State Medicaid Policy and LTC: A Multi-State Qualitative Study of Policy Influence on Caregiver Experiences

This study focuses on long-term care (LTC) state Medicaid policy and its impact on caregiver decisions and experiences. It examines respondents’ general knowledge of LTC state policies and services, challenges with navigating LTC policies and services, and decision-making pathways based on these factors. Using purposive sampling, 63 family caregivers across eight states participated in open-ended qualitative interviews (2019-2020) until thematic saturation was reached. Questions broadly examined caregivers’ experiences and decisions, focusing on decisions made around type of care setting and experiences with LTC state policy. States were selected to represent variation in Home and Community Based Service (HCBS) expenditures as a percentage of total Medicaid long-term services and support expenditures. While LTC policies and services vary significantly by state, we identified many parallels in caregiver experiences and perceptions across states, as respondents often lacked specific knowledge about LTC policies and services and how to access them. Overarching themes include LTC policy navigation challenges, distrust in state-funded LTC services and supports, and moral expectations of caregiving. To manage these challenges, caregivers employed coping strategies such utilizing informal support networks, hiring care coordination assistance, and “stretching things thin” to fill the policy and service gaps. Study findings highlight potential strategies to improve LTC services across states. There is a need to improve community trust with state services by employing transparent regulatory and evaluation procedures for LTC. Wider access to case management may improve communication and knowledge of available services to maximize benefit from HCBS expansions.

Decline in Frequency of Newborn Male Circumcision After Change in Medicaid Coverage Status in Selected States in the United States

Objectives Male circumcision is linked to a reduction in the risk of HIV infection, sexually transmitted infections, penile inflammatory skin disorders, cancers, urinary tract infections, and other complications. We examined the extent to which the change in circumcision recommendation by the American Academy of Pediatrics in 1999 and Medicaid coverage status in states affected the total number of procedures performed. Methods We used data from the Nationwide Inpatient Sample for 1998-2011 collected annually by the Healthcare Cost and Utilization Project. We examined data on all male births in the United States with Medicaid and private health insurance. We then categorized births into 4 groups: (1) births with newborn male circumcision procedure, (2) births with Medicaid or private health insurance, (3) births that occurred in states where Medicaid coverage for newborn male circumcision was removed, and (4) births that occurred before or after the policy change. We used multivariable logistic regression to estimate the adjusted odds of newborn male circumcision. Results In the 10 states where a change in Medicaid policy occurred, circumcision frequency had a mean percentage-point decrease of 21.4% among Medicaid beneficiaries and 3.2% among private health insurance beneficiaries from before to after the policy change. In states where coverage was maintained, the change in circumcision frequency was negligible for Medicaid and private health insurance beneficiaries. These changes resulted in an estimated 163 456 potential circumcisions not performed. Conclusion Decreases in newborn male circumcision frequency correlated with the Medicaid policy change for the procedure. Efforts should be made to reduce barriers for cost-effective preventive procedures that promote health, such as newborn male circumcision.

Work Requirements and Perceived Deservingness of Medicaid

Does an individual’s effort to acquire employer-sponsored health insurance through employment affect whether they are deserving of health insurance? Much of the current literature that examines the deservingness of federally-funded health insurance focuses on an individual’s responsibility in becoming ill. However, logic from the welfare literature would suggest the willingness to work for one’s welfare, or reciprocity, is an important determinant of deservingness. The relevance of employment-seeking in Medicaid deservingness comes at a crucial time given recent attempts by state governments to implement work requirements as a part of Medicaid eligibility. Using a series of survey experiments, I compare the importance of responsibility versus reciprocity and find that responsibility, what one does to become ill, is the primary driver of judgments of deservingness. What one does to earn their Medicaid by working plays a negligible role in driving attitudes. These findings have implications for how we understand the determinants of support for Medicaid policy.

Lactation Care: Advocating for Equitable Access at the Ohio Department of Medicaid

BackgroundLactation consultants understand the mechanisms and research supporting breastfeeding's positive impact on infant mortality reduction, including lifelong health outcomes and associated cost savings. Lactation services can enhance the success of programs intended to improve infant mortality rates, health outcomes, and cost effectiveness.ProgramAs leaders serving the Ohio Lactation Consultant Association (OLCA), we pursued engagement with Ohio Department of Medicaid policy chiefs to ensure incorporation of these facts as programs are created to improve health and optimize allocation of Medicaid resources.ResultAfter a productive meeting, we specifically proposed that professional lactation services be standard care and fully integrated across the healthcare continuum regardless of setting and ability to pay.