holahan 听J锘, Garfield 听R锘. Medicaid spending growth compared to other payers: a look at the evidence. Kaiser Family Foundation. April 13, 2016. Accessed January 15, 2022.
41.
Kaiser Family Foundation. Medicaid-to-Medicare fee index. Accessed July 15, 2022.
42.
Williams 听E锘, Rudowitz 听R锘. The impact of the COVID-19 recession on Medicaid coverage and spending. Kaiser Family Foundation. March 1, 2022. Accessed July 15, 2022.
43.
Williams 听E锘, Rudowitz 听R锘, Corallo 听B锘. Fiscal and enrollment implications of Medicaid continuous coverage requirement during and after the PHE ends. Kaiser Family Foundation. May 10, 2022. Accessed July 15, 2022.
44.
Franco Montoya 听D锘, Chehal 听PK锘, Adams 听EK锘. 听Medicaid managed care鈥檚 effects on costs, access, and quality: an update.听锘 听Annu Rev Public Health. 2020;41:537-549. doi:锘
45.
Sparer 听M锘. Medicaid managed care: costs, access, and quality of care. Robert Wood Johnson Foundation. September 2012. Accessed September 15, 2021.
46.
Zuckerman 听S锘, Brennan 听N锘, Yemane 听A锘. 听Has Medicaid managed care affected beneficiary access and use?听锘 听滨苍辩耻颈谤测. 2002;39(3):221-242. doi:锘
47.
Marton 听J锘, Yelowitz 听A锘, Talbert 听JC锘. 听A tale of two cities? the heterogeneous impact of Medicaid managed care.听锘 听J Health Econ. 2014;36:47-68. doi:锘
48.
Herring 听B锘, Adams 听EK锘. 听Using HMOs to serve the Medicaid population: what are the effects on utilization and does the type of HMO matter?听锘 听Health Econ. 2011;20(4):446-460. doi:锘
49.
Draper 听DA锘, Hurley 听RE锘, Short 听AC锘. 听Medicaid managed care: the last bastion of the HMO?听锘 听Health Aff (Millwood). 2004;23(2):155-167. doi:锘
50.
Hinton 听E锘, Stolyar 听L锘. Medicaid authorities and options to address social determinants of health (SDOH). Kaiser Family Foundation. August 5, 2021. Accessed July 15, 2022.
51.
Medicaid and CHIP Payment and Access Commission. Chapter 3: managed long-term services and supports: status of state adoption and areas of program evolution. Accessed September 15, 2021.
52.
Centers for Medicare & Medicaid Services. Long-term services and supports rebalancing toolkit. November 2020. Accessed February 15, 2022.
53.
Medicare Payment Advisory Commission; Medicaid and CHIP Payment and Access Commission. Beneficiaries dually eligible for Medicare and Medicaid. Accessed February 5, 2022.
54.
Centers for Medicare & Medicaid Services. Medicare-Medicaid Coordination Office: FY 2019 report to Congress. 2019. Accessed February 15, 2022.
55.
Baker 听LC锘, Afendulis 听C锘. 听Medicaid managed care and health care for children.听锘 听Health Serv Res. 2005;40(5, pt 1):1466-1488. doi:
56.
Ndumele 听CD锘, Cohen 听MS锘, Cleary 听PD锘. 听Association of state access standards with accessibility to specialists for Medicaid managed care enrollees.听锘 听闯础惭础 Intern Med. 2017;177(10):1445-1451. doi:锘
57.
Kaiser Family Foundation. Medicaid delivery system and payment reform: a guide to key terms and concepts. June 2015. Accessed June 1, 2015.
58.
Centers for Medicare & Medicaid Services. Health Care Innovation Awards. Accessed October 14, 2021.
59.
McConnell 听KJ锘. 听Oregon鈥檚 Medicaid coordinated care organizations.听锘 听闯础惭础. 2016;315(9):869-870. doi:锘
60.
McConnell 听KJ锘, Charlesworth 听CJ锘, Meath 听THA锘, George 听RM锘, Kim 听H锘. 听Oregon鈥檚 emphasis on equity shows signs of early success for Black and American Indian Medicaid enrollees.听锘 听Health Aff (Millwood). 2018;37(3):386-393. doi:锘
61.
Medicaid and CHIP Payment and Access Commission. Delivery system reform incentive payment programs. April 2020. Accessed July 15, 2022.
62.
Mohamoud 听S锘, Idala 听D锘, Perez 听R锘, Malomo-Paris 听K锘. Health home program evaluation: CY 2013 to CY 2018. Hilltop Institute, University of Maryland Baltimore County. March 18, 2021. Accessed July 15, 2022.
63.
McConnell 听KJ锘, Renfro 听S锘, Chan 听BK锘, 听et al. 听Early performance in Medicaid accountable care organizations: a comparison of Oregon and Colorado.听锘 听闯础惭础 Intern Med. 2017;177(4):538-545. doi:锘
64.
Shane 听DM锘, Nguyen-Hoang 听P锘, Bentler 听SE锘, Damiano 听PC锘, Momany 听ET锘. 听Medicaid health home reducing costs and reliance on emergency department: evidence from Iowa.听锘 听Med Care. 2016;54(8):752-757. doi:锘
65.
McGinty 听EE锘, Stone 听EM锘, Kennedy-Hendricks 听A锘, 听et al. 听Effects of Maryland鈥檚 Affordable Care Act Medicaid Health Home Waiver on quality of cardiovascular care among people with serious mental illness.听锘 听J Gen Intern Med. 2020;35(11):3148-3158. doi:锘
66.
McGinty 听EE锘, Kennedy-Hendricks 听A锘, Linden 听S锘, Choksy 听S锘, Stone 听E锘, Daumit 听GL锘. 听An innovative model to coordinate healthcare and social services for people with serious mental illness: a mixed-methods case study of Maryland鈥檚 Medicaid health home program.听锘 听Gen Hosp Psychiatry. 2018;51:54-62. doi:锘
67.
Guth 听M锘, Ammula 听M锘. Building on the evidence base: studies on the effects of Medicaid expansion, February 2020 to March 2021. Kaiser Family Foundation. May 6, 2021. Accessed September 15, 2021.
68.
Kaiser Family Foundation. Status of state Medicaid expansion decisions: interactive map. July 21, 2022. Accessed May 15, 2021.
69.
Wehby 听GL锘, Lyu 听W锘. 听The impact of the ACA Medicaid expansions on health insurance coverage through 2015 and coverage disparities by age, race/ethnicity, and gender.听锘 听Health Serv Res. 2018;53(2):1248-1271. doi:锘
70.
Lee 听H锘, Porell 听FW锘. 听The effect of the Affordable Care Act Medicaid expansion on disparities in access to care and health status.听锘 听Med Care Res Rev. 2020;77(5):461-473. doi:锘
71.
Baumgartner 听JC锘, Collins 听SR锘, Radley 听DC锘, Hayes 听SL锘. 听How the Affordable Care Act has narrowed racial and ethnic disparities in access to health care.听 The Commonwealth Fund. January 16, 2020. Accessed August 15, 2021.
72.
Figueroa 听JF锘, Khorrami 听P锘, Bhanja 听A锘, Orav 听EJ锘, Epstein 听AM锘, Sommers 听BD锘. 听COVID-19-related insurance coverage changes and disparities in access to care among low-income US adults in 4 southern states.听锘 听闯础惭础 Health Forum. 2021;2(8):e212007. doi:锘
73.
Hill 听SC锘, Abdus 听S锘. 听The effects of Medicaid on access to care and adherence to recommended preventive services.听锘 听Health Serv Res. 2021;56(1):84-94. doi:锘
74.
Simon 听K锘, Soni 听A锘, Cawley 听J锘. 听The impact of health insurance on preventive care and health behaviors: evidence from the first two years of the ACA Medicaid expansions.听锘 听J Policy Anal Manage. 2017;36(2):390-417. doi:锘
75.
Hendryx 听M锘, Luo 听J锘. 听Increased cancer screening for low-income adults under the Affordable Care Act Medicaid expansion.听锘 听Med Care. 2018;56(11):944-949. doi:锘
76.
Soni 听A锘, Simon 听K锘, Cawley 听J锘, Sabik 听L锘. 听Effect of Medicaid expansions of 2014 on overall and early-stage cancer diagnoses.听锘 听Am J Public Health. 2018;108(2):216-218. doi:锘
77.
Miller 听S锘, Johnson 听N锘, Wherry 听LR锘. 听Medicaid and mortality: new evidence from linked survey and administrative data.听锘 听Quarterly Journal of Economics. 2021;136(3):1783-1829. doi:
78.
Zewde 听N锘, Eliason 听E锘, Allen 听H锘, Gross 听T锘. 听The effects of the ACA Medicaid expansion on nationwide home evictions and eviction-court initiations: United States, 2000-2016.听锘 听Am J Public Health. 2019;109(10):1379-1383. doi:锘
79.
Allen 听HL锘, Eliason 听E锘, Zewde 听N锘, Gross 听T锘. 听Can Medicaid expansion prevent housing evictions?听锘 听Health Aff (Millwood). 2019;38(9):1451-1457. doi:锘
80.
Callison 听K锘, Walker 听B锘. 听Medicaid expansion and medical debt: evidence from Louisiana, 2014-2019.听锘 听Am J Public Health. 2021;111(8):1523-1529. doi:锘
81.
Miller 听S锘, Hu 听L锘, Kaestner 听R锘, Mazumder 听B锘, Wong 听A锘. The ACA Medicaid expansion in Michigan and financial health. National Bureau of Economic Research Working Paper Series. Revised March 2020. Accessed September 15, 2021.
82.
Zewde 听N锘, Wimer 听C锘. 听Antipoverty impact of Medicaid growing with state expansions over time.听锘 听Health Aff (Millwood). 2019;38(1):132-138. doi:锘
83.
Yeung 听R锘. 听The effect of the Medicaid expansion on dropout rates.听锘 听J Sch Health. 2020;90(10):745-753. doi:锘
84.
He 听Q锘, Barkowski 听S锘. 听The effect of health insurance on crime: evidence from the Affordable Care Act Medicaid expansion.听锘 听Health Econ. 2020;29(3):261-277. doi:锘
85.
Vogler 听J锘. 听Access to health care and criminal behavior: short-run evidence from the ACA Medicaid expansions.听 SSRN. November 14, 2017. Accessed September 15, 2021. doi:
86.
Fry 听CE锘, McGuire 听TG锘, Frank 听RG锘. 听Medicaid Expansion鈥檚 spillover to the criminal justice system: evidence from six urban counties.听锘 听搁厂贵. 2020;6(2):244-263. doi:
87.
Lindrooth 听RC锘, Perraillon 听MC锘, Hardy 听RY锘, Tung 听GJ锘. 听Understanding the relationship between Medicaid expansions and hospital closures.听锘 听Health Aff (Millwood). 2018;37(1):111-120. doi:锘
88.
Hamel 听L锘, Kearny 听A锘, Kirzinger 听A锘, Lopes 听L锘, Brodie 听M锘. KFF health tracking poll: May 2020. Kaiser Family Foundation. May 27, 2020. Accessed July 15, 2022.
89.
Grogan 听CM锘, Park 听SE锘. 听The racial divide in state Medicaid expansions.听锘 听J Health Polit Policy Law. 2017;42(3):539-572. doi:锘
90.
Omi 听M锘, Winant 听H锘. 听Racial Formation in the United States. 3rd ed. Routledge; 2014. doi:锘
91.
Fording 听RC锘, Patton 听DJ锘. 听Medicaid expansion and the political fate of the governors who support it.听锘 听Policy Stud J. 2019;47(2):274-299. doi:锘
92.
Haeder 听SF锘, Sylvester 听SM锘, Callaghan 听T锘. 听Lingering legacies: public attitudes about Medicaid beneficiaries and work requirements.听锘 听J Health Polit Policy Law. 2021;46(2):305-355. doi:锘
93.
Kaiser Family Foundation. Data note: 5 charts about public opinion on Medicaid. February 28, 2020. Accessed September 15, 2021.
94.
Solomon 听J锘. Federal action needed to close Medicaid 鈥渃overage gap,鈥 extend coverage to 2.2 million people. Center on Budget and Policy Priorities. May 6, 2021. Accessed September 15, 2021.
95.
Artiga 听S锘, Orgera 听K锘, Damico 听A锘. Changes in health coverage by race and ethnicity since implementation of the ACA, 2013-2017. Kaiser Family Foundation. February 2019. Accessed September 15, 2021.
96.
Musumeci 听MB锘. Medicaid provisions in the American Rescue Plan Act. Kaiser Family Foundation. March 18, 2021. Accessed July 15, 2022.
97.
Goldman 听AL锘, Sommers 听BD锘. 听Among low-income adults enrolled in Medicaid, churning decreased after the Affordable Care Act.听锘 听Health Aff (Millwood). 2020;39(1):85-93. doi:锘
98.
Solomon 听J锘. 听Continuous Coverage Protections in Families First Act Prevent Coverage Gaps by Reducing 鈥淐hurn.鈥锘 Center on Budget and Policy Priorities; 2020.
99.
Albertson 听EM锘, Scannell 听C锘, Ashtari 听N锘, Barnert 听E锘. 听Eliminating gaps in Medicaid coverage during reentry after incarceration.听锘 听Am J Public Health. 2020;110(3):317-321. doi:锘
100.
Kumar 听NR锘, Borders 听A锘, Simon 听MA锘. 听Postpartum Medicaid extension to address racial inequity in maternal mortality.听锘 听Am J Public Health. 2021;111(2):202-204. doi:锘
101.
Thielke 听A锘, Curtis 听P锘, King 听V锘. Addressing COVID-19 health disparities: opportunities for Medicaid programs. Milbank Memorial Fund. June 28, 2021. Accessed September 15, 2021.
102.
Medicaid and CHIP Payment and Access Commission. Racial and ethnic disparities in Medicaid: an annotated bibliography. April 2021. Accessed September 15, 2021.
103.
Barnett 听ML锘, Clark 听KL锘, Sommers 听BD锘. 听State policies and enrollees鈥 experiences in Medicaid: evidence From a new national survey.听锘 听Health Aff (Millwood). 2018;37(10):1647-1655. doi:锘
104.
Nguyen 听KH锘, Wilson 听IB锘, Wallack 听AR锘, Trivedi 听AN锘. 听Racial and ethnic disparities in patient experience of care among nonelderly Medicaid managed care enrollees.听锘 听Health Aff (Millwood). 2022;41(2):256-264. doi:锘
105.
McGregor 听B锘, Li 听C锘, Baltrus 听P锘, 听et al. 听Racial and ethnic disparities in treatment and treatment type for depression in a national sample of Medicaid recipients.听锘 听Psychiatr Serv. 2020;71(7):663-669. doi:锘
106.
Donohue 听JM锘, Jarlenski 听MP锘, Kim 听JY锘, 听et al; Medicaid Outcomes Distributed Research Network (MODRN). 听Use of medications for treatment of opioid use disorder among US Medicaid enrollees in 11 states, 2014-2018.听锘 听闯础惭础. 2021;326(2):154-164. doi:锘
107.
Parekh 听N锘, Jarlenski 听M锘, Kelley 听D锘. 听Prenatal and postpartum care disparities in a large Medicaid program.听锘 听Matern Child Health J. 2018;22(3):429-437. doi:锘
108.
Lee 听H锘, Hodgkin 听D锘, Johnson 听MP锘, Porell 听FW锘. 听Medicaid expansion and racial and ethnic disparities in access to health care: applying the National Academy of Medicine definition of health care disparities.听锘 听滨苍辩耻颈谤测. 2021;58(Jan-Dec):46958021991293.
109.
Centers for Medicare & Medicaid Services. Beneficiary information: race and ethnicity. Accessed October 7, 2021.
110.
State Health & Value Strategies. Collection of race, ethnicity, language (REL) data in Medicaid applications: a 50-state review of the current landscape. May 21, 2021. Accessed July 15, 2022.
111.
Smithey 听A锘, Patel 听S锘; Center for Health Care Strategies. Building a culture of health equity from within: spotlight on Virginia Medicaid. June 14, 2021. Accessed September 20, 2021.
112.
Office of Minority Health, Centers for Medical & Medicaid Services. Paving the way to equity: a progress report. Accessed September 20, 2021.
113.
Cook 听BL锘. 听Effect of Medicaid managed care on racial disparities in health care access.听锘 听Health Serv Res. 2007;42(1, pt 1):124-145. doi:锘
114.
Marton 听J锘, Yelowitz 听A锘, Shores 听M锘, Talbert 听JC锘. 听Does Medicaid managed care help equalize racial and ethnic disparities in utilization?听锘 听Health Serv Res. 2016;51(3):872-891. doi:锘
115.
Bindman 听AB锘, Chattopadhyay 听A锘, Osmond 听DH锘, Huen 听W锘, Bacchetti 听P锘. 听The impact of Medicaid managed care on hospitalizations for ambulatory care sensitive conditions.听锘 听Health Serv Res. 2005;40(1):19-38. doi:锘
116.
Aizer 听A锘, Currie 听J锘, Moretti 听E锘. 听Does managed care hurt health? evidence from Medicaid mothers.听锘 听Rev Econ Stat. 2007;89(3):385-399. doi:锘
117.
Kuziemko 听I锘, Meckel 听K锘, Rossin-Slater 听M锘. 听Does managed care widen infant health disparities? evidence from Texas Medicaid.听锘 听Am Econ J Econ Policy. 2018;10(3):255-293. doi:锘
118.
Swaminathan 听S锘, Ndumele 听CD锘, Gordon 听SH锘, Lee 听Y锘, Trivedi 听AN锘. 听Association of Medicaid-focused or commercial Medicaid managed care care plan type with outpatient and acute care.听锘 听闯础惭础 Intern Med. 2020;180(12):1672-1679. doi:锘
119.
Wallace 听J锘. What does a provider network do? evidence from random assignment in Medicaid managed care. SSRN. May 7, 2019. Accessed August 15, 2021.
120.
Bailit Health. Medicaid managed care contract language: health disparities and health equity. August 2021. Accessed September 20, 2021.
121.
Taylor 听E锘, Dyer 听MB锘, Bailit 听M锘. Promoting health equity in Medicaid managed care: a guide for states. Bailit Health. September 9, 2021. Accessed July 15, 2022.
122.
US Department of Health and Human Services Office of Minority Health. Think Cultural Health. Updated October 2, 2018. Accessed September 30, 2021.
123.
Pennsylvania Department of Human Services. Pennsylvania receives grant funding to promote racial equity in pregnancy and child health. September 9, 2021. Accessed July 15, 2022.
124.
Brooks-LaSure 听C锘, Fowler 听E锘, Seshamani 听M锘, Tsai 听D锘. Innovation at the centers for Medicare and Medicaid Services: a vision for the next 10 years. Health Affairs. August 12, 2021. Accessed August 28, 2021.
125.
Agniel 听D锘, Martino 听SC锘, Burkhart 听Q锘, 听et al. 听Incentivizing excellent care to at-risk groups with a health equity summary score.听锘 听J Gen Intern Med. 2021;36(7):1847-1857. doi:锘
126.
Holgash 听K锘, Heberlein 听M锘. Physician acceptance of new Medicaid patients: Medicaid and CHIP Payment and Access Commission. January 24, 2019. Accessed July 25, 2022.
127.
Gaskin 听DJ锘, Dinwiddie 听GY锘, Chan 听KS锘, McCleary 听RR锘. 听Residential segregation and the availability of primary care physicians.听锘 听Health Serv Res. 2012;47(6):2353-2376. doi:锘
128.
Vinekar 听K锘. 听Pathology of racism: a call to desegregate teaching hospitals.听锘 听N Engl J Med. 2021;385(13):e40. doi:锘
129.
Kangovi 听S锘, Mitra 听N锘, Norton 听L锘, 听et al. 听Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: a randomized clinical trial.听锘 听闯础惭础 Intern Med. 2018;178(12):1635-1643. doi:锘
130.
Silver 听JK锘, Bean 听AC锘, Slocum 听C锘, 听et al. 听Physician workforce disparities and patient care: a narrative review.听锘 听Health Equity. 2019;3(1):360-377. doi:锘
131.
Howell 听EA锘, Egorova 听NN锘, Janevic 听T锘, 听et al. 听Race and ethnicity, medical insurance, and within-hospital severe maternal morbidity disparities.听锘 听Obstet Gynecol. 2020;135(2):285-293. doi:锘
132.
Maina 听IW锘, Belton 听TD锘, Ginzberg 听S锘, Singh 听A锘, Johnson 听TJ锘. 听A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test.听锘 听Soc Sci Med. 2018;199:219-229. doi:锘
Views 8,353
Special Communication
厂别辫迟别尘产别谤听20, 2022

The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity

Author Affiliations
  • 1Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
  • 2Grantmakers In Health, Washington, DC
  • 3Department of Government and School of Public Policy, Cornell University, Ithaca, New York
JAMA. 2022;328(11):1085-1099. doi:10.1001/jama.2022.14791
Key Points

QuestionWho does Medicaid insure, how is the program financed and delivered, how have policies evolved, and how could reforms address racial and ethnic health equity?

FindingsIn 2022, Medicaid insured approximately 80.6 million individuals (56.4% from racial and ethnic minority groups in 2019). In 2020, estimated Medicaid spending was $671.2 billion (16.3% of total US health spending). The proportion of beneficiaries enrolled in Medicaid managed care was 69.5% in 2019, 45 states have pursued 139 Medicaid delivery system reforms from 2003 to 2019, and 38 states and Washington, DC, have expanded Medicaid under the Affordable Care Act. Racial and ethnic health disparities are common within Medicaid, and evidence on the association of Medicaid policies and reforms with achieving racial health equity remains limited.

MeaningMedicaid is an important source of insurance and accounts for substantial health care spending. Medicaid reforms have expanded coverage and provide further opportunities to reduce disparities and address health inequities.

Abstract

ImportanceMedicaid is the largest health insurance program by enrollment in the US and has an important role in financing care for eligible low-income adults, children, pregnant persons, older adults, people with disabilities, and people from racial and ethnic minority groups. Medicaid has evolved with policy reform and expansion under the Affordable Care Act and is at a crossroads in balancing its role in addressing health disparities and health inequities against fiscal and political pressures to limit spending.

ObjectiveTo describe Medicaid eligibility, enrollment, and spending and to examine areas of Medicaid policy, including managed care, payment, and delivery system reforms; Medicaid expansion; racial and ethnic health disparities; and the potential to achieve health equity.

Evidence ReviewAnalyses of publicly available data reported from 2010 to 2022 on Medicaid enrollment and program expenditures were performed to describe the structure and financing of Medicaid and characteristics of Medicaid enrollees. A search of PubMed for peer-reviewed literature and online reports from nonprofit and government organizations was conducted between August 1, 2021, and February 1, 2022, to review evidence on Medicaid managed care, delivery system reforms, expansion, and health disparities. Peer-reviewed articles and reports published between January 2003 and February 2022 were included.

FindingsMedicaid covered approximately 80.6 million people (mean per month) in 2022 (24.2% of the US population) and accounted for an estimated $671.2 billion in health spending in 2020, representing 16.3% of US health spending. Medicaid accounted for an estimated 27.2% of total state spending and 7.6% of total federal expenditures in 2021. States enrolled 69.5% of Medicaid beneficiaries in managed care plans in 2019 and adopted 139 delivery system reforms from 2003 to 2019. The 38 states (and Washington, DC) that expanded Medicaid under the Affordable Care Act experienced gains in coverage, increased federal revenues, and improvements in health care access and some health outcomes. Approximately 56.4% of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, and disparities in access, quality, and outcomes are common among these groups within Medicaid. Expanding Medicaid, addressing disparities within Medicaid, and having an explicit focus on equity in managed care and delivery system reforms may represent opportunities for Medicaid to advance health equity.

Conclusions and RelevanceMedicaid insures a substantial portion of the US population, accounts for a significant amount of total health spending and state expenditures, and has evolved with delivery system reforms, increased managed care enrollment, and state expansions. Additional Medicaid policy reforms are needed to reduce health disparities by race and ethnicity and to help achieve equity in access, quality, and outcomes.

×