hpm 211 Flashcards
(42 cards)
Federally Qualified Health Centers
Relies on hrsa
Receives cost-based, enhanced reimbursement from Medicaid
HRSA Criteria:
Serves in a medically-underserved area or serves a medically-underserved population (low-income urban, rural, HIV+, migrant workers, LGBT, etc.)
Governing board at least 51% patients
Non-profit or public
Takes all patients, regardless of ability to pay / immigrant status
DSH payments:
- Federal funds provided via Medicaid & Medicare to help hospitals caring for a disproportionate share of low-income and publicly-insured patients
- States decide how to disperse to qualifying hospitals: mostly non profit hospitals
Safety net definition:
Providers who either by legal mandate or explicitly adopted mission they maintain an ‘open door,’ offering access to services for patients regardless of their ability to pay;
Vulnerable populations/ why they matter
defined by race/ethnicity, socio-economic status, geography, gender, age, disability status, risk status related to sex and gender, and other populations identified as at-risk for health disparities.
They matters because of how policy impacts the population/definition
Voltage Drop Barriers to care from Eisenberg and Power
- The different voltage drops subset/transition into the next
-Ensuring high-quality health care requires that each of these “voltage drops” be recognized and addressed.
Who lacks health insurance:
40 million uninsured pre aca
This number drops to 25 million after ACA
Insurance coverage by age:
-65+ is more covered because of medicare
- children because of chip
- Non-elderly childless-adult lacks coverage
Independent risk factors for being uninsured:
income, citizenship, age, education level, race/ethnicity
Causes of uninsured status:
affordability, cultural barriers, lack of knowledge, eligibility for public programs
Churning
- transition between different types of coverage and/or becoming uninsured.
- More gaps in non expansion states due to churning
What does insurance do:
- Strong evidence that it improves financial burden, care access, and utilization.
- Fairly good evidence that it impacts health and mortality. Bens paper shows that theres a 3% decline statewide
- Expanding health insurance does impact health disparities that are related to insurance status
Insurance does not:
-Expanding health insurance will not save us money
-Does not impact large health disparities
Oregon health insurance experiment:
-study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes (no statistically significant change in diabetes control, cholesterol, or blood pressure)in the first 2 years,
-but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.
Kosnick paper on insurance impacts:
Study showed no mortality impact of health insurance
Sommers paper on insurance impacts:
3% decline in mortality statewide (esp in low-income counties and for health-care amenable causes)
- improvements in self-reported health, usual source of care, and physician’s visit in past year
Pre aca medicaid requirements:
Low Income and some other eligibility category - disabled, pregnant,
Post ACA mediciad:
-ACA took away the categorical requirements.
-Expanded to all citizens up to 138 FPL.
Medicaid expansion in 2023:
40 states expanded, 1 pending, 10 states have not expanded and it is an equity issue across states
medicaid expansion status in 2014
23 states did not expand, 26 did, 2 maybes
Coverage gap for non expansion states:
The options are Medicaid or marketplace; but there is a gap inbetween
-In states that didn’t expand, there is a coverage gap for childless adults. 44% -100% fpl do not have a place to get coverage
Medicaid benefits:
Medicaid is the Only payer for long term care. Medicare does not.
Federal requirements: outpatient, inpatient, ER, maternity, and long-term care
Federal limits on cost-sharing (5% income)
Optional benefits: drugs (though all states offer), vision, dental, medical equipment
Section 1115 wavers
trial periods for new things to add on to medicaid coverage
- experimental, pilot, or demonstration projects
- Approved by CMS for 5-year periods
Medicaid managed care:
private payer gets capitated funds from state to provide coverage
Per member per month payment to private payer
Now covers 70% of beneficiaries
Studies on medicaid mcos are mixed: