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  1. Article ; Online: COVID-19-related Medicaid enrollment in Medicaid expansion and non-expansion states.

    Benitez, Joseph A / Dubay, Lisa

    Health services research

    2022  Volume 57, Issue 6, Page(s) 1321–1331

    Abstract: Research objective: To explore whether expanded Medicaid helps mitigate the relationship between unemployment due to COVID and being uninsured. Unanticipated unemployment spells are generally associated with disruptions in health insurance coverage, ... ...

    Abstract Research objective: To explore whether expanded Medicaid helps mitigate the relationship between unemployment due to COVID and being uninsured. Unanticipated unemployment spells are generally associated with disruptions in health insurance coverage, which could also be the case for job losses during the COVID-19 pandemic. Expanded access to Medicaid may insulate some households from long uninsurance gaps due to job loss.
    Data source: Phase 1 of the Census Bureau's Experimental Household Pulse Survey covering April 23, 2020-July 21, 2020.
    Study design: We compare differences in health insurance coverage source and status linked to recent lob losses attributable to the COVID-19 pandemic in states that expanded Medicaid against states that did not expand Medicaid.
    Data collection/extraction methods: Our analytical dataset was limited to 733,181 non-elderly adults aged 20-64.
    Principal findings: Twenty-six percent of our study sample experienced an income loss between March 13, 2020, and the time leading up to the survey-16% experienced job losses (e.g., layoff, furlough) due to the COVID-19 crisis, and 11% had other reasons they were not working. COVID-linked job losses were associated with a 20 (p < 0.01) percentage-point (PPT) lower likelihood of having employer-sponsored health insurance (ESI). Relative to persons in states that did not expand Medicaid, persons in Medicaid expansion states experiencing COVID-linked job losses were 9 PPT (p < 0.01) more likely to report having Medicaid and 7 PPT (p < 0.01) less likely to be uninsured. The largest increases in Medicaid enrollment were among people who, based on their 2019 incomes, would not have qualified for Medicaid previously.
    Conclusions: Our findings suggest that expanded Medicaid eligibility may allow households to stabilize health care needs and they should become detached from private health coverage due to job loss during the pandemic. Households negatively affected by the pandemic are using Medicaid to insure themselves against the potential health risks they would incur while being unemployed.
    MeSH term(s) Adult ; United States ; Humans ; Middle Aged ; Medicaid ; Insurance Coverage ; COVID-19/epidemiology ; Pandemics ; Medically Uninsured ; Patient Protection and Affordable Care Act ; Insurance, Health ; Health Services Accessibility
    Language English
    Publishing date 2022-07-22
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 410435-3
    ISSN 1475-6773 ; 0017-9124
    ISSN (online) 1475-6773
    ISSN 0017-9124
    DOI 10.1111/1475-6773.14029
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: The Relationship Between Coronavirus Disease 2019 (COVID-19) Pandemic-linked Job Losses and Health Care Access and Household Financial Health in Medicaid Expansion and Nonexpansion States.

    Benitez, Joseph A / Huang, Huang / Johnson, Portia L

    Medical care

    2023  Volume 61, Issue 12, Page(s) 872–881

    Abstract: Background: Unemployment associated with the coronavirus disease 2019 (COVID-19) pandemic was linked to financial insecurity and disruptions in access to health care.: Objective: To explore whether expanded access to Medicaid mitigated the likelihood ...

    Abstract Background: Unemployment associated with the coronavirus disease 2019 (COVID-19) pandemic was linked to financial insecurity and disruptions in access to health care.
    Objective: To explore whether expanded access to Medicaid mitigated the likelihood of health and non-health financial hardship associated with pandemic-linked job loss.
    Design: We estimate linear regression models comparing differences in the levels of outcomes attributable to pandemic-linked joblessness in Medicaid expansion and nonexpansion states.
    Observations: A total of 20,281 adults aged 19-64 were in the 2021 National Financial Capability Study.
    Measures: Our key exposure was job loss, layoffs, and furloughs, attributable to the COVID-19 pandemic. Outcomes under evaluation include indicators of health care access and household financial health.
    Results: Relative to persons reporting pandemic-linked unemployment in nonexpansion states, adults experiencing pandemic-linked job loss in expansion states were less likely to report as uninsured [-6.2 percentage points (PPs); 95% CI: -10.8, -1.6; P < 0.01], having unpaid medical bills (-4.3 PP; 95% CI: -8, -0.6; P < 0.05), having unmet medical needs due to cost (-5.3 PP; 95% CI: -10.1, -0.5; P < 0.05), and having calls from debt collection agencies (-6.9 PP; 95% CI: -10.6, -3.1; P < 0.01). Patterns consistent with Medicaid acting as a safety net for the adverse financial effects of job loss were more pronounced for middle-income households.
    Conclusions: In economic downturns, such as the COVID-19 crisis, Medicaid can help insulate households from diminished health care access and financial distress associated with job loss.
    MeSH term(s) Adult ; United States/epidemiology ; Humans ; Medicaid ; Pandemics ; Patient Protection and Affordable Care Act ; COVID-19/epidemiology ; Health Services Accessibility
    Language English
    Publishing date 2023-10-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 411646-x
    ISSN 1537-1948 ; 0025-7079
    ISSN (online) 1537-1948
    ISSN 0025-7079
    DOI 10.1097/MLR.0000000000001933
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Impact of state Medicaid expansion on cross-sector health and social service networks: Evidence from a longitudinal cohort study.

    Hogg-Graham, Rachel / Mamaril, Cezar B / Benitez, Joseph A / Gatton, Kelsey / Mays, Glen P

    Health services research

    2023  Volume 58, Issue 3, Page(s) 634–641

    Abstract: Objective: To examine the impact of state Medicaid expansion on the delivery of population health activities in cross-sector health and social services networks. Community networks are multisector, interorganizational networks that provide services ... ...

    Abstract Objective: To examine the impact of state Medicaid expansion on the delivery of population health activities in cross-sector health and social services networks. Community networks are multisector, interorganizational networks that provide services ranging from the direct provision of individual social services to the implementation of population-level initiatives addressing community outcomes.
    Data sources: We used data measuring the composition of cross-sector population health networks 2006-2018 National Longitudinal Survey of Public Health Systems (NALSYS) linked with the Area Health Resource File.
    Study design: A difference-in-differences approach was used to examine the impact of expansion on organization engagement in population health activities and network structure.
    Data collection/extraction methods: Stratified random sampling of local public health jurisdictions in the United States. We restricted our data to jurisdictions serving populations of 100,000 or more and states that had NALSYS observations across all time periods, resulting in a final sample size of 667.
    Principal findings: Results from our adjusted difference-in-differences estimates indicated that Medicaid expansion was associated with a 2.3 percentage point increase in the density of population health networks (p < 0.10). Communities in states that expanded Medicaid experienced significant increases in the participation of local public health, local government, hospital, nonprofit, insurer, and K-12 schools. Of the organizations with significant increases in expansion communities, nonprofits (7.7 percentage points, p < 0.01), local public health agencies (6.5 percentage points, p < 0.01), hospitals (5.8 percentage points, p < 0.01), and local government agencies (6.0 percentage points, p < 0.05) had the largest gains.
    Conclusions: Our study found increases in cross-sector participation in population health networks in states that expanded Medicaid compared with nonexpansion states, suggesting that additional coverage gains are associated with positive changes in population health network structure.
    MeSH term(s) Humans ; United States ; Medicaid ; Longitudinal Studies ; Patient Protection and Affordable Care Act ; Cohort Studies ; Social Work ; Insurance Coverage
    Language English
    Publishing date 2023-03-09
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, Non-U.S. Gov't
    ZDB-ID 410435-3
    ISSN 1475-6773 ; 0017-9124
    ISSN (online) 1475-6773
    ISSN 0017-9124
    DOI 10.1111/1475-6773.14144
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Did Medicaid slow declines in access to health care during the great recession?

    Benitez, Joseph A / Perez, Victoria E / Chen, Jie

    Health services research

    2021  Volume 56, Issue 4, Page(s) 655–667

    Abstract: Objective: We examine whether broadened access to Medicaid helped insulate households from declines in health coverage and health care access linked to the 2007-2009 Great Recession.: Data source: 2004-2010 Behavioral Risk Factor Surveillance System ( ...

    Abstract Objective: We examine whether broadened access to Medicaid helped insulate households from declines in health coverage and health care access linked to the 2007-2009 Great Recession.
    Data source: 2004-2010 Behavioral Risk Factor Surveillance System (BRFSS).
    Study design: Flexible difference-in-difference regressions were used to compare the impact of county-level unemployment on health care access in states with generous Medicaid eligibility guidelines versus states with restrictive guidelines.
    Data collection/extraction methods: Nonelderly adults (aged 19-64) in the BRFSS were linked to county unemployment rates from the Bureau of Labor Statistics' Local Area Unemployment Statistics Program. We created a Medicaid generosity index by simulating the share of a nationally representative sample of adults that would be eligible for Medicaid under each state's 2007 Medicaid guidelines using data from the 2007 Current Population Survey's Annual Social and Economic Supplement.
    Principal findings: A percentage point (PPT) increase in the county unemployment rate was associated with a 1.3 PPT (95% CI: 0.9-1.6, P < .01) increase in the likelihood of being uninsured and a 0.86 PPT (95% CI: 0.6-1.1, P < .01) increase in unmet medical needs due to cost in states with restrictive Medicaid eligibility guidelines. Conversely, a one PPT increase in unemployment was associated with only a 0.64 PPT (P < .01) increase in uninsurance among states with the most generous eligibility guidelines. Among states in the fourth quartile of generosity (ie, most generous), rises in county-level unemployment were associated with a 0.68 PPT (P < .10) increase in unmet medical needs due to cost-a 21% smaller decrease relative to states with the most restrictive Medicaid eligibility guidelines.
    Conclusions: Increased access to Medicaid during the Great Recession mitigated the effects of increased unemployment on the rate of unmet medical need, particularly for adults with limited income.
    MeSH term(s) Adult ; Behavioral Risk Factor Surveillance System ; Economic Recession/statistics & numerical data ; Female ; Health Services Accessibility/statistics & numerical data ; Humans ; Insurance Coverage/statistics & numerical data ; Male ; Medicaid/statistics & numerical data ; Middle Aged ; Unemployment/statistics & numerical data ; United States ; Young Adult
    Language English
    Publishing date 2021-03-03
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 410435-3
    ISSN 1475-6773 ; 0017-9124
    ISSN (online) 1475-6773
    ISSN 0017-9124
    DOI 10.1111/1475-6773.13645
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Longitudinal Trends in Insurer Participation in Multisector Population Health Activities.

    Hogg-Graham, Rachel / Waters, Teresa M / Clear, Emily R / Pearson, Kendall / Benitez, Joseph A / Mays, Glen P

    Inquiry : a journal of medical care organization, provision and financing

    2024  Volume 61, Page(s) 469580241249092

    Abstract: Healthcare organizations increasingly engage in activities to identify and address social determinants of health (SDOH) among their patients to improve health outcomes and reduce costs. While several studies to date have focused on the evolving role of ... ...

    Abstract Healthcare organizations increasingly engage in activities to identify and address social determinants of health (SDOH) among their patients to improve health outcomes and reduce costs. While several studies to date have focused on the evolving role of hospitals and physicians in these types of population health activities, much less is known about the role health insurers may play. We used data from the National Longitudinal Survey of Public Health Systems for the period 2006 to 2018 to examine trends in health insurer participation in population health activities and in the multi-sector collaborative networks that support these activities. We also used a difference-in-differences approach to examine the impact of Medicaid expansion on insurer participation in population health networks. Insurer participation increased in our study period both in the delivery of population health activities and in the integration into collaborative networks that support these activities. Insurers were most likely to participate in activities focusing on community health assessment and policy development. Results from our adjusted difference-in-differences models showed variation in association between insurer participation in population health networks and Medicaid expansion (Table 2). Population health networks in expansion states experienced significant increases insurer participation in assessment (4.48 percentage points,
    MeSH term(s) Humans ; United States ; Longitudinal Studies ; Insurance, Health/statistics & numerical data ; Population Health ; Medicaid/statistics & numerical data ; Insurance Carriers/statistics & numerical data ; Insurance Carriers/trends ; Social Determinants of Health
    Language English
    Publishing date 2024-04-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 42153-4
    ISSN 1945-7243 ; 0046-9580
    ISSN (online) 1945-7243
    ISSN 0046-9580
    DOI 10.1177/00469580241249092
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  6. Article ; Online: US Health Care Reform and Rural America: Results From the ACA's Medicaid Expansions.

    Benitez, Joseph A / Seiber, Eric E

    The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association

    2017  Volume 34, Issue 2, Page(s) 213–222

    Abstract: Purpose: Medicaid expansions, prompted by the Affordable Care Act, generated generally positive effects on coverage and alleviated much of the financial burden associated with seeking health care. We do not know if these shifts also extend to the nation' ...

    Abstract Purpose: Medicaid expansions, prompted by the Affordable Care Act, generated generally positive effects on coverage and alleviated much of the financial burden associated with seeking health care. We do not know if these shifts also extend to the nation's rural populations.
    Methods: Using 2011-2015 Behavioral Risk Factor Surveillance System data, this study compares trend changes for coverage, access to care, and health care utilization in response to Medicaid expansion among urban and rural residents using a difference-in-differences regression approach.
    Findings: Following Medicaid expansion, low-income rural and urban residents both experienced reductions in uninsurance; however, the coverage uptake in rural settings (8.5 percentage points [pp], P < .01) was much larger than the uptake in coverage in more urban settings (4.1 pp, P > .10). In spite of larger uptakes in coverage among rural residents, reductions in cost-related barriers to medical care were slightly larger among urban residents, and access to a regular source of medical care (5.2 pp, P < .05) and doctor visitation (4.5 pp, P < .01) were only statistically significant among urban residents.
    Conclusions: The ACA Medicaid expansions produced larger gains in coverage for rural residents than urban residents; however, it appears there remain opportunities to improve access to care among potentially vulnerable rural residents.
    MeSH term(s) Behavioral Risk Factor Surveillance System ; Health Care Reform/methods ; Health Care Reform/trends ; Health Services Accessibility/standards ; Health Services Accessibility/statistics & numerical data ; Humans ; Insurance Coverage/statistics & numerical data ; Medicaid/organization & administration ; Medicaid/statistics & numerical data ; Medicaid/trends ; Patient Protection and Affordable Care Act/organization & administration ; Patient Protection and Affordable Care Act/statistics & numerical data ; Rural Population/statistics & numerical data ; United States
    Language English
    Publishing date 2017-11-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 639160-6
    ISSN 1748-0361 ; 0890-765X
    ISSN (online) 1748-0361
    ISSN 0890-765X
    DOI 10.1111/jrh.12284
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Making pandemic era Medicaid continuous coverage automatic in future crises.

    Shafer, Paul R / Lim, Kenneth / Goutos, Demetri / Huberfeld, Nicole / Benitez, Joseph A / Hsu, Kevin S / Raifman, Julia R

    Health services research

    2023  Volume 58, Issue 6, Page(s) 1157–1160

    MeSH term(s) United States ; Humans ; Medicaid ; Pandemics ; Insurance, Health ; Insurance Coverage
    Language English
    Publishing date 2023-09-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 410435-3
    ISSN 1475-6773 ; 0017-9124
    ISSN (online) 1475-6773
    ISSN 0017-9124
    DOI 10.1111/1475-6773.14225
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: US Health Care Reform and Rural America: Results From the ACA's Medicaid Expansions

    Benitez, Joseph A / Eric E. Seiber

    Journal of rural health. 2018 Mar., v. 34, no. 2

    2018  

    Abstract: PURPOSE: Medicaid expansions, prompted by the Affordable Care Act, generated generally positive effects on coverage and alleviated much of the financial burden associated with seeking health care. We do not know if these shifts also extend to the nation' ... ...

    Abstract PURPOSE: Medicaid expansions, prompted by the Affordable Care Act, generated generally positive effects on coverage and alleviated much of the financial burden associated with seeking health care. We do not know if these shifts also extend to the nation's rural populations. METHODS: Using 2011‐2015 Behavioral Risk Factor Surveillance System data, this study compares trend changes for coverage, access to care, and health care utilization in response to Medicaid expansion among urban and rural residents using a difference‐in‐differences regression approach. FINDINGS: Following Medicaid expansion, low‐income rural and urban residents both experienced reductions in uninsurance; however, the coverage uptake in rural settings (8.5 percentage points [pp], P < .01) was much larger than the uptake in coverage in more urban settings (4.1 pp, P > .10). In spite of larger uptakes in coverage among rural residents, reductions in cost‐related barriers to medical care were slightly larger among urban residents, and access to a regular source of medical care (5.2 pp, P < .05) and doctor visitation (4.5 pp, P < .01) were only statistically significant among urban residents. CONCLUSIONS: The ACA Medicaid expansions produced larger gains in coverage for rural residents than urban residents; however, it appears there remain opportunities to improve access to care among potentially vulnerable rural residents.
    Keywords health services ; monitoring ; risk factors ; rural health ; urban areas ; United States
    Language English
    Dates of publication 2018-03
    Size p. 213-222.
    Publishing place John Wiley & Sons, Ltd
    Document type Article
    Note JOURNAL ARTICLE
    ZDB-ID 639160-6
    ISSN 0890-765X
    ISSN 0890-765X
    DOI 10.1111/jrh.12284
    Database NAL-Catalogue (AGRICOLA)

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  9. Article ; Online: Does Primary Care Provider Supply Influence Medicaid Acceptability?

    Benitez, Joseph A / Tipirneni, Renuka / Perez, Victoria / Davis, Matthew M

    Medical care

    2019  Volume 57, Issue 5, Page(s) 348–352

    Abstract: Background: Following the Affordable Care Act's Medicaid expansions, access to care improved through elevated coverage rates among the low-income population. In Michigan, a major factor contributing to improved access among low-income patients was ... ...

    Abstract Background: Following the Affordable Care Act's Medicaid expansions, access to care improved through elevated coverage rates among the low-income population. In Michigan, a major factor contributing to improved access among low-income patients was increased Medicaid acceptance in primary care settings.
    Objectives: Prior evidence shows substantial geographic variation preacceptance and postacceptance of Medicaid. In this study, we determine whether physician's willingness to accept new Medicaid patients is moderated by the availability of other providers in close proximity.
    Methods: The study uses Michigan simulated patient (ie, "secret shopper") data collected during 2014 and 2015, and applies a difference-in-differences styled event-study regression approach comparing trends in Medicaid acceptability and appointment scheduling between areas in Michigan with higher densities of primary care providers against those with lower densities of providers that could arguably be classified a health professional shortage areas.
    Results: Through one year after Michigan's Medicaid expansion, practices in low-supply areas appeared no more likely (P>0.10) to turn away a newly insured Medicaid patient than a practice in a supply-rich area. The wait times for patients in a low-supply area were about a day longer (P<0.05) than for patients in supply-rich areas through 4 months after the expansion, though this difference dissipated through 8 and 12 months after the expansion.
    Conclusions: These results indicate that newly insured Medicaid patients are gaining access to care in settings with limited health care supply.
    MeSH term(s) Female ; Health Services Accessibility/statistics & numerical data ; Humans ; Insurance Coverage/statistics & numerical data ; Male ; Medicaid/statistics & numerical data ; Michigan ; Patient Protection and Affordable Care Act ; Poverty/statistics & numerical data ; Primary Health Care/statistics & numerical data ; United States
    Language English
    Publishing date 2019-04-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 411646-x
    ISSN 1537-1948 ; 0025-7079
    ISSN (online) 1537-1948
    ISSN 0025-7079
    DOI 10.1097/MLR.0000000000001110
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Who and Where Are Kentucky's Remaining Uninsured?

    Benitez, Joseph A / Creel, Liza M / Jennings, J'Aime C

    Medical care

    2017  Volume 55, Issue 3, Page(s) 215–219

    Abstract: Background: While most research has focused on insurance uptake and describing the makeup of the newly insured, less is known about the characteristics among the remaining uninsured in expansion states.: Objectives: Using Kentucky as a case study, we ...

    Abstract Background: While most research has focused on insurance uptake and describing the makeup of the newly insured, less is known about the characteristics among the remaining uninsured in expansion states.
    Objectives: Using Kentucky as a case study, we evaluate individual and contextual characteristics to learn more about groups who-despite expanded access to coverage options through US health care reform-reported being uninsured at the end of 2014.
    Research design: Cross-sectional data from Kentucky's Behavioral Risk Factor Surveillance System was linked to county data from the Area Health Resource File, and we used logistic regression models to assess relationships between both person-level and county-level characteristics with uninsured status.
    Subjects: The study sample included nonelderly adults aged 18-64 residing in Kentucky during the time of the survey.
    Results: Before the implementation of the Medicaid expansion and rollout of the state-based health insurance marketplace, adults who were younger (aged 18-47), unmarried, had lower levels of educational attainment, and considered to be low income were more likely to be uninsured. However, many but not all of these differences faded away by the end of 2014 when only unemployment, low-income status, and Hispanic ethnicity were positively correlated with being uninsured.
    Conclusions: At the end of 2014, Kentucky's adult uninsured rate was below 5% and few statistically meaningful coverage gaps remain, suggesting Kentucky's experience under health reform may contribute to long-run closures in disparities in health care access and outcomes.
    MeSH term(s) Adolescent ; Adult ; Behavioral Risk Factor Surveillance System ; Continental Population Groups/statistics & numerical data ; Cross-Sectional Studies ; Female ; Humans ; Income/statistics & numerical data ; Kentucky ; Male ; Medically Uninsured/statistics & numerical data ; Middle Aged ; Socioeconomic Factors ; Unemployment/statistics & numerical data ; Young Adult
    Language English
    Publishing date 2017-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 411646-x
    ISSN 1537-1948 ; 0025-7079
    ISSN (online) 1537-1948
    ISSN 0025-7079
    DOI 10.1097/MLR.0000000000000646
    Database MEDical Literature Analysis and Retrieval System OnLINE

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