Medicaid and Children's Health: Other Issues

Immigrant Issues

From the American Journal of Public Health:

Dental disease is the most common health problem in this country, yet even those with public insurance have difficulty gaining access to primary dental services. "Problems With Access to Dental Care for Medicaid-Insured Children: What Caregivers Think" presents the results of a study undertaken to gain insight into the experiences and perceptions of a racially diverse group of caregivers regarding barriers to dental care for their Medicaid-insured children. Those caregivers who successfully searched for providers, arranged for an appointment, and found transportation often had to contend with additional barriers, including long waiting times and disrespectful and discriminatory behavior from staff and providers because of their race and public assistance status. (January 2002)

From the Bazelon Center for Mental Health Law:

As the effectiveness of Medicaid's home- and community-based waivers becomes increasingly evident, it's also become clear that Washington should take the lead to help states use the waiver process to serve children with mental health needs. Medicaid Waiver Can Help States Serve Children explains why the waiver process is underused nationally and why access to home- and community-based services for children remains limited. (February 2004)

Medicaid is the primary source of payment for most community-based mental health services and the only health coverage that finances a full range of the rehabilitative services needed by people with mental illness. Making the Right Choices: Reforming Medicaid to Improve Outcomes for People Who Need Mental Health Care analyzes recent proposals to change Medicaid from the perspective of adults and children with mental illness. The Issue Brief examines proposals that would do everything from reducing the range of available services states must provide to reducing the number of beneficiaries entitled to services. (July 2003)

From the Center for Health Care Strategies:

The Faces of Medicaid II: Recognizing the Care Needs of People with Multiple Chronic Conditions identifies the prevalence of chronic conditions within the Medicaid population, as well as the patterns of health care utilization and the associated cost. The report suggests that the ultimate goal of policymakers should be to develop more appropriate guidelines and care models that will help control costs within publicly financed care. (October 2007)

From the Center for Studying Health System Change:

The budget conference agreement passed by the Senate in December and the House in February contains a provision that would require all people applying or reapplying for Medicaid to produce a passport of birth certificate to prove that they are U.S. citizens. The Inspector General of the Department of Health and Human Services has deemed this new requirement unnecessary. New Requirement for Birth Certificates of Passports Could Threaten Medicaid Coverage for Vulnerable Beneficiaries: A State by State Analysis estimates that an overwhelming number of applicants would be negatively affected by significant enrollment barriers created by this new requirement. (January 2006)

Mounting Pressures: Physicians Serving Medicaid Patients and the Uninsured, 1997-2001 reports that the percentage of doctors providing any kind of charity care decreased from 76.3 percent in 1997 to 71.5 percent in 2001. The proportion of physicians serving Medicaid patients decreased by a lesser amount during that time frame, from 87.1 percent to 85.4 percent. The authors note that while these decreases do not appear to have had any negative consequences for Medicaid beneficiaries, they are consistent with other evidence showing decreased access to physicians by the uninsured. (December 2002)

Prescription Drug Access: Not Just a Medicare Problem presents the results of the 2000-2001 Community Tracking Study Household Survey. The survey found that 26 percent of Medicaid beneficiaries aged 18-64 couldn't afford to get a prescription filled in the previous year. According to the study, individual cost-control measures-such as copayments, prior-authorization, and mandated generic substitution-do not appear to affect beneficiaries' access to prescription drugs, but when multiple cost-control measures are implemented, beneficiary access to prescription drugs is affected to a much greater extent. (April 2002) More detailed study results can be found in Affording Prescription Drugs: Not Just a Problem for the Elderly.

From The Center on Budget and Policy Priorities:

The White House has claimed that increasing the federal tobacco tax to pay for a CHIP expansion is bad policy because 1) It would primarily be paid for by low-income people, since most smokers have low incomes, and 2) It would create a “middle-class entitlement.” Expanding Children’s Health Insurance and Raising Federal Tobacco Taxes Helps Low-Income Families discredits these claims and explains why using a tobacco tax increase to fund CHIP would be beneficial. (October 2007)

The New Medicaid Citizenship Documentation Requirement: A Brief Overview reviews the federal requirement regarding proof of citizenship and identity. It argues that, rather than preventing illegal immigrants from enrolling (its purported goal), it far more likely to impede coverage for many eligible U.S. citizens. (September 2007)

The Administration’s Dubious Claims about the Emerging Children’s Health Legislation: Myth and Reality explains how a number of recent Administration claims about SCHIP reauthorization legislation, such as that it would advance a “Washington-run, government-owned” health plan designed to pave the way for a single-payer system, do not reflect reality. (July 2007)

Medicaid Documentation Requirement Disproportionately Harms Non-Hispanics New State Data Show: Rule Mostly Hurts U.S. Citizen Children, Not Undocumented Immigrants uses newly available data that provide further evidence that the requirement, purportedly aimed at preventing undocumented immigrants from improperly obtaining Medicaid, is instead overwhelmingly affecting eligible U.S. citizens. (July 2007)

The Deficit Reduction Act (DRA) allows states, with federal approval, to move certain groups of Medicaid beneficiaries into “benchmark” plans that do not provide all of the benefits covered by regular Medicaid. The Illusion of Choice: Vulnerable Medicaid Beneficiaries Being Placed in Scaled-Back “Benchmark” Benefit Packages explains that in certain states, groups of vulnerable beneficiaries that were declared exempt from this law—including the elderly, pregnant women, and people with disabilities—are being placed in scaled-back benchmark plans. (September 2006)

Federal and state officials are discussing possible ways to reduce Medicaid expenditures, and one common proposal is to increase the copayments Medicaid beneficiaries must pay. Out-of-Pocket Medical Expenses for Medicaid Beneficiaries are Substantial and Growing explains that out-of-pocket medical expenses for low-income, adult Medicaid beneficiaries have grown twice as fast as their incomes in recent years. These individuals now spend more than three times as much of their incomes on out-of-pocket medical costs as middle-class adults with private health insurance. (May 31, 2005)

Charging the Poor More for Health Care: Cost-Sharing in Medicaid makes the point that, while cost-sharing is commonplace for middle-class people with private insurance, its consequences are more serious for low-income beneficiaries served by Medicaid. This report examines the effects of cost-sharing on health care utilization and status, examines how much beneficiaries pay now, looks at who the most vulnerable beneficiaries are, and shows that increased cost-sharing can jeopardize health for low-income beneficiaries. (May 2003)

Expanding Medicaid coverage to low-income parents reduces number of uninsured children, new research finds. Parental Coverage Also Improves Utilization, Does Not Significantly Erode Employer Insurance. (September 5, 2000)

The Ins and Outs of Delinking: Promoting Medicaid Enrollment of Children Who are Moving In and Out or the TANF System discusses the decreases in the Medicaid rolls since the TANF regulations have changed.

From the Child Health Insurance Research Initiative (CHIRI):

SCHIP Enrollees with Special Health Care Needs and Access to Care found that, in general, these children are able to obtain both care from a primary health care provider and routine specialty services. However, state restrictions make it difficult for some children with special health care needs to obtain specialty services. (August 2006)

Tooth decay is one of the most preventable childhood diseases, yet dental care remains the most prevalent unmet health care need for children in the United States. A new Issue Brief, Children's Dental Care Access in Medicaid: The Role of Medical Care Use and Dentist Participation, reports on children's dental care use in the Alabama and Georgia Medicaid programs and strategies for improving access to dental care. Researchers found that less than 40 percent of Medicaid-enrolled children in the study states received dental care, which was typical of other states during the period covered by the study. (June 2003)

From the Commonwealth Fund:

Separate and Unequal: Racial Segregation and Disparities in Quality across U.S. Nursing Homes summarizes the findings from an article published in “Health Affairs,” which suggests that there is a link between racial segregation in nursing homes and disparities in the care that is provided to minorities. In order to ensure more equitable care for all residents, researchers recommend policy changes such as improving the payment structures for nursing homes with a high proportion of Medicaid residents, leveling the amount of money paid to nursing homes by Medicaid and private payers, and monitoring admissions practices. (September 2007)

Instability of Public Health Insurance Coverage for Children and Their Families: Causes, Consequences and Remedies reviews national and state studies and interviews Medicaid and SCHIP administrators, as well as providers and health plan representatives, in four states that have implemented policies to improve coverage. It finds that coverage instability can largely be averted by adopting key policies and procedures, such as limiting the frequency of required renewals; developing easy, seamless transitions between public programs; and setting affordable limits on premiums. (June 2006)

Health care for children in the United States is appallingly bad, according to Quality of Health Care for Children and Adolescents: A Chartbook. The extensive report includes chart sections on effectiveness of pediatric care; patient safety; racial, ethnic and other disparities; and more. Most importantly, the report provides an examination of the capacity for improvement in this critical area of health care. (April 2004)

From Community Voices:

Reaching Out: Successful Efforts to Provide Children and Families with Health Care presents a menu of approaches aimed at breaking down barriers to enrolling and retaining "hard-to-reach" populations in Medicaid and SCHIP. It also offers personal stories that exemplify the successes and frustrations such communities face, the public policies that help and hinder their efforts, and policy recommendations geared toward facilitating community-based enrollment in and retention of health coverage. In addition, it includes a list of resources available to community workers and policymakers. (June 2002)

From Covering Kids & Families:

While the number of low-income children with health coverage has increased over the past several years due largely to expansions of Medicaid and SCHIP (the State Children's Health Insurance Program), as the economy has weakened, some states have considered proposals that would cut eligibility levels, eliminate outreach, and remove simplification procedures. Maintaining the Gains: The Importance of Preserving Coverage in Medicaid and SCHIP presents evidence of why it is important to maintain these gains and build on them. Substantial research evidence shows that expanding enrollment in Medicaid and SCHIP has important benefits both for the children and families enrolled and for the communities in which they live. (June 2003)

From The Department of Health and Human Services:

Medicaid Managed Care Appeals Process, State Oversight Inconsistent: This report, put out by the Office of Inspector General of the Department of Health and Human Services, summarizes an evaluation of the dispute resolution process for Medicaid beneficiaries enrolled in managed care plans and how well states have implemented federal due process requirements. The Inspector General's office found that, while the dispute resolution systems in the nine states studied appeared to be working as intended, there were still a number of problems: states conduct few managed care hearings, and managed care organizations receive relatively few complaints and grievances; member materials and notices are often inadequate; regulations governing fair hearing time frames can be ambiguous; states have different interpretations of the plan's role, as well as their own, in fair hearings; and oversight of dispute resolution is inconsistent. (May 2001)

From First Focus:

CMS’ Medicaid Regulations: Indications for Children with Special Health Care Needs analyzes each of the new proposed regulations that CMS has issued for Medicaid and CHIP and finds that they will have a disproportionate impact on children with special health care needs. The rules pose a direct threat to programs and services for these children, including public health nurses who provide care in children’s homes and at their schools. (March 2008)

From The General Accounting Office:

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services: The General Accounting Office has issued a new report on EPSDT services that states are required to provide children under 21, services that include comprehensive, periodic evaluations of health, developmental, and nutritional status. According to the report, Medicaid: Stronger Efforts Needed to Ensure Children's Access to Health Screening Services, the available evidence indicates many children are not receiving EPSDT services, and state reporting on EPSDT services is "unreliable and incomplete," especially for children in managed care. The report provides examples of innovative state programs. (July 2001)

Oral Health: Factors Contributing to Low Use of Dental Services by Low-Income Populations (September 2000)

Medicaid and SCHIP: Comparisons of Outreach, Enrollment Practices, and Benefits analyzes the differences between both programs with regard to outreach, application and eligibility determination, screening and enrollment, and benefits. (April, 2000)

From Health Affairs:

Medicaid/SCHIP Cuts and Hospital Emergency Department Use finds that Medicaid and SCHIP eligibility cuts would increase emergency department visits by the uninsured. This suggests that cost containment actions based on cutting public coverage will achieve cost saving largely by reducing access and shifting costs. (January 2006) MUST PURCHASE ONLINE

Improving the Quality of Medicaid Personal Assistance through Consumer Direction reports on the initial findings from an ongoing evaluation of the Cash and Counseling demonstration project. In the project, participating Medicaid beneficiaries with disabilities are given an allowance and a high degree of flexibility and freedom to choose personal care assistants. The study found that participants in Arkansas who directed their own supportive services were significantly more satisfied and appeared to get better care than those receiving services through home care agencies. (March 2003)

From the Health Assistance Partnership:

Screening for Medicaid and State Children's Health Insurance Program (SCHIP) Eligibility (July 2003)

From the Journal of Ambulatory Care Management:

Policymakers continue to struggle with how to ensure adequate access to physician services in public programs such as Medicaid and SCHIP. Translating Research to Action: Improving Physician Access in Public Insurance provides the framework for identifying and measuring barriers to access, where and why problems exist, and how to intervene. (January/March 2006) MUST PURCHASE ONLINE

From The Kaiser Commission on Medicaid and the Uninsured:

Uninsured Children in the South, December 2007 covers 17 Southern states and the District of Columbia. The study reveals the disproportionate numbers of uninsured children in the South compared to the rest of the country. It contains state-specific fact sheets with estimates of uninsured children and uninsured pregnant women. (December 2007)

Resources on Children and Family Health Coverage provides the information released in a policy briefing on state coverage trends for children and families. These policy reports include:

“Enrolling Children in Medicaid and SCHIP: Insights from Focus Groups with Low-Income Parents”
“SCHIP Turns 10: An Update on Enrollment and the Outlook on Reauthorization from the Program’s Directors”
“Family Coverage under SCHIP Waivers”
“Health Insurance Coverage and Access to Care for Low-Income Non-Citizen Children”

(May 2007)

Interactive Children’s Health Insurance Coverage Timeline (2007)

Aging out of Early and Periodic Screening, Diagnostic and Treatment (EPSDT): Issues for Young Adults with Disabilities discusses the challenges and implications for young people with disabilities when they become adults and lose their EPSDT benefits. It also examines the effects of recent changes to the Deficit Reduction Act that increase states’ power to aid individuals with disabilities. (January 2007)

The slide presentation Resuming the Path to Health Coverage for Children and Parents consists primarily of charts showing the state of health insurance access for families. States have shown renewed enthusiasm for covering the uninsured, especially children, but the DRA has also caused some setbacks. (January 9, 2007)

Medicaid Enrollment in 50 States provides data on Medicaid enrollment by state, including information updated through June 2005. (December 2006)

SCHIP Program Enrollment: June 2005 Update tracks changes in enrollment in the SCHIP program from June 2004 to June 2005. Economic improvements allowed many states to relax restrictions on enrollment, resulting in a net increase in enrollment nationwide. Some states that still have heavy restrictions continued to show large decreases in enrollment. (December 2006)

In the face of prolonged budge difficulties, a number of states have cut eligibility or are considering such cuts in public coverage. What Happens When Public Coverage Is No Longer Available? concludes that no more than 9 percent of low-income adults would have access to an alternative source of insurance in the absence of public coverage. (January 2006)

Health Insurance Premiums and Cost-Sharing: The Impact on Low-Income Populations summarizes the issues surrounding premiums and cost-sharing in public coverage programs. The fact sheet also discusses the impact of these mechanisms on participation and health outcomes: It asserts that research shows that even low premiums can decrease participation in public health programs, and cost-sharing can negatively affect health care utilization and health outcomes. (March 2003)

Medicaid and Prescription Drugs is an updated fact sheet that summarizes the latest statistics and trends regarding the role of Medicaid in providing prescription drug coverage. (October 2002)

Medicaid and the Prescription Drug Benefit: Cost Containment Strategies and State Experiences provides background information on Medicaid and its prescription drug benefit. It also provides examples of how states are using the cost containment mechanisms at their disposal, and it addresses issues surrounding beneficiary access to outpatient drugs. (September 2002)

Medicaid Matters for America's Families provides a brief description of how Medicaid assists low-income American families with their health coverage, particularly children. It also reports that parents overwhelmingly view Medicaid as a good program. (September 2002)

Reaching Uninsured Children through Medicaid: If You Build It Right, They Will Come examines what it takes to modernize Medicaid and how modernization has increased enrollment in both Medicaid and SCHIP. The report includes tables that present enrollment figures for all 50 states and D.C., examine the relationship of Medicaid to overall enrollment of children, families, and pregnant women, and list the states that have not simplified their enrollment processes. The authors note that one of the current challenges is "to not let barriers creep back into the system as a hidden cost saving mechanism." (June 2002)

Medicaid Eligibility for the Elderly (January, 1999)

A Medicaid Fact Sheet explains the program and gives enrollment statistics and other useful information.

From The Kaiser Family Foundation:

Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles reports that, between July 2006 and January 2008, nearly two-thirds of states expanded access in these public programs. The report contains state-specific charts and tables that show changes in health coverage, income thresholds for parents applying for Medicaid, and the way that the August 2007 CMS directive affected states. (January 2008)

Women’s Health Insurance Coverage provides data on the percentages of women who are privately insured or have job-based coverage, those with Medicaid, and those who are uninsured. Although women make up three-quarters of Medicaid beneficiaries, childless women who are not disabled are almost never eligible for coverage no matter their income. (December 2007)

Medicaid’s Role in Family Planning reviews the role of Medicaid in financing and promoting access to family planning services for low-income women. For example, it examines the extent to which women of reproductive age rely on Medicaid for their care, as well as the special status and range of services covered under the rubric of family planning. (October 2007)

While often not considered to be a “women’s health program,” women comprise the majority (69 percent) of adult Medicaid beneficiaries. Medicaid’s Role for Women examines the wide range of health services offered in Medicaid specifically for women and explains why maintaining these services is important. (October 2007)

Approximately 70 percent of Medicaid’s adult beneficiaries are low-income women. Medicaid’s Role for Women presents the latest data on women enrolled in Medicaid and discusses the program’s role in women’s health across several life stages. It also summarizes some of the latest policy developments in Medicaid and their consequences for low-income women. (May 2006)

Financing long-term care for the nearly 10 million Americans who need services and support to assist them in life's daily activities continues to be a challenge. While Medicaid is the nation's major source of financing for long-term care services, paying for over 40 percent of total long-term care, its role is not well understood. A new fact sheet, Medicaid's Role in Long-Term Care: Q & A, provides basic information on Medicaid's role for those with long-term care needs. (May 13, 2005)

Medicare and Medicaid provide health coverage and long-term care services to roughly one-third of the 53 million people with cognitive, developmental, physical, and mental disabilities. Navigating Medicare and Medicaid, 2005: A Resource Guide for People with Disabilities, Their Families, and Their Advocates explains the critical role the two programs play in the lives of people with disabilities. The guide is intended to be understandable to people who are completely unfamiliar with Medicare and/or Medicaid. (February 2005)

The program rules for Medicare and Medicaid with regard to work are complex. Recently, Congress has enacted additional legislation to remove more of the disincentives to working and to continuing to receive health care coverage through these two programs. Keeping Medicare and Medicaid When You Work, 2005: A Resource Guide for People with Disabilities, Their Families, and Their Advocates explains many of the complex issues and policies that can be used to help people with disabilities keep their health coverage and seek employment. (February 2005)

The Kaiser Family Foundation and its Commission on Medicaid and the Uninsured have released two new fact sheetsthat demonstrate how specific changes in the unemployment rate affect both the number of uninsured Americans and the demand for Medicaid coverage. In Rising Unemployment and the Uninsured, Kaiser presents its analysis showing that, for every percentage point increase in the unemployment rate, 1.2 million people will become uninsured. (January 2002)

Medicaid Coverage During Times of Rising Unemployment discusses how much an increase in unemployment would be likely to increase Medicaid enrollment and state Medicaid spending. (December 2001)

Medicaid has become one of the major funders of prenatal care and delivery services for women in the U.S., but during the 1990's, the Medicaid program changed dramatically with the broad adoption of managed care arrangements for Medicaid beneficiaries. To understand how this shift has changed the way states organize and finance perinatal care, the Kaiser Family Foundation conducted a national survey, and the results of that survey are presented in Medicaid Coverage of Perinatal Services: Results of a National Survey. Among the survey results was that, though most state Medicaid programs cover a comprehensive range of perinatal services, relatively few cover smoking cessation or breastfeeding support services, "two services that can have a dramatic effect and immediate effect on infants' health." (November 2001)

Restructuring Medicaid Financing: Implications of the NGA Proposal This report analyzes the National Governor's Association proposal to restructure Medicaid, including the financial impact of the core elements of the proposal, considers possible responses to the reforms, and outlines some issues to consider as policymakers think about reforming the program. (June 2001)

Medicaid: "Mandatory" and "Optional" Eligibility and Benefits. This policy brief details the eligibility and benefit structure of Medicaid and shows which portions of enrollment and spending are mandatory and optional. (June 2001)

From the Kaiser Family Foundation and Health Affairs:

Outlook for Health Spending, the first report resulting from a continuing Health Affairs and Kaiser Family Foundation partnership, has leading health policy experts examining new projections of future health care spending, including implications of the new Medicare prescription drug benefit. This partnership will publish a series of Web exclusives to speed dissemination of critical health care data. Web casts and related links are part of the package. (February 2004)

From the Kaiser Family Foundation and the National Women's Law Center:

State policies play a critical role in shaping women's access to health care. Women's Access to Care: A State-Level Analysis of Key Health Policies details state activity on a range of polices that affect women's access to care, with an emphasis on private coverage, Medicaid, and reproductive health. Specific policies covered in the report include Medicaid eligibility expansions, managed care protections, and assistance with the costs of prescription drugs. (July 2003)

From the Maternal and Child Health Library:

Knowledge Path: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services is an electronic guide on current, high-quality resources for health professionals and families about providing and strengthening EPSDT services. The resource also includes guidelines for the frequency, timing, and content of health promotion and disease prevention services for infants, children, and adolescents. (July 2003)

From Mathematica Policy Research, Inc.:

National Evaluation of the State Children’s Health Insurance Program: A Decade of Expanding Coverage and Improving Access contains seven components to its evaluation of the State Children’s Health Insurance Program, including an analysis of SCHIP enrollment, disenrollment, and reenrollment patterns based on the SCHIP Enrollment Data System. (September 2007)

States have shown creativity and adaptability in developing outreach strategies to promote State Children’s Health Insurance Program (SCHIP) enrollment. Evolution of State Outreach Efforts under SCHIP reviews how these strategies have changed using information from all 50 states and the District of Columbia. The article notes that, over time, states have adapted their outreach to close the gaps in enrolling hard-to-reach populations by modifying their target populations, messages, and organizational strategies. (Summer 2007)

New Medicaid Drug Use and Cost Data Highlight Issues for States after Medicare Part D examines a number of Medicaid prescription drug issues that states still need to address after the movement of dual eligibles into Medicare Part D. (June 2007)

Prescription Drug Use and Expenditures among Dually Eligible Beneficiaries in particular examines three important subgroups: the elderly, people with disabilities, and full-year nursing home residents. The analyses indicate great variation in use and expenditures across states that cannot be explained by differences in use of cost-containment strategies. (Summer 2007)

Inadequate access to private health insurance, which can be expensive and may not cover needed services, is a critical barrier to employment for people with disabilities. Understanding Enrollment Trends and Participant Characteristics of the Medicaid Buy-In Program, 2003-2004 describes enrollment and participation in the Medicaid Buy-In program, part of the federal effort to make it easier for people with disabilities to work without losing health benefits. (January 2006)

Eligibility expansions for low-income children and families under Medicaid and the State Children's Health Insurance Program (SCHIP) have improved access to physicians for many, but problems in this area persist. Access to Physician Services in Public Insurance Programs for Low-Income Populations: A Framework for Assessment and Action organizes what is known about the determinants of physician access into a framework that is intended to help states identify three factors: 1) the sources of problems with physician access, 2) the interventions that may solve these problems (including examples), and 3) the major parties involved in implementing these interventions. (August 2003)

From Medical Care Research and Review:

The Effects of Medicaid Reimbursement on the Access to Care of Medicaid Enrollees: A Community Perspective shows that high Medicaid acceptance rates by physicians in a community are more important than fee levels per se in affecting enrollees' access to medical care. Although high fee levels increase the probability that individual physicians will accept Medicaid patients, high fee levels do not necessarily lead to high levels of physician acceptance of Medicaid patients in an area. (December 2005) REQUIRES SUBSCRIPTION

From the National Association of Community Health Centers:

Thirty-six million Americans, some of whom actually have health insurance coverage, lack access to basic medical care because they live in communities where there is an acute shortage of health care providers. A Nation's Health at Risk describes who and where those people are, why having a regular provider is so important, and how the national initiative to expand community health centers has helped meet this pressing need. (March 2004)

From the National Council of Jewish Women:

Facing the Crisis in Women’s Health Care addresses the special challenges that many American women face in affording and obtaining comprehensive health care. The article discusses women’s health needs and barriers to care, the growing number of uninsured, and the emerging issues for women in Medicaid and Medicare. (Summer 2006)

From the National Governors Association:

Enrollment Hits the Web: States Maximize Internet Technology in SCHIP and Medicaid describes how states have used online enrollment in an attempt to reduce enrollment time and increase access for applicants. This Issue Brief describes online enrollment programs in California, Georgia, Pennsylvania, Texas, and Washington. (May 2002)

From The National Health Law Program (NHeLP):

Medicaid Transportation Services discusses states’ coverage of transportation services for Medicaid recipients who have no other means of reaching their health care providers. The fact sheet examines enforcement of the transportation mandate and outlines the best state practices for ensuring that Medicaid recipients have access to this service. (February 2008)

42 U.S.C. § 1983 and Enforcement of the Medicaid Act provides U.S. Supreme Court and Congressional activity-focused background and a docket of cases on the enforceability of particular Medicaid Act provisions. (Updated January, 1999)

Access to Medicaid Since the Personal Responsibility and Work Opportunity Reconciliation Act (January, 1998)

From the National Health Law Program and the National Association of Community Health Centers:

The Deficit Reduction Act of 2005 (DRA) provides states with the authority to impose new premium and cost-sharing requirements on certain groups of Medicaid beneficiaries. The DRA also permits states to substantially redefine and limit covered services and benefits. Role of State Law in Limiting Medicaid Changes provides state-by-state analyses of regulatory requirements for modifying each state’s Medicaid program. The study also investigates how the DRA has affected family planning Medicaid benefits in each state. (revised August 2006)

From the National Health Policy Forum:

Title V is a limited source of federal funds that states can use to help address the social, financial, behavioral, and structural barriers to health care for women, children, and families. Many of the children Title V serves also have Medicaid or CHIP coverage. The Title V Maternal and Child Health Block Grant Program highlights the key components of Title V and its interaction with Medicaid and CHIP. (September 2007)

From the National Initiative for Children's Healthcare Quality:

Improving Cultural Competency in Children's Health Care—Expanding Perspectives is a practical guide that offers ways to improve children's health care and reduce health disparities through increased cultural competency. The guide offers simple steps providers can take to deliver more culturally competent care. It incorporates providers experiences with the recommendations based on two pilot tests with Medi-Cal providers in California. (July 2005)

From The National Senior Citizens Law Center:

Medicaid Division of Assets and Income Rules for Long-Term Care -- Spousal Impoverishment (April, 1999)

Medicaid Buy-In Programs for Low-Income Medicare Beneficiaries: Some low-income Medicare beneficiaries are entitled to have their Medicare premiums paid for by the Medicaid program. This report gives details. (April, 1999)

Poverty Guidelines Affect Federal Programs (March, 1999)

From NPR, the Kaiser Family Foundation, and the Harvard School of Public Health:

Public Views on SCHIP Reauthorization Survey Highlights finds strong majority support for the reauthorization and expansion of SCHIP. As many as seven in 10 Americans say they back the program. (October 2007)

From The Packard Foundation's Journal, The Future of Children:

The spring issue of The Future of Children, called Health Insurance for Children, contains numerous articles on many aspects of providing health coverage for children. Topics covered include a historical overview of children's health coverage, why some children are still uninsured, access to health care for special populations of children (including children with special health care needs), reducing health disparities among children, and express lane eligibility. (Spring 2003)

From Pediatrics:

Preventive Care for Children in Low-Income Families: How Well Do Medicaid and State Children’s Health Insurance Programs Do? examines the way these public programs help encourage positive health behaviors in children. The report concludes that children enrolled in Medicaid and SCHIP received more preventive advice about health behaviors than those with private insurance or no insurance. (December 2007)

Many eligible children are not enrolled in public insurance programs. Low-Income Uninsured Children with Special Health Care Needs: Why Aren’t They Enrolled in Public Health Insurance Programs? concludes that parents’ lack of information about the programs and negative perceptions of the application process are two primary reasons why eligible children are not being enrolled. (A subscription is necessary to view the full article.) (January 2007)

From The Urban Institute:

San Mateo County offers children a comprehensive mental health benefits package. Are Children Accessing and Using Needed Mental Health Care Services? The Case of the San Mateo County Healthy Kids Program discusses how many children are obtaining mental health services through the program, how they obtain those services, and possible reasons for why children who need these services are not using them. (October 2007)

Can the President’s Health Care Tax Proposal Serve as an Effective Substitute for SCHIP Expansion? compares the financial burden that parents would incur in obtaining coverage for their children under the President’s tax deduction proposal against that associated with SCHIP and finds that the financial burden would be much higher under the President’s proposal. (October 2007)

Between 2001 and 2005, Americans have seen a significant decline in employer-sponsored health coverage. Medicaid and the State Children’s Health Insurance Program (SCHIP) were created to provide assistance for low-income families who are especially vulnerable because they cannot afford to purchase private health coverage. The Role of Medicaid and SCHIP as an Insurance Safety Net examines data from across the states to assess the two programs’ effectiveness in offsetting declining employer-sponsored coverage for low-income children and adults. (August 2006)

States as Innovators in Low-Income Health Coverage examines the extent to which states have been innovative in designing programs to provide health coverage to low-income people beyond what is required for Medicaid and SCHIP. The report begins by discussing the mechanisms available for states to use when expanding coverage. It then divides states into four groups, from most to least innovative, and concludes that most states have not made serious attempts to extend coverage. (June 2002)

Snapshots of America's Families II is the Urban Institute's first look at the well being of children and adults through the lens of their 1999 National Survey of America's Families (NSAF). The report presents a picture of how the experiences of American families have changed in the first few years following federal welfare reform and other major policy changes. It also offers national and state-specific portraits of family well-being that can inform future debates on welfare, health care, and the social safety net in America. (October 2000)

Medicaid: Ten Basic Questions Answered

Reducing Medicaid Spending on Long Term Care (Fall, 1996)

Recovering Hidden Assets: The Magic Bullet for Medicaid Savings? (September, 1995)

Immigrant Issues:

From the American Immigration Law Foundation:

Not Getting What They Paid For: Limiting Immigrants' Access to Benefits Hurts Families Without Reducing Healthcare Costs examines immigrants' access to public benefits. Benefit restrictions have increased food insecurity and reduced access to health insurance for both legal immigrants and their U.S.-citizen children, while failing to significantly reduce government health care expenditures due to the high costs of caring for the uninsured. (June 2003)

From the American Public Health Association:

The Health Disparities Projects and Interventions database details projects and interventions that address health disparity challenges in our communities. These interventions have been reported by a wide range of groups from across the country, including City and State Departments of Public Health, non-profits, and academic think tanks. (March 2004)

From The Center on Budget Policy Priorities:

Recent Studies Make Clear that Many Parents Who are Current or Former Welfare Recipients Have Disabilities and Other Medical Conditions summarizes research about parents with disabilities and other health conditions who have a connection to TANF. The report examines evidence suggesting that a significant portion of parents who receive TANF or who have left TANF have disabilities or health conditions that affect their ability to succeed in the workplace if they are not provided with appropriate supports and services to help them succeed. (February 2000)

From the Commonwealth Fund:

Patient populations have become increasingly diverse. Promising Practices for Patient-Centered Communication with Vulnerable Populations: Examples from Eight Hospitals identifies promising practices for health care organizations to communicate effectively across cultural, language, and health literacy barriers. (August 2006)

Health Coverage for Immigrants in New York: An Update on Policy Developments and Next Steps examines the ways in which federal welfare reform restricted legal immigrants' access to Medicaid and how a New York State Court of Appeals decision provides coverage for those previously denied. The report also examines states' need for federal financial assistance to help provide legal immigrants with health coverage. In addition, the authors consider the national implications of the federal government's retreat from supporting Medicaid coverage for immigrants. (July 2002)

From The Department of Health and Human Services (HHS) and Agriculture (USDA):

Issue Guidance on How States May Ask Questions About Immigration Status and Social Security Numbers informs state welfare and health officials about when a state is required to request information about citizenship or immigration status, and social security numbers on joint and single-program applications, and the circumstances under which a state may or may not deny benefits when an applicant does not provide the information that the state has requested. (September, 2000)

From the Kaiser Commission on Medicaid and the Uninsured:

Since the enactment of the Deficit Reduction Act (DRA) of 2005, most U.S. citizens and nationals applying for or renewing their Medicaid coverage face a new federal requirement to provide documentation of their citizenship status. Citizenship Documentation Requirements in Medicaid provides up-to-date information on these requirements and discusses the implications for Medicaid beneficiaries and states. (January 2007)

From the Kaiser Family Foundation:

Medicaid and SCHIP Eligibility for Immigrants provides an overview of the current rules on immigrants’ eligibility for Medicaid and the State Children’s Health Insurance Program. (April 2006)

Covering New Americans: A Review of Federal and State Policies Related to Immigrants' Eligibility and Access to Publicly Funded Health Insurance provides a brief overview of health coverage challenges facing immigrants, the federal rules regarding immigrants' eligibility for Medicaid and SCHIP, and state efforts to provide replacement coverage for immigrants who are ineligible for Medicaid and SCHIP. (November 2004)

Health Coverage for Immigrants summarizes health coverage for immigrants, including the restrictions to coverage via Medicaid and SCHIP and the implications of these policies. (November 2004)

The Immigration Survey examines the public's views on immigration in America. The survey reviews native-born Americans' and immigrants' attitudes towards legal immigration, how immigration affects the American culture and economy, attitudes towards illegal immigration and government regulations, and how immigrants' views differ from those of non-immigrants. (Joint effort of the Kaiser Family Foundation, National Public Radio, and Kennedy School of Government, October 2004)

How Race/Ethnicity, Immigration Status, and Language Affect Health Insurance Coverage, Access to and Quality of Care Among the Low-Income Population examines the roles that race, language, and citizenship status play in insurance coverage, access to health care, and quality of health care, particularly for the low-income Latino population. (August 2003)

Immigrants' Health Care Coverage and Access provides a profile of immigrants (including trends, country of origin, and legal status) and changes in public policies that generally affect immigrants' access to public benefits. The final section of the report examines access to health care services for immigrants and highlights potential barriers to services for this population. (August 2003)

From Mathematica Policy Research, Inc. and the Connecticut Health Foundation:

Seeking Solutions: Enhancing Health Care Delivery for People in Connecticut with Limited English Proficiency addresses the state’s increasingly diverse population and the need for culturally and linguistically appropriate health care. The report looks at the cost of providing interpreters for Medicaid recipients with limited English proficiency and the steps states have taken to make this possible. The report is also available in Spanish. (August 2006)

From the National Council of La Raza and HHS:

Protect Your Family's Health...with Confidence explains how parents can receive low-cost or free health coverage. This bilingual booklet examines Medicaid and SCHIP and answers questions regarding children's health coverage when a parent is not a U.S. citizen. It also serves as a guide for families with concerns about immigration status. (Fall 2002)

From The National Health Law Program (NHeLP):

Immigrant Access to Health Benefits: A Resource Manual is a primer on health access for immigrants. The manual details and explains basic eligibility requirements for key federal and state programs and identifies issues that can be significant barriers to access to health care for immigrants and their families. (August 2002)

The Impact of INS Public Charge Determinations on Immigrant Access to Health Care documents the stories of immigrant families who are fearful of seeking medical attention because of the risk of being determined a "public charge" by the INS. The report presents the potentially disastrous public health consequences of the INS policy. (May 1998)

Not-Qualified Immigrants' Access to Public Health and Emergency Services After the Welfare Law examines the impact of the Personal Responsibility and Work Opportunities Act on the problems of access to health care. It looks specifically at the issue of access to public health and emergency services for immigrants who are not qualified and therefore no longer eligible for full-scope Medicaid. (January 1998)

Welfare Reform Implementation: Continuing Medicaid Coverage for Qualified Aliens analyzes key elements of the provision of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 that granted states the authority to determine eligibility of qualified aliens for Medicaid, including those who lose SSI cash assistance. (November 1996)

Health Related Provisions in the Illegal Immigration Reform and Immigration Responsibility Act of 1996 explains the potential health impact of the Illegal Immigration Reform and Immigrant Responsibility Act ("Immigration Reform Act") which contained a number of provisions that modified the Personal Responsibility and Work Opportunity Reconciliation Act ("Welfare Act") signed into law in August 1996. (October 1996)

From the National Immigration Law Center:

Many worry that the new Medicaid citizenship documentation requirements will affect immigrants’ access to care. Immigrants Are Not Affected by the New Medicaid Law explains that the procedures immigrants must follow for obtaining Medicaid coverage have not been changed. The report is also a useful resource for advocates working with immigrants. (June 2006)

From The Urban Institute:

Health Insurance Coverage of Children in Mixed-Status Immigrant Families uses survey data to examine changes in health insurance coverage for low-income citizen children with either citizen parents or at least one noncitizen parent. The report analyzes this data in light of policy changes to the availability of public benefits to legal noncitizens. (November 2003)

The New Neighbors: A Users' Guide to Data on Immigrants in U.S. Communities is a guidebook designed to help local policy makers, program implementers, and advocates analyze existing data sources to identify the characteristics, contributions, and needs of immigrant populations in their local communities. (August 2003)

The Health and Well-Being of Children in Immigrant Families examines survey data to measure the well-being of children with one or more immigrant parents compared to families with native-born parents. The report compares children based on both income and citizenship status. (November 2002)

The Dispersal of Immigrants in the 1990s looks at changes in immigration patterns between 1990 and 2000 and identifies the areas that experienced the most rapid growth in immigrant populations. (2002)

The Scope and Impact of Welfare Reform's Immigrant Provisions, which relies on 1995 and 2000 Current Population Survey data, discusses the background and character of the changes introduced by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). The report also sketches the post-enactment responses of Congress, states, and the courts. The report focuses primarily on families with children whose incomes are below 200 percent of poverty, and it distinguishes between native citizens, naturalized citizens, legal non-citizens, and undocumented immigrants. (January 2002)

From the U.S. Census Bureau

The Foreign-Born Population in the United States: 2003 provides a profile of demographic and socioeconomic characteristics of the foreign-born population in the United States, including region of birth, geographic distribution in the United States, age, educational attainment, earnings, and poverty status. Also included are comparisons to the native-born population and a discussion of the variability within the foreign-born population. (August 2004)

Coming to America: A Profile of the Nation's Foreign-Born (2000 Update) summarizes the demographic characteristics of the foreign-born population in the United States, based on data collected in the 2000 Current Population Survey. (February 2002)

Peer-Reviewed Articles

"Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis" examines immigration survey data to estimate the health care expenditures of immigrants and compare them to those of U.S.-born persons. The multivariate analysis reveals that health care expenditures are approximately 55 percent lower for immigrants, refuting the assumption that immigrants represent a disproportionate financial burden on the U.S. health care system. (American Journal of Public Health, August 2005)

"Restrictions on Undocumented Immigrants' Access to Health Services: The Public Health Implications of Welfare Reform" examines the impact of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 on the provision of public benefits to undocumented immigrants. Intended to serve as a tool for reducing illegal immigration and protecting public resources, federal restrictions to undocumented immigrants' access to publicly financed health services unduly burden health care providers and threaten the public's health. (American Journal of Public Health, October 2003).

"Left Out: Immigrants' Access to Health Care and Insurance" looks at the effects of policy changes that have limited immigrants' access to insurance and health care. The authors conclude that immigration status is an important component of racial and ethnic disparities in insurance coverage and access to care. (Health Affairs, Jan/Feb 2001)

"Health Insurance Coverage of Immigrants Living in the United States: Differences by Citizenship Status and Country of Origin" is a study that examines health insurance coverage among immigrants who are not U.S. citizens and among individuals from 16 countries with the largest number of immigrants living in the United States. Immigrants who are not U.S. citizens are much less likely to receive employer-sponsored health insurance or government coverage; 44 percent were uninsured at the time of the study. (American Journal of Public Health, June 2000).

Miscellaneous Resources

North Carolina Latino Health 2003 is an extensive report published by the North Carolina Institute of Medicine that examines the major health issues facing the Latino population in North Carolina. The report focuses particularly on the barriers to health care facing recent immigrants to the state and the health disparities between Latinos and other ethnic and racial groups. (February 2003)

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