Investigating the systems and circumstances that contribute to inequality. 94 0 obj <>/Filter/FlateDecode/ID[<83AFCCF09FEC604BA7EFF2E3A47539DB><19AA0E14F38C16448574B22521BC03D4>]/Index[68 50]/Info 67 0 R/Length 122/Prev 718862/Root 69 0 R/Size 118/Type/XRef/W[1 3 1]>>stream Howlader N, Forjaz G, Mooradian MJ, et al. The dashed line for trend comparison, for easier visual comparison of temporal trends, is equal to the trends of the nonexpansion states translated up or down such that the comparison mortality rates at the end of the preexpansion study period (2013) are equal to the rate in the 2014 expansion group. Legislation passed in March made North Carolina the 40th state to expand access to Medicaid. Additionally, there were statistically significant early expansionassociated decreases in liver cancer mortality, but the parallel trends assumption was violated (Supplementary Table 1, available online). Finally, Medicaid expansion is associated with increased access to surgery and decreased time to treatment initiation for some cancers, though data show mixed results (4350). The additional booster dose will improve your level of protection significantly and is the best way to protect your health and those around you. Without Medicaid expansion, North Carolina has missed out on an estimated $521 million each month that could go to improving mental health and helping rural hospitals remain open. Inclusion in an NLM database does not imply endorsement of, or agreement with, In exploratory analyses, the decrease in uninsured rates in early expansion vs nonexpansion states was small, from 2007 to 2013 (0.39 percentage points [%]) (Figure 2; Table 3), but much larger from 2013 to 2016 (3.20%), which translates to a net 1.76 million individuals gaining insurance coverage from 2013 to 2017 in early expansion states. North Carolina is the 40th state to expand Medicaid. Did the ACA Medicaid expansion save lives? Roy Cooper signs a Medicaid expansion law on March 27, 2023, in Raleigh, N.C. I continue to encourage everyone to receive the doses they are eligible for as and when they become available.. Research also shows that states that have expanded Medicaid have fewer families declaring bankruptcy because of medical bills. Adults aged 1964 who make up to 138 percent of the Federal Poverty Level (FPL) qualify for Medicaid expansion. Lansdorp-Vogelaar I, Goede SL, Ma J, et al. Debate about Medicaid expansion will shift back to the states. 0 NA = not applicable. However, you will need to visit the Medicaid managed care provider directory to find out which health plan works with your provider. Association of Medicaid expansion under the Affordable Care Act with stage at diagnosis and time to treatment initiation for patients with head and neck squamous cell carcinoma. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA, 2 Not only did the ACA create state health insurance exchanges to make private insurance affordable, but it also allows states to expand their Medicaid programs by raising the income limits to 138% of the federal poverty level. Medicaid policies that could help address health equity include closing the coverage gap for adults in non-expansion states; increasing coverage among those eligible but not enrolled; and expanding benefits such as pregnancy and postpartum services, housing and housing-related supports, and community health worker services. The trends in cancer mortality rates for all cancers combined changed similarly over time for Medicaid expansion and nonexpansion states, with the exception of 2009. Without adequate insurance coverage, its more challenging to arrange follow-up visits and ensure patients have access to medications they need. Capitated managed care remains the predominant delivery system for Medicaid in most states. Data from 2002-2006 were not used in the primary DID analyses but were used to establish preexpansion mortality rate trends and in a sensitivity analysis. For the county-level analyses, 3715 county-year units were included in the analysis (see Supplementary Figure 2, available online, for the CONSORT diagram). Instead, the law stipulates that North Carolinas Medicaid expansion program becomes effective on the latter of two dates: If N.C. lawmakers and Governor Cooper do not agree on a state budget by June 30, 2024, the Medicaid expansion law will expire, and the legislative process must start again. Cooper (D) persisted in leading state and local agencies and coalitions to advocate for expansion. Your feedback helps us to improve this website. Expanding Medicaid in NC would bring affordable health coverage to more than 100,000 low-income parents with children at home, including thousands of parents of children with special needs. , and Beyond telehealth, many states are taking steps to expand access to behavioral health services as the pandemic has heightened demand for these services. The marginal posterior distribution was used to obtain the DID estimate (the mean), 95% credible interval (95% CrI = 2.5 and 97.5 percentiles) and the 1-tailed probability Pr of the estimate being greater than 0 (or <0, for positive means) (30). The year-to-year change in overall and pancreatic cancer mortality rates was similar in early Medicaid expansion and nonexpansion states from 2002-2009 (with the exception of 2005 in the overall cancer mortality rate analysis). What Medicaid expansion means and why it matters Jones says his staff at Piedmont Health Services has been notifying patients about their redetermination dates and checking Medicaid eligibility when they come for a visit. What efforts will emerge to improve rates of booster take-up? Exploratory analyses of the 2014 Medicaid expansions showed a decrease in pancreatic cancer mortality (0.18 deaths per 100 000, 95% confidence interval = 0.32 to 0.05) in states that expanded Medicaid by 2014 compared with nonexpansion states. State-level cancer mortality attributable to cigarette smoking in the United States. The federal government subsidizes the added costs to the states. JNCI Journal of the National Cancer Institute, https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model, A First Look at Medicaid Expansions Impact on Cancer Mortality Rates, https://www.census.gov/data/datasets/time-series/demo/popest/intercensal-2000-2010-counties.html, https://www.census.gov/data/tables/time-series/demo/popest/2010s-counties-detail.html#, https://www.census.gov/programs-surveys/saipe/data/datasets.html, https://www.ers.usda.gov/data-products/county-level-data-sets/, https://www.kff.org/medicaid/state-indicator/rate-by-age-3/, https://www.statmodel.com/download/IntroBayesVersion 3.pdf, https://www.census.gov/data-tools/demo/sahie/#/, https://seer.cancer.gov/statfacts/html/all.html, No. The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California. Raleigh These 5 states will be the first to kick residents off Medicaid - CNN Several states have recently implemented Medicaid managed care programs. For over a decade North Carolina and other states have refused to expand Medicaid as allowed under the Patient Protection and Affordable Care Act (PPACA). Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA, 14 Finally, a major limitation of the study revolves around the early Medicaid expansions themselves. Starting this year, California state employees can choose to take Juneteenth off in lieu of a personal holiday. Vaccine programme moves to next stage - gov.scot - The Scottish Government We encourage you to use this PDF flyer to spread the word. Its imperative to prevent any interruption in the continuity of patient care. Trends and patterns of disparities in cancer mortality among US Counties, 1980-2014. All content is available under the Open Government Licence v3.0, except for graphic assets and where otherwise stated, individuals aged 12 years and over who are immunosuppressed. Learn smart gadget and internet tips and tricks with our entertaining and ingenious how-tos. Sineshaw HM, Ellis MA, Yabroff KR, et al. Many small businesses cant afford to offer health coverage to employees even in the best of times. We retrieved pre- and post-early expansion county-level covariate information (metropolitan residence status, percent unemployed, percent high school education, percent poverty, percent non-White, percent Black, percent Hispanic, percent elderly, and percent female) published by the United States Census Bureau and the US Department of Agriculture Economic Research Service (see the Supplementary Methods, available online for details) (24-27). 117 0 obj <>stream You can print it out and share it with friends and family. hb```e``Z "ED@(1aQ ]q?:00vtt400J )$ ! Vaccination has been our most effective tool against coronavirus. If N.C. lawmakers and Governor Cooper do not agree on a state budget by June 30, 2024, the Medicaid expansion law will expire, and the legislative process must start again. %%EOF Cause of death was based on the International Classification of Diseases, 10th Revision (ICD-10) codes from death certificates. If North Carolina were to expand its Medicaid program, 372,400 uninsured nonelderly adults would become eligible for coverage, 37% of the state's uninsured nonelderly adult population. Medicaid: What to Watch in 2023 | KFF Preexpansion Medicaid coverage rates [based on 2008 data (28)] were similar between state groups (Supplementary Table 3, available online). Early expansion states expanded at different times, had heterogeneous Medicaid eligibility criteria, including varying criteria by county in California and variable usage of Section 1115 waivers, and enacted further Medicaid eligibility expansions in 2014 (4). Today, Governor Roy Cooper signed House Bill 76, Access to Healthcare Options, into law. the contents by NLM or the National Institutes of Health. Rather, these data suggest that regions that implemented early Medicaid expansion saw fewer cancer deaths, which may be attributable to the policy (53,54). Interestingly, others have shown that states that expanded Medicaid early had expansion-associated improvements in cancer screening rates and overall cancer survival after 2014 in contrast to no statistically significant expansion-associated changes for states that expanded in 2014 (18,33). North Carolina Gov. Medicaid expansion provides health coverage for more North Carolina veterans who have served to protect our country. Changes in cancer mortality rates associated with Medicaid expansions occurring in 2014. USDA ERS - county-level data sets. Changes in cancer mortality rates associated with early Medicaid expansion. There will be more information coming soon from the N.C. Department of Health and Human Services on how to enroll. Sommers BD, Arntson E, Kenney GM, Epstein AM.. 68 0 obj <> endobj Most states have or plan to adopt permanent Medicaid telehealth expansions that will remain in place after the pandemic, including expansions of allowable modalities, services, and providers. The impact of comorbidity on cancer survival: a review, The fallacy of the ecological fallacy: the potential misuse of a concept and the consequences. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Reddit (Opens in new window), What is home? States also report actions to address other telehealth challenges, including access to technology and broadband, program integrity, outreach and education, and equity. Although Medicaid expansion is associated with decreased uninsured rates and earlier cancer diagnoses, no study has demonstrated an association between Medicaid expansion and cancer mortality. Other reported state Medicaid initiatives to reduce racial health disparities include outreach to underserved populations, increasing cultural competency, and establishing departments and dedicated staff positions focused on promoting equity. Some communities get left behind altogether when a hospital closes. The services at ECU Health Multispecialty Clinic meet important health care needs in the community, but rural providers have had to think differently about how to provide care. We had sheriffs from rural communities saying that they cant arrest their way out of a mental health problem, Kinsley says. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (, GUID:1274D0E3-8800-4C60-87B1-20E326FC3CF8, Socioeconomic and racial/ethnic disparities in cancer mortality, incidence, and survival in the United States, 1950-2014: over six decades of changing patterns and widening inequalities, United States Health Care Reform: progress to date and next steps. , But since the major Affordable Care Act Provisions took hold in 2014, charity care and bad debt have fallen among hospitals. The 2014 expansion states included AZ, AR, CA, CO, CT, DE, DC, HI, IL, IA, KY, MA, MD, MI, MN, NV, NH, NJ, NM, NY, ND, OH, OR, RI, VT, WA, and WV. Weve been paying for all of this [health care] only in the most expensive way possible. Earlier this year, we found that Black Americans were more likely than white people to test positive for COVID-19, almost four times as likely to be hospitalized and nearly three times as likely to die of the virus. Despite strong political headwinds and conservative opposition, Gov. Roy Coopers office and, as a result, rural residents are 30%-40% more likely to be uninsured, according to Kody Kinsley, secretary of the North Carolina Department of Health and Human Services. It is unclear whether the lack of an overall effect is due to inadequate follow-up or whether there was minimal impact on cancer mortality. [After expansion] Emergency Department team members will be able to refer uninsured patients to the Department of Social Services or Access East, the care management arm of ECU Health, to connect them with Medicaid resources, Patterson says. Penny-wise and pound-foolish.. hXkOH+XiKR"t7X%n=Q;$J]xfk9$BPF""BLHF NC Department of Health and Human Services I will say that we are fortunate to be connected to a system of care, Beamer adds. United States Census Bureau. Jackie Duda is a Maryland-based writer with disabilities specializing in health care, disability, and travel writing. To Improve Behavioral Health, Start by Closing the Medicaid Coverage Similarly, Han et al. Individual-level inferences cannot be drawn from these data; we do not know if the cancer deaths that were averted in early Medicaid expansion states occurred among individuals who gained coverage under the Medicaid expansions. Will the Administration release new guidance in 2023 to address access to care and what provisions will be included in the anticipated access and revised managed care regulations? Under current law, after the 60 days of postpartum coverage, many people who qualify for pregnancy-related Medicaid lose that coverage because Medicaid eligibility levels for parents are much lower than for pregnant people in most states, and especially innon-expansion states. Sign Up Here for Engagement Programs and Updates. In particular, nearly all states added or expanded audio-only telehealth coverage. Error bars denote 95% confidence intervals. The differential expansion status across states and the temporal nature of these expansions provide a natural experiment for examining potential impacts of Medicaid expansion (5). Early expansion states include CA, CT, DC, MN, NJ, and WA; not early expansion includes all other states. In Mississippi, 78% of the people who would become eligible for health insurance with expansion are poor adults without children. In adjusted difference-in-differences analyses, we observed a statistically significant decrease of 3.07 (95% credible interval = 2.19 to 3.95) cancer deaths per 100 000 in early expansion vs nonexpansion states, which translates to an estimated decrease of 5276 cancer deaths in the early expansion states during the study period. KFF estimates that through federal fiscal year 2022, states received more than double the amount in federal fiscal relief relative to the costs of enrollment due to the continuous enrollment provision, with some variation across states. Counties attributes were statistically significantly different between early and not early Medicaid expansion states with P of .006 or less for percent metropolitan, percent unemployed, percent poverty, percent Black, percent Hispanic, percent elderly, and percent female. What Expanding Medicaid Would Mean for North Carolina Results from a randomized trial on the impacts of acquiring Medicaid coverage, Prostate cancer screening in early Medicaid expansion states. Some will lose their Medicaid coverage because their income is too high pre-expansion, and will have to reapply when expansion is allowed to begin. Visit 'Set cookie preferences' to control specific cookies. Less than half of North Carolinas veterans receive their health coverage through the Department of Veterans Affairs and a portion of those have family members who remain uninsured. The effect of advances in lung-cancer treatment on population mortality, Changes in smoking prevalence among U.S. adults by state and region: estimates from the tobacco use supplement to the current population survey, 1992-2007. Cooper took office in 2017, he began building bipartisan coalitions, which led to the historic vote. Evita B., a child care worker in the North Carolina Triangle area, is one of the many who will finally be eligible for Medicaid under expansion. North Carolina has a significant rural population, and the impact of rejecting Medicaid expansion has been devastating in those areas. The new proposed rule on eligibility and enrollment could increase enrollment among all Medicaid eligibility groups, but especially among seniors and people with disabilities. We applaud the efforts by the General Assembly to move this forward. The COVID-19 pandemic has exacerbated the mental health crisis in this country. Results for breast, cervix, and lung cancer mortality were inconsistent. The Affordable Care Act (ACA) provided states the opportunity to expand Medicaid to additional low-income individuals (3). Our objective was to quantify cancer mortality changes associated with the early Medicaid expansions using state- and county-level mortality data . Copyright 2023 | The American Prospect, Inc. | All Rights Reserved, The Alt-Labor Chronicles: Americas Worker Centers, In North Carolina, the Uninsured Say Medicaid Expansion Will Be Life-Changing. The plan focuses on three areas: making mental health services more available when and where people need them; building strong systems to support people in crisis and people with complex behavioral needs; and enabling better health access and outcomes with data and technology. Even with the Medicaid program for pregnant women, disparities persist. Democrats in Congress last year discussed a federal option to fill in the Medicaid coverage gap but ultimately did not pass it, and such an approach is now highly unlikely with divided control in Washington. The independent source for health policy research, polling, and news. Han X, Yabroff KR, Ward E, Brawley OW, Jemal A.. Do not give any personal information because we cannot reply to you directly. Medicaid coverage rates for the nonelderly by age. State Government websites value user privacy. North Carolina, like other states, is currently dealing with an opioid and substance abuse crisis. This is a huge win for North Carolina, with benefits that can be life saving and life changing. State Government websites value user privacy. After X-rays revealed she needed three wisdom teeth extracted and the cost would be more than $1,000, Evita held off on treatment and has been enduring constant tooth pain ever since. What turned the tide in North Carolina and swayed the minds of legislators was the promise of a fiscal bump from the American Rescue Plan to the tune of an extra$1.8 billion, a signing bonus for states that expand. Early expansion states combined only enrolled approximately 500 000 individuals from 2010 to 2012 compared with the millions gaining coverage due to the main Medicaid expansions occurring in 2014 (4). However, we found no detectable expansion-associated decrease in overall cancer mortality (non-statistically significant DID estimate favoring nonexpansion states). FOIA ARPA included an option, made permanent in the Consolidated Appropriations Act, to allow states to extend postpartum coverage from 60 days to 12 months. Instead, the assistance remains solid, with the feds picking up90%of the tab. Residents will now be at a greater risk of losing their Medicaid coverage and not having affordable alternatives. Death, pain and at-home treatments like over-the-counter medications and herbal medicine were something many North Carolinians suffered through living in a state that has rejected Medicaid expansion until this year. On March 23, all that changed when the state House of Representatives voted 87-24 on a bipartisan basis, and North Carolina became the 40th state to approve Medicaid expansion. The legislation will expand Medicaid, which is expected to provide health coverage to over 600,000 people across North Carolina and bring billions in federal dollars to the state.