Credit where it is due: Investigating pathways from earned income tax credit expansion to maternal mental health.

While earned income tax credit (EITC) expansions are typically associated with improvements in maternal mental health, little is known about the mechanisms through which the program affects this outcome. The EITC could primarily affect mental health through changes in family financial resources, changes in labor supply or changes in health insurance coverage of participants. We attempt to disentangle these mechanisms by assessing the effects of state and federal EITC expansion on mental health, employment, and health insurance by maternal marital status. We find that federal EITC expansions are associated with improved self-reported mental health for all mothers and large positive effects on employment for unmarried mothers. State EITC expansions are associated with improvements in mental health for married mothers only and have no effect on employment for married or unmarried mothers. Overall and for most subgroups of mothers, we find little association between EITC expansions and changes in health insurance coverage. These findings suggest that while EITC expansions improved mental health for unmarried mothers through a combination of the credit and employment effects, for married mothers, improved mental health is driven through the direct credit alone.

Validation of the Casa Colina Fall Risk Assessment Scale in Predicting Falls in Inpatient Rehabilitation Facilities.

OBJECTIVE: The aim of this study was to assess the validity, efficacy, and generalizability of a fall risk assessment tool created specifically for inpatient rehabilitation facilities (IRFs). DESIGN: The Casa Colina Falls Risk Assessment Scale (CCFRAS) was assessed both retrospectively and prospectively on consecutive patients at three IRFs to determine the sensitivity and specificity of this tool in predicting fall risk. SETTING: The setting was in three IRFs. PARTICIPANTS: Individuals admitted to three IRFs participated in the study. MAIN OUTCOMES MEASURES: Each IRF quantified the number of falls detected for the patient population under evaluation and determined the site-specific sensitivity and specificity of the CCFRAS. RESULTS: The sensitivity and specificity of the CCFRAS ranged from 75% to 80% and from 47% to 70%, respectively, for the different IRFs. Using a logistic regression analysis, we identified the optimal CCFRAS cutoff score for identifying high-risk patients at each individual facility, thus improving the specificity to 70%-79%. CONCLUSION: Multisite evaluation of this assessment tool indicates that the CCFRAS is effective and broadly generalizable for predicting patients at high risk for falling.

Medicaid Expansion Increased Coverage, Improved Affordability, And Reduced Psychological Distress For Low-Income Parents.

Despite receiving less attention than their childless counterparts, low-income parents also experienced significant expansions of Medicaid eligibility under the Affordable Care Act (ACA). We used data for the period 2010-15 from the National Health Interview Survey to examine the impacts of the ACA's Medicaid expansion on coverage, access and use, affordability, and health status for low-income parents. We found that eligibility expansions increased coverage, reduced problems paying medical bills, and reduced severe psychological distress. We found only limited evidence of increased use of care among parents in states with the smallest expansions, and no significant effects of the expansions on general health status or problems affording prescription drugs or mental health care. Together, our results suggest that the improvements in mental health status may be driven by reduced stress associated with improved financial security from insurance coverage. We also found large missed opportunities for low-income parents in states that did not expand Medicaid: If these states had expanded Medicaid, uninsurance rates for low-income parents would have fallen by an additional 28 percent.

Marketplaces Helped Drive Coverage Gains In 2015; Affordability Problems Remained.

Health insurance coverage through the Marketplaces increased in 2015, with more nonelderly adult enrollees insured all year and fewer reporting health care affordability problems than in 2014. In 2015 more Marketplace enrollees in Medicaid nonexpansion states reported trouble paying family medical bills, compared to those in expansion states (23 percent versus 15 percent).