Medicaid Expansion Under The Affordable Care Act Essay

Medicaid Expansion Under The Affordable Care Act Essay

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Medicaid expansion under the Affordable Care Act (ACA) has greatly increased the challenges to states to maintain their fiscal integrity and a sustainable source of financing for the programs. One common approach adopted by states to provide high quality and cost-efficient care is to shift patients from a Fee-for-Service Medicaid plan (FFS) to a Managed Medicaid Plan (MMC). In California, the transition of low-income seniors and people with disabilities (SPDs) took place in June 2011 and completed in July 2012. As SPDs make up a quarter of Medicaid enrollees yet account for 70% of overall Medicaid cost, it would be important to understand their health service utilization and identify a better model of care for their healthcare management.[1]
The health profiles of Medicaid SPDs tend to be the most complex and vulnerable enrollees, including individuals with serious mental illness and behavioral health diagnoses, developmental disorders, severe chronic illness and persons with disabling brain or spinal cord injuries. With the transition of these heavy health service utilizers to a managed Medicaid program, it mitigated the budget crisis that the state was facing. However, it could lead to overwhelm the existing resource in a MMC and contribute to an even fragmented, episodic, and uncoordinated health care – a so called crowding out effect.
The patient-centered medical home (PCMH) model which strives to deliver comprehensive, patient-centered, coordinated, accessible, and high quality care has emerged as a promising remedy to the challenges faced by Medicaid. The standards for the PCMH model were developed in 2007 and featured by 1) an ongoing relationship with a personal physician who directs a patient care team; 2) enhanced acces...


... middle of paper ...


...results will offer timely information that can aid policymakers across the country in redesigning a Medicaid program.
Aim 1: To evaluate the impact of PCMH on the healthcare utilizations including acute hospitalization, preventable hospitalization, readmission, emergency room visit, avoidable emergency room visit, and continuity of care (Bice–Boxerman Index) in non-SPDs through a difference-in-difference (DID) analysis.
Aim 2: To evaluate the impact of PCMH on the healthcare utilizations including acute hospitalization, preventable hospitalization, readmission, emergency room visit, avoidable emergency room visit, and continuity of care (Bice–Boxerman Index) in SPDs through an instrumental variable approach.
Aim 3: To assess the extent to which the effect of PCMH varies in response to an influx of SPDs through a difference-in-difference-in-difference (DIDID) design.

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