Urban Institute

About: Urban Institute is a nonprofit organization based out in Washington D.C., District of Columbia, United States. It is known for research contribution in the topics: Medicaid & Population. The organization has 927 authors who have published 2330 publications receiving 86426 citations.

Medicaid spenddown in nursing homes.

Abstract: This paper employs information from nationally representative surveys to examine the incidence and causes of Medicaid spenddown among disabled elderly persons About 10% of nursing home discharges experience "asset spenddown," the process of converting from private pay to Medicaid In contrast, over 50% of nursing home patients remain private pay throughout their stays In addition, becoming a Medicaid patient is more common among community residents than among nursing home residents Implications of findings for health care policies are discussed

The effects of Medicaid and CHIP policy changes on receipt of preventive care among children.

Abstract: Timely receipt of preventive medical and dental care for children is important for screening and early diagnosis of health problems, including developmental and behavioral problems that may require early intervention, and it has been shown to be associated with reductions in avoidable hospital admissions, reductions in dental costs later in life, and improved child health (Hakim and Bye 2001; Savage et al 2004;) The American Academy of Pediatrics guidelines recommend that children ages 3–21 receive annual well-child visits and more frequent visits under age 3 (Hagan, Shaw, and Duncan 2008), while the American Academy of Pediatric Dentistry recommends semi-annual clinical oral examinations beginning at age 6–12 months (American Academy of Pediatric Dentistry 2009) National data indicate that the receipt of preventive care for children falls below recommended levels, particularly for children in low-income families (Selden 2006; Edelstein and Chinn 2009;) This study examines Medicaid and Children's Health Insurance Program (CHIP) policy changes in Kentucky and Idaho aimed at increasing use of preventive care among children National surveys vary widely in their estimates of the share of Medicaid/CHIP children who received a well-child visit (40–91 percent) and a preventive dental visit (24–76 percent) over a 12-month period (Kenney, McFeeters, and Yee 2005; National Survey of Children's Health 2007; Perry and Kenney 2007;) Medicaid covers well-child and preventive dental care under its Early and Periodic Screening, Diagnostic, and Treatment benefit In CHIP, well-child care is mandatory; dental benefits have been included in almost all CHIP programs, though it was an optional benefit until CHIP was reauthorized in 2009 (Kaye, Pernice, and Cullen 2006) Preventive care receipt likely falls below recommended levels because of both supply and demand barriers Public programs often reimburse physicians and dentists at lower rates than commercial insurers (Berman et al 2002; Zuckerman et al 2004;), and other payment issues (such as delays in reimbursement) may make providers less willing to provide services to children covered under these programs (Cunningham and O'Malley 2009) The literature suggests that higher Medicaid reimbursement rates can increase receipt of preventive care but that such an effect is not assured (Mayer et al 2000; Hughes et al 2005; McInerny, Cull, and Yudkowsky 2005; Shen and Zuckerman 2005;) In terms of demand barriers, some families may not place a high value on preventive services, particularly if their children appear to be healthy (Blumberg, O'Connor, and Kenney 2005), or they may face difficulty obtaining preventive medical and dental services due to language and transportation barriers, low quality of care, or discrimination (Cohen and Christakis 2006; Kelly et al 2005;) Evidence on past attempts to use incentives to raise the use of preventive services is mixed (Redmond, Solomon, and Lin 2007; Sutherland, Christianson, and Leatherman 2008;) This paper examines whether reimbursement increases, incentives, and the adoption of managed care in two state Medicaid/CHIP programs led to greater preventive care receipt among publicly insured children

The Human Factor: The Promise & Limits of Online Education

Abstract: The idea that online learning might revolutionize higher education, lowering the cost of high-quality learning opportunities for students with limited access to traditional higher education, follow...

Crowding Out: How Big A Problem?

Abstract: Although they use different methods, both David Cutler and Jonathan Gruber and Lisa Dubay and Genevieve Kenney find that the crowding out of private insurance is a serious issue for Medicaid expansions that cover children and pregnant women, particularly those that extend coverage to persons with incomes above the federal poverty line. Analyzing this issue is difficult because it is hard to control for the secular and business cycle–induced declines in employersponsored coverage. Thus, it is not surprising that the authors’ estimates differ. However, both studies seem to agree that the potential for crowding out is great, especially for the near-poor. Here, I comment on themeaning of these results. n Access to private coverage. Although at least 17 percent and possibly as much as 50 percent of the added coverage attributable to Medicaid expansions to cover low-income children and pregnant women might be offset by directly related reductions in private coverage, the rest of the expanded coverage would not be offset. For the most part, during the late 1980s and early 1990s, Medicaid extended coverage to persons who otherwise would be uninsured. By 1994 Medicaid covered 5.2 million children and pregnant women under poverty-related expansions. Based on the results by Cutler and Gruber and by Dubay and Kenney, 80 percent of the new enrollees, or four million Americans, would have been uninsured in the absence of the expansions. Cutler and Gruber’s results suggest a spillover effect in which persons not eligible for Medicaid would have dropped private coverage. If all of the Medicaid enrollment increases that occurred during this period, including growth in the Aid to Families with Dependent Children (AFDC) and disabled populations, had not occurred, there would be even more uninsured low-income Americans. Between 1988 and 1993 nine million enrollees were added to Medicaid; most of them were below poverty and therefore were unlikely to have had access to private coverage. n Employer-sponsored coverage. Employer-sponsored coveragewas declining during this period for all groups, even persons with higher incomes. These declines likely were caused by factors other than crowding out, such as large increases in insurance premiums relative to the compensation increases that businesses could afford. Medicaid crowding out had a small effect on the decline in employer-sponsored coverage. Between 1988 and 1993 the percentage of nonelderly persons with employer-sponsored coverage fell from 67 percent to 61 percent. If the proportion with employer-sponsored coverage had stayed at 67 percent, 13.3 million more persons would have had coverage in 1993. If 50 percent of the increase in Medicaid enrollment during this period resulted in crowding out, then 4.5 million persons declined private coverage because of the availability of Medicaid. If only 20 percent of the increase in Medicaid resulted in crowding out, then 1.8 million low-income persons gave up private

How Many Struggle To Get By In Retirement

Abstract: Purpose : This study compared the offi cial poverty rate for adults aged 65 years and older with alternative measures that portray the true resources and needs of older adults. Design and Methods : The analysis used data from the 2004 Health and Retirement Study on income, assets, in-kind transfers, and out-of-pocket medical expenses. It also incorporated the effects of federal and state income taxes on net incomes, and accounted for the potential annuity value of assets in measuring resources. Results : The alternative poverty measures that account for outof-pocket health spending estimate that between 0.3 and 1.5 million more older adults live in poverty than acknowledged by the offi cial measure. Implications : These results highlight the need to update poverty measures so that they better refl ect older adults ’ circumstances. This will become increasingly important as policymakers consider reforms to improve solvency in the Social Security and Medicare programs that may require benefi t cuts or increased cost sharing.