Medicaid Expansions and Cervical Cancer Screening for Low-Income Women.

OBJECTIVE: Medicaid coverage for low-income women may play an important role in ensuring access to preventive care. This study examines how Medicaid eligibility expansions to nonelderly adults impact cervical cancer screening among low-income women. DATA SOURCES: We use data from the Behavioral Risk Factor Surveillance System from 2000 to 2010. The primary outcome of interest is whether women in the relevant guideline consistent age range reported having a Pap test in the previous year. STUDY DESIGN: We use a difference-in-differences approach with matched treatment and comparison states and a simulated eligibility approach based on a continuous measure of Medicaid generosity. PRINCIPAL FINDINGS: Our results indicate that cervical cancer screening increased among low-income women in expansion states relative to comparison states. Increases in screening rates are largest among low-income Hispanic women. CONCLUSIONS: Medicaid expansions during the period from 2000 to 2010 were associated with improved cervical cancer screening rates, which is critical for early cervical cancer detection and prevention of cancer morbidity and mortality in women. The results suggest that more widespread Medicaid expansions may have positive effects on preventive health care for women.

Medicaid and CHIP Premiums and Access to Care: A Systematic Review.

BACKGROUND: Premiums are required in Medicaid and the Children's Health Insurance Program in many states. Effects of premiums are raised in policy debates. OBJECTIVE: Our objective was to review effects of premiums on children's coverage and access. DATA SOURCES: PubMed was used to search academic literature from 1995 to 2014. STUDY SELECTION: Two reviewers initially screened studies by using abstracts and titles, and 1 additional reviewer screened proposed studies. Included studies focused on publicly insured children, evaluated premium changes in at least 1 state/local program, and used longitudinal or repeated cross-sectional data with pre/postchange measures. DATA EXTRACTION: We identified 263 studies of which 17 met inclusion criteria. RESULTS: Four studies examined population-level coverage effects by using national survey data, 11 studies examined trends in disenrollment and reenrollment by using administrative data, and 2 studies measured additional outcomes. No eligible studies evaluated health status effects. Increases in premiums were associated with increased disenrollment rates in 7 studies that permitted comparison. Larger premium increases and stringent enforcement tended to have larger effects on disenrollment. At a population level, premiums reduce public insurance enrollment and may increase the uninsured rate for lower-income children. Little is known about effects of premiums on spending or access to care, but 1 study reveals premiums are unlikely to yield substantial revenue. LIMITATIONS: Effect sizes were difficult to compare across studies with administrative data. CONCLUSIONS: Public insurance premiums often increase disenrollment from public insurance and may have unintended consequences on overall coverage for low-income children.

Changes in Public Prenatal Care Coverage Options for Noncitizens Since Welfare Reform: Wide State Variation Remains.

Before 1996, most lawfully present noncitizens were eligible for the same prenatal Medicaid benefits as U.S. citizens. However, the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA)-welfare reform-restricted benefits for certain lawful noncitizens for the first time. Welfare reform also gave states unprecedented authority to determine Medicaid eligibility. More recent federal policy changes have allowed states to cover some noncitizen pregnant women initially excluded under welfare reform. However, there are few comprehensive studies examining state implementation of these policy options. This study documents state-level trends in prenatal Medicaid and state-funded coverage options for low-income noncitizens just prior to and since welfare reform. While some states have substantially expanded prenatal coverage since PRWORA, wide variation remains. These findings have important implications for understanding the potential effects of the Affordable Care Act and Medicaid expansion on health care utilization and birth outcomes among pregnant noncitizens.