权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Increasing Medicaid Acquisition and Sustainment among the Uninsured

增加未参保人群的医疗补助获取和维持

基本信息

批准号：
10742494
负责人：
Lisa Marie Knowlton
金额：
$ 68.08万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-06-30 至 2027-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10742494
关键词：
Accident and Emergency department Adult American Black race California Caring Case Study Characteristics Clinical Collaborations Counseling County Data Data Set Development Disadvantaged Discipline Disease Disparity Eligibility Determination Emergency Situation Enrollment Ethnic Population Factor Analysis Feedback Focus Groups Funding Future Geography Goals Health Health Expenditures Health Services Health Services Accessibility Health system Healthcare Hispanic Hospital Personnel Hospitalization Hospitals Improve Access Individual Inpatients Insurance Insurance Coverage Intervention Interview Investigation Job loss Knowledge Left Location Logistic Regressions Medicaid Medical Mental Health Methods Minority Groups Modeling National Institute on Minority Health and Health Disparities Operative Surgical Procedures Outcome Patients Policy Maker Rehabilitation therapy Resources Sampling Site Social Work Solvents Specialist Structure Testing Time Training Uncompensated Care Underinsured Uninsured Work cost effectiveness/implementation trial evidence base follow-up health care availability health care service health disparity health service use implementation study improved innovation minority patient mortality novel participant enrollment point of care programs racial minority population response sociodemographics success system-level barriers usability

项目摘要

ABSTRACT Uninsured patients are subject to catastrophic health expenditures, have higher rates of mortality, and far more limited access to important healthcare resources (e.g., preventative or specialist care, rehabilitation, mental health) compared to insured patients. Uninsured individuals often defer care until treatment is urgently required, which can lead to debilitating disease, job loss and high medical bills. With more than 70% of uninsured patients unable to pay for their healthcare, U.S. hospitals and states are left to bear the brunt of uncompensated care ($42 billion). Hospital Presumptive Eligibility (HPE), a hospital-based emergency Medicaid program, is a successful solution to these problems. Patients enroll in temporary HPE healthcare coverage (up to 60 days), with an opportunity to sustain insurance by applying for Medicaid full coverage. Although HPE is a national Medicaid requirement, California is among the more inclusive in terms of HPE eligibility. Among the 31 million remaining uninsured Americans, 10% are in California, the world’s 5th largest economy. During our previously funded R21 through the NIMHD, we collaborated with the California Department of Healthcare Services (DHCS) to create an innovative new dataset that tracks HPE enrollees across the state and follows them longitudinally to evaluate for Medicaid sustainment. Over 100,000 previously uninsured Californians enroll in HPE annually, up to 64% of whom sustain Medicaid at six-months. Inpatients, those requiring surgery or post-discharge health services are more likely to sustain insurance, with minority groups less likely to sustain. Across hospitals, Medicaid sustainment ranges from 33-97%. Our preliminary data suggests that patient socio demographics, availability and training of hospital personnel and county-level engagement contribute to success of Medicaid sustainment after HPE enrollment. In response to PAR-20-310, investigation of modifiable predictors of Medicaid sustainment will guide our development of a DHCS, hospital and county-stakeholder informed “best practice” toolkit intervention for dissemination across hospitals, with the goal of increasing reducing insurance-based disparities. We will pursue 3 specific aims: (SA1) quantitatively characterize distribution of sustainment across hospitals and identify patient and hospital-level factors associated with Medicaid sustainment after HPE, (SA2) qualitatively identify hospital and county practices that promote or limit success Medicaid sustainment across diverse settings, and (SA3) develop a stakeholder-informed best practice “toolkit” aimed at increasing Medicaid sustainment across hospitals and counties. Our goal by developing strategies for increasing sustained insurance coverage is to improve access to care, clinical outcomes and financial health among disadvantaged and uninsured patients.

摘要