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On May 11, 2023, the federal COVID-19 public health emergency (PHE) ended after more than 3 years,[1] marking the conclusion of significant federal health care support for states and individuals. The federal government and states can be better prepared for the next crisis, whether economic, public health, or climate, by automating the Medicaid continuous coverage provision as a proactive response. Another example of Medicaid-focused crisis response was a Section 1115 waiver to expand Medicaid and Children's Health Insurance Program coverage to those affected by the Flint water crisis[29]; however, these expansions were reactive and slowed by political processes. [Extracted from the article] more...

The objective of this study was to determine the prevalence and predictors of testing for sexually transmitted infections (STIs) under an accountable care model of health care delivery. Data sources were claims and encounter records from the Massachusetts Medicaid and Children's Health Insurance Program (MassHealth) for enrollees aged 13 to 64 years in 2019. This cross-sectional study examines the one-year prevalence of STI testing and evaluates social determinants of health and other patient characteristics as predictors of such testing in both primary care and other settings. We identified visits with STI testing using procedure codes and primary care settings from provider code types. Among 740,417 members, 55% were female, 11% were homeless or unstably housed, and 15% had some level of disability. While the prevalence of testing in any setting was 20% (N = 151,428), only 57,215 members had testing performed in a primary care setting, resulting in an 8% prevalence of testing by primary care clinicians (PCCs). Members enrolled in a managed care organization (MCO) were significantly less likely to be tested by a primary care provider than those enrolled in accountable care organization (ACO) plans that have specific incentives for primary care practices to coordinate care. Enrollees in a Primary Care ACO had the highest rates of STI testing, both overall and by primary care providers. Massachusetts' ACO delivery systems may be able to help practices increase STI screening with explicit incentives for STI testing in primary care settings. [ABSTRACT FROM AUTHOR] more...

OBJECTIVES: To evaluate the 30-day postoperative mortality and palliative care consultations in patients that underwent surgical procedures in the United States before and after Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA) implementation. DESIGN: Retrospective, Observational cohort study. SETTING: Secondary data were collected from the U.S. National Inpatient Sample, the largest hospital database in the country. The time span was from 2011 to 2019. PATIENTS: Adult patients that electively underwent 1 of 19 major procedures. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was cumulative postoperative mortality in two study cohorts. The secondary outcome was palliative care use. We identified 4,900,451 patients and categorized them into two study cohorts: PreM: 2011-2014 (n = 2,103,836) and PostM: 2016-2019 (n = 2,796,615). Regression discontinuity estimates and multivariate analysis were used. Across all procedures, 149,372 patients (7.1%) and 156,610 patients (5%) died within 30 days of their index procedures in the PreM and PostM cohorts, respectively. There was no statistically significant increase in mortality rates around postoperative day (POD) 30 (POD 26-30 vs 31-35) for both cohorts. More patients had inpatient palliative consultations during POD 31-60 compared with POD 1-30 in PreM (8,533 of 2,081,207 patients [0.4%] vs 1,118 of 22,629 patients [4.9%]) and PostM (18,915 of 2,791,712 patients [0.7%] vs 417 of 4,903 patients [8.5%]). Patients were more likely to receive palliative care consultations during POD 31-60 compared with POD 1-30 in both the PreM (odds ratio [OR] 5.31; 95% CI, 2.22-8.68; p < 0.001) and the PostM (OR 7.84; 95% CI, 4.83-9.10; p < 0.001) cohorts. CONCLUSIONS: We did not observe an increase in postoperative mortality after POD 30 before or after MACRA implementation. However, palliative care use markedly increased after POD 30. These findings should be considered hypothesis-generating because of several confounders. [ABSTRACT FROM AUTHOR] more...

Objectives: Medicaid and the Children's Health Insurance Program (CHIP) provide health insurance coverage to more than 90 million Americans as of early 2023. There is substantial variation in eligibility criteria, application procedures, premiums, and other programmatic characteristics across states and over time. Analyzing changes in Medicaid policies is important for state and federal agencies and other stakeholders, but such analysis requires data on historical programmatic characteristics that are often not available in a form ready for quantitative analysis. Our objective is to fill this gap by synthesizing existing qualitative policy data to create a new data resource that facilitates Medicaid policy research. Data description: Our source data were the 50-state surveys of Medicaid and CHIP eligibility, enrollment, and cost-sharing policies, and budgets conducted near annually by KFF since 2000, which we coded through 2020. These reports are a rich source of point-in-time information but not operationalized for quantitative analysis. Through a review of the measures captured in the KFF surveys, we developed five Medicaid policy domains with 122 measures in total, each coded by state-quarter—1) eligibility (28 measures), 2) enrollment and renewal processes (39 measures), 3) premiums (16 measures), 4) cost-sharing (26 measures), and 5) managed care (13 measures). [ABSTRACT FROM AUTHOR] more...

Objective: To estimate the effects of prenatal public health insurance targeting noncitizens on the health of U.S.‐born children of noncitizen mothers beyond birth outcomes. Data Sources and Study Setting: This paper uses the restricted version of the 1998–2014 National Health Interview Survey with state‐level geographic identifiers. Study Design: The empirical strategy compares outcomes in states that adopted the Children's Health Insurance Plan (CHIP) Unborn Child Option with states that never adopted or adopted it at different times, controlling for differences in the pre‐treatment period. I use a flexible event‐study analysis to quantify the effects of the Unborn Child Option on noncitizen women's health insurance coverage, health care utilization, and their children's health. Data Collection/Extraction Methods: All data are derived from pre‐existing sources. Principal Findings: The study finds that the impact of the Unborn Child Option is a 4.7%‐point increase in public health insurance coverage (p < 0.01) and 0.48 more doctor's office visits (p < 0.1) annually among noncitizens of childbearing ages. Subsequently, the reform leads to a 7%‐point rise in the rate of parents reporting their 4–6‐year‐old children are in "excellent" or "very good" health (p < 0.01). While no improvements are evident at birth and at younger ages, observed health improvements begin to appear by preschool age. Conclusions: The study contributes to the literature by providing evidence that certain benefits of in‐utero public health insurance targeting noncitizens may appear several years after birth, specifically around preschool age. [ABSTRACT FROM AUTHOR] more...

We explore how access to Head Start affects maternal labor supply. By relaxing childcare constraints, public preschools like Head Start might lead mothers to reallocate time among employment, childcare, and other activities. Using the 1990s enrollment and funding expansions and the 2002 Head Start Impact Study randomized controlled trial, we show that Head Start increases short-run employment and wage earnings of single mothers without reducing quality parent-child interactions. Even before including long-run benefits to children, the short-run benefit to single mothers and the government is $0.93 per dollar. Head Start is a family-level treatment with impacts beyond children. [ABSTRACT FROM AUTHOR] more...

• Time from US infant birth hospitalization discharge to the first outpatient visit (FOV) was assessed. • FOV completion within 5 days of birth hospitalization discharge for Medicaid infants is substantially lower than that of commercially insured infants. • For infants born during the RSV season administration of RSV antibodies in the newborn nursery would ensure optimal uptake. New extended half-life antibodies for the single-dose prevention of medically attended (MA) respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) have been developed for administration to all infants before or during their first RSV season. For infants born during the season, administration as soon as feasible after birth would provide optimal protection and minimize access disparities. The objective of this study was to assess the time from birth hospitalization discharge to the first outpatient visit (FOV) among US infants in order to determine optimal site of administration for the extended half-life antibody. This retrospective, observational, time-to-event analysis uses the Merative™ MarketScan® Commercial and Multi-State Medicaid Databases. Time to FOV is reported separately for the COVID-19 and recent pre-COVID-19 eras and for commercially insured and Medicaid infants. Overall, 73.8 % of Medicaid infants had an FOV within 5 days as compared to 84.7 % of commercially insured infants. Estimates were higher during the COVID-19 era. Urban commercially insured infants had much higher FOV completion than their counterparts. Among Medicaid infants, urban Black and rural White infants were least likely to complete their FOV within 5 days of birth hospitalization discharge. FOV within 5 days after birth hospitalization discharge for Medicaid infants is substantially lower than that of commercially insured infants. Approximately 1 in 4 Medicaid infants and 1 in 8 infants with commercial insurance did not have an outpatient visit within 5 days of birth hospitalization discharge. For US infants born during the RSV season, administration of extended half-life RSV antibodies in the newborn nursery prior to discharge would ensure optimal uptake and minimize access disparities. [ABSTRACT FROM AUTHOR] more...

As state and federal policy makers seek to improve mental health, many aim to boost upstream approaches to prevent or mitigate diagnosable conditions. Home visiting offers a wholistic approach for new parents and children at home through health education, parenting support, and other services. Evidence of its benefits has accumulated across a growing number of home visiting models, some of which have demonstrated direct mental health outcomes, such as improved access to mental health services and reductions in family stress and maternal depression. Despite growing federal investments, home visiting reaches only a small fraction of families who might benefit. Public and private grant funding has successfully built and expanded home visiting in every state, but the current landscape of programs remains limited. As the nation's largest single coverage source for children, Medicaid, along with the Children's Health Insurance Program, has unsurpassed reach, to more than 40 million children and millions more families annually. Medicaid offers a natural vehicle to scale home visiting programs to promote early childhood development and address the mental health of both mothers and young children. To scale home visiting and reach far more families across the country who could benefit, federal policy makers should establish home visiting as a required Medicaid benefit and make additional investments to help states build capacity as the approach is scaled. [ABSTRACT FROM AUTHOR] more...

Background: Child death rates are often regarded as reliable indicators for overall welfare of a country since they give insight of health accessibility and development. For planning and controlling purposes, it is important to understand which ages are at higher risks of experiencing child death as well as determinants thereof. Methods: We used the Sierra Leone DHS 2019 data which was collected using two stage sampling methods. Data collection involved interviewing women aged from 15–49 to obtain information about children they had in the past up to 2019. Age at death of child was modelled using discrete-time survival analysis with a logit link at the same time applying survey weights. The analysis also sought to estimate the determinants of child death (under-five mortality). The baseline hazard was modelled with a polynomial function. Results: Results showed that children from rural areas had significantly lower odds of dying compared with those from urban areas (odds ratio (OR) = 0.861, p-value = 0.0003). Children of mothers who were currently using contraceptives, and those whose mothers had been using since their last birth were at higher odds of child death compared to children whose mothers had never used contraceptives before (currently using: OR = 1.118, p-value = <.0001; used since last birth: OR = 1.372, p-value = <.0001). Children with no health insurance had significantly higher odds of death than those with health insurance (OR = 1.036, p-value = <.0001). Children of women who were married, and of women who were formerly married were at significantly higher odds of experiencing child death than children of women who had never been in union (married: OR = 1.207, p-value = 0.0003; formerly married: OR = 1.308, p-value = 0.0009 compared to those that have never been married). Increase in the age group of mothers increases the odds of their children experiencing child death compared to mothers in their teenage years (20-29: OR = 1.943, p-value = <.0001, 30-39: OR = 2.397, p-value = <.0001 and > = 40: OR = 2.895, p-value = <.0001 compared to mothers in their 15-19 years). Conclusion: The study provides evidence that residing in urban areas, marital union of the mother, children having no health insurance, use of contraceptives by mother, older ages of the mother and no health insurance significantly increase the odds of child death. This points out to a possible need for improved health infrastructure to be made available to citizens in all places of delivery and more awareness on pregnancy related complications. [ABSTRACT FROM AUTHOR] more...

This article examines the use of public benefits by Hispanic and non-Hispanic older immigrants in the United States. It highlights that immigrant and native populations in the US use public benefits at different rates, with immigrant households having higher participation rates in noncash programs like Medicaid and food stamps. The study also discusses the impact of policies and regulations on immigrants' eligibility for public benefits, such as the expansion of the "public charge" rule. The findings suggest that older immigrants receive fewer benefits than nonimmigrants, and there has been a decline in their use of public benefits over time, particularly during the Trump administration. However, the study emphasizes that older immigrants are not a disproportionate burden on the welfare system. [Extracted from the article] more...

The article focuses on the challenges and successes of the Vaccine for Children (VFC) Program, which provides free vaccines to millions of children in the US. Topics include the impact of rising anti-vaccine sentiment, political polarization around COVID-19 vaccines, and the decline in vaccination rates leading to an increased risk of vaccine-preventable diseases such as measles. more...

• RSV incidence and costs in hospitalised infants < 3 months decreased during 2020/21. • An increase in the age of RSV hospitalisations significantly reduce the total costs. • Newborn passive immunisation strategies may be still cost-effective despite age shift. Preventive measures applied during the COVID-19 pandemic have modified the age distribution, the clinical severity and the incidence of Respiratory Syncytial Virus (RSV) hospitalisations during the 2020/21 RSV season. The aim of the present study was to estimate the impact of these aspects on RSV-associated hospitalisations (RSVH) costs stratified by age group between pre-COVID-19 seasons and 2020/21 RSV season. We compared the incidence, the median costs, and total RSVH costs from the national health insurance perspective in children < 24 months of age during the COVID-19 period (2020/21 RSV season) with a pre-COVID-19 period (2014/17 RSV seasons). Children were born and hospitalised in the Lyon metropolitan area. RSVH costs were extracted from the French medical information system (Programme de Médicalisation des Systémes d'Information). The RSVH-incidence rate per 1000 infants aged < 3 months decreased significantly from 4.6 (95 % CI [4.1; 5.2]) to 3.1 (95 % CI [2.4; 4.0]), and increased in older infants and children up to 24 months of age during the 2020/21 RSV season. Overall, RSVH costs for RSVH cases aged below 2 years old decreased by €201,770 (31 %) during 2020/21 RSV season compared to the mean pre-COVID-19 costs. The sharp reduction in costs of RSVH in infants aged < 3 months outweighed the modest increase in costs observed in the 3–24 months age group. Therefore, conferring a temporal protection through passive immunisation to infants aged < 3 months should have a major impact on RSVH costs even if it results in an increase of RSVH in older children infected later in life. Nevertheless, stakeholders should be aware of this potential increase of RSVH in older age groups presenting with a wider range of disease to avoid any bias in estimating the cost-effectiveness of passive immunisation strategies. [ABSTRACT FROM AUTHOR] more...

The authors find that arts learning reduces the proportion of students receiving disciplinary infractions, increases standardized writing achievement scores, and increases students' emotional empathy. Test-based accountability pressures and budget constraints that lead to a narrowing of curricular offerings have been more severe at schools serving historically-underserved students, specifically those serving higher proportions of lower-income, Black, Hispanic, and immigrant students. Despite receiving equal standing alongside math and reading in the most recent reauthorization of the Elementary and Secondary Education Act's definition of a well-rounded education, arts education in the United States has been in steady decline since the 1980s. [Extracted from the article] more...

In terms of number of beneficiaries, Medicaid is the single largest health insurance program in the US. Along with the Children's Health Insurance Program (CHIP), Medicaid covers nearly half of all births and provides health insurance to nearly half of the children in the country. This article provides a broad introduction to Medicaid and CHIP for the pediatric radiologist with a special focus on topics relevant to pediatric imaging and population health. This includes an overview of Medicaid's structure and eligibility criteria and how it differs from Medicare. The paper examines the means-tested programs within the context of pediatric radiology, reviewing pertinent topics such as the rise of Medicaid managed care plans, Medicaid expansion, the effects of Medicaid on child health, and COVID-19. Beyond the basics of benefits coverage, pediatric radiologists should understand how Medicaid and CHIP financing and reimbursement affect the ability of pediatric practices, radiology groups, and hospitals to provide services for children in a sustainable manner. The paper concludes with an analysis of future opportunities for Medicaid and CHIP. [ABSTRACT FROM AUTHOR] more...

Background: Pediatric heart transplantation (HT) is resource intensive. In adults, there has been an increase in the proportion of HTs funded by public insurance, with post‐HT outcomes inferior to those funded by private sources. Trends in the funding of pediatric HT and outcomes in children have not been described. Methods: We queried the United Network for Organ Sharing (UNOS) database for children (<18 years) listed for and undergoing HT between 2004 and 2021. We identified the primary payer at listing, HT, 1 year, and 1–5 years following HT. Trends were analyzed using generalized logit models. Multivariable‐extended Cox regression models were used to test the relationship between insurance type at the time of transplant and time to death or re‐transplant. Results: There were 6382 pediatric patients who underwent transplants and had either public or private insurance at the time of transplant. The percentage of patients with public insurance at the time of HT increased over time. Public insurance at the time of HT was associated with an increased risk of death or re‐transplant beyond 2 months after HT (adjusted HR at 6 months = 1.43, 95% CI: 1.13–1.81, p =.003; adjusted HR at 9 months = 1.67, 95% CI: 1.17–2.37, p =.004). Conclusion: There has been a statistically significant trend toward increasing public insurance for children awaiting, at the time of, and after HT. Black patients and those with public insurance at HT have worse long‐term outcomes. This study highlights ongoing disparities in pediatric HT and the need to focus efforts on achieving equitable outcomes. [ABSTRACT FROM AUTHOR] more...

Low utilization of dental services among low-income individuals and racial minorities reflects pervasive inequities in U.S. health care. There is limited research determining common characteristics among dentists who participate in Medicaid or the Children's Health Insurance Program. Using detailed Medicaid claims data and a provider database, we estimate that among dentists with 100 or more pediatric Medicaid patients, 48% practice in high-poverty areas, 10% practice in rural areas, and 29% work in large practices (11 or more dentists). Among those with zero Medicaid patients, 18% practice in high-poverty areas, 4% practice in rural areas, and 11% work in large practices. We found that dentist race/ethnicity has an independent effect on Medicaid participation even when adjusting for community characteristics, meaning non-White dentists are more likely to treat Medicaid patients, regardless of the median income or racial/ethnic profile of the community. [ABSTRACT FROM AUTHOR] more...

To determine if health disparities impact pediatric tonsillectomy rates. Inequities in pediatric tonsillectomy have been identified in individual studies, however, a systematic review characterizing how the specific social determinants of health impact differences in receipt of pediatric tonsillectomy is needed. PubMed, Scopus, and CINAHL databases. A systematic review was performed in accordance with the PRISMA guidelines. The literature search aimed to capture all articles published through August 2022. Included articles evaluated tonsillectomy for the treatment of tonsillitis and/or obstructive sleep-disordered breathing in patients less than 21 years in which one or more social determinants of health were evaluated. A total of 801 unique articles were identified. Of those, 22 met inclusion criteria. Eight studies (36 %) evaluated tonsillectomy in the context of race, of which all showed that Black children underwent tonsillectomy at significantly lower rates than their White counterparts. Nine studies (41 %) evaluated insurance status, with population-based studies concluding that tonsillectomy utilization was higher in patients with public insurance. Studies of race and insurance were all from the United States. Eight studies (36 %) assessed socioeconomic status and six (28 %) assessed geographic location; however, these latter factors were difficult to compare given the varying metrics and locations among studies. This systematic review shows that Black children undergo tonsillectomy at lower rates than White children, and children with public insurance undergo tonsillectomy at higher rates than children with other insurance types in the United States. Findings for rurality and socioeconomic status were heterogenous given regional and national differences in study settings. I. [ABSTRACT FROM AUTHOR] more...

Taking advantage of an Arizona children's health insurance program enrollment freeze, I study how the loss of children's public insurance affects children and parents. I confirm that the policy led to a decrease in public coverage among children and find partially offsetting gains in employer-sponsored insurance coverage. I find evidence that parents of affected children responded by enrolling in employer-sponsored plans rather than adjusting labor supply. Parents of slightly older children who were unaffected by the policy do not exhibit any responses to the freeze. These results can be informative of the ongoing Medicaid unwinding. [ABSTRACT FROM AUTHOR] more...

The article focuses on a significant shift in health insurance coverage in 2023-2024, marked by a historic low in the uninsured rate due to increased subsidies and pandemic-era Medicaid policies. It mentions the continuous-coverage provision, implemented during the Covid-19 pandemic, led to a substantial increase in Medicaid enrollment, but states are now allowed to disenroll individuals based on eligibility criteria, with federal funding returning to prepandemic levels in January 2024. more...

An editorial is presented on the postpandemic status of teledermatology in the U.S., focusing on changes in policies, reimbursement, and licensing requirements. It highlights the uncertainty around the future of teledermatology, despite recent legislative extensions, and addresses potential challenges and opportunities for sustained implementation. more...

The article reports about the lack of a constitutional right to healthcare in the United States and the Supreme Court's ruling that deliberate indifference to incarcerated people's medical needs is a violation of the Eighth Amendment. Incarcerated individuals face obstacles in accessing legal recourse for inadequate medical care, and efforts to protect their constitutional right to healthcare must be explored. more...

Background: Attributes defining the Social Determinants of Health (SDoH) are associated with disproportionate exposures to environmental hazards and differential health outcomes among communities. The dynamics between SDoH, disproportionate environmental exposures, and differential health outcomes are often specific to micro-geographic areas. Methods: This study focused on children less than 20 years of age who lived in Douglas County, Nebraska, during 2016–2019. To assess the role of SDoH in differential exposures, we evaluated the association between SDoH metrics and criteria pollutant concentrations and the association between SDoH and pediatric asthma exacerbations to quantify the role of SDoH in differential pediatric asthma outcomes. The Bayesian Poisson regression model with spatial random effects was used to evaluate associations. Results: We identified significant positive associations between the annual mean concentration of criteria pollutants (carbon monoxide, particulate matter2.5, nitrogen dioxide, sulfur dioxide) with race (Non-Hispanic Black and Hispanic/Latino), financial stability, and literacy. Additionally, there were significant positive associations between higher rates of pediatric asthma emergency department visits and neighborhoods with more Non-Hispanic Black children, children without health insurance coverage, and households without access to a vehicle. Conclusions: Non-Hispanic Black and Hispanic/Latino children living in Douglas County, NE experience disproportionately higher exposure to criteria pollutant concentrations. Additionally, higher rates of asthma exacerbations among Non-Hispanic Black children could be due to reduced access to respiratory care that is potentially the result of financial instability and vehicle access. These results could inform city planners and health care providers to mitigate respiratory risks among these higher at-risk populations. [ABSTRACT FROM AUTHOR] more...

Keywords: Policy leadership training; Truth to power; Research practice partnerships; Role of foundations; Measuring the magic EN Policy leadership training Truth to power Research practice partnerships Role of foundations Measuring the magic 17 21 5 03/15/23 20230101 NES 230101 Science Meets Policy Early in her career, a young professor was invited to testify at a state budget subcommittee hearing. Collaborating with the engines of change: State and local government While students were training and becoming policy gerontologists, my colleagues and I worked on a number of policy research projects with state and local partners. In one of the Policy Leadership classes, a seasoned staffer was asked how he dealt with setbacks and disappointments after investing time and energy in high priority policies. [Extracted from the article] more...

Publicly funded adult health insurance through the Affordable Care Act (ACA) has had positive effects on low‐income adults. We examine whether the ACA's Medicaid expansions influenced child development and family functioning in low‐income households. We use a difference‐in‐differences framework that exploits cross‐state policy variation and focus on children in low‐income families from a nationally representative, longitudinal sample followed from kindergarten to fifth grade. The ACA Medicaid expansions improved children's reading test scores by ~2% (0.04 SD). Potential mechanisms for these effects within families are more time spent reading at home, less parental help with homework, and eating dinner together. We find no effects for children's math test scores or socioemotional skill development. [ABSTRACT FROM AUTHOR] more...

Key Points: Question: Among children and adolescents from lower-income families in the US, is family income associated with health? Findings: This cross-sectional study included 795 000 US participants aged 5 to 17 years with family income under 200% of the federal poverty threshold who accessed health care through Medicaid or the Children's Health Insurance Program. Higher family income was significantly associated with a lower prevalence of diagnosed infections, mental health disorders, injury, asthma, anemia, and substance use disorders and lower 10-year mortality. Meaning: Higher family income was associated with lower claims-based measures of morbidity and mortality among children and adolescents in lower-income families in the US. Importance: Family income is known to be associated with children's health; the association may be particularly pronounced among lower-income children in the US, who tend to have more limited access to health resources than their higher-income peers. Objective: To investigate the association of family income with claims-based measures of morbidity and mortality among children and adolescents in lower-income families in the US enrolled in Medicaid or the Children's Health Insurance Program. Design, Setting, and Participants: This cross-sectional analysis included 795 000 participants aged 5 to 17 years enrolled in Medicaid (Medicaid Analytic eXtract claims, 2011-2012) living in families with income below 200% of the federal poverty threshold (American Community Survey, 2008-2013). Follow-up ended in December 2021. Exposures: Family income relative to the federal poverty threshold. Main Outcomes and Measures: Record of International Classification of Diseases, Ninth Revision codes for an infection, mental health disorder, injury, asthma, anemia, or substance use disorder and death record within 10 years of observation (Social Security Administration death records through 2021). Results: Among 795 000 individuals in the sample (all statistics weighted: mean [SD] income-to-poverty ratio, 90% [53%]; mean [SD] age, 10.6 [3.9] years; 56% aged 10 to 17 years), 33% had a diagnosed infection, 13% had a mental health disorder, 6% had an injury, 5% had asthma, 2% had anemia, 1% had a substance use disorder, and 0.6% died between 2011 and 2021, with the mean (SD) age at death of 19.8 (4.2) years. For those aged 5 to 9 years, higher family income was associated with lower adjusted prevalence of all outcomes, except mortality: children in families with an additional 100% income relative to the federal poverty threshold had 2.3 (95% CI, 1.8-2.9) percentage points fewer infections, 1.9 (95% CI, 1.5-2.2) percentage points fewer mental health diagnoses, 0.7 (95% CI, 0.5-0.8) percentage points fewer injuries, 0.3 (95% CI, 0.09-0.5) percentage points less asthma, 0.2 (95% CI, 0.08-0.3) percentage points less anemia, and 0.06 (95% CI, 0.03-0.09) percentage points fewer substance use disorder diagnoses. Except for injury and anemia, the associations were more pronounced among those aged 10 to 17 years than those 5 to 9 years (P for interaction <.05). For those aged 10 to 17 years, an additional 100% income relative to the federal poverty threshold was associated with a lower 10-year mortality rate by 0.18 (95% CI, 0.12-0.25) percentage points. Conclusions and Relevance: Among children and adolescents in the US aged 5 to 17 years with family income under 200% of the federal poverty threshold who accessed health care through Medicaid or the Children's Health Insurance Program, higher family income was significantly associated with a lower prevalence of diagnosed infections, mental health disorders, injury, asthma, anemia, and substance use disorders and lower 10-year mortality. Further research is needed to understand whether these associations are causal. This study examines the association between family income and the prevalence of claims-based diagnoses for 6 types of chronic and acute conditions, along with 10-year mortality, among children and adolescents in lower-income families. [ABSTRACT FROM AUTHOR] more...

Specifically, Medicaid policy can improve health equity through several pathways, including (1) collecting member demographics and social determinants of health, (2) monitoring and evaluating health equity in Medicaid policy, and (3) incentivizing health equity. MONITORING AND EVALUATING HEALTH EQUITY IN MEDICAID Without federal Medicaid analytic data sets that enable and accelerate equity-focused research, coalitions of the willing are taking the first steps in driving policy change by innovating in this space to monitor and evaluate health equity. Currently, 92% of Americans have health insurance, the highest coverage rate in our nation's history.1 Much of the growth in coverage comes from states expanding Medicaid eligibility over the past decade and maintaining enrollment in Medicaid programs in response to the COVID-19 crisis. Platforms like MODRN provide cross-state evidence needed to facilitate evidence-based policy making in Medicaid programs, including emerging efforts to incentivize equity in Medicaid managed care contracts. [Extracted from the article] more...

Objective: To estimate the effects of Children's Health Insurance Reauthorization Act (CHIPRA), a policy that provided states the option to extend Medicaid/CHIP eligibility to immigrant children who have not been legal residents for five years or more, on insurance coverage, access, utilization, and health outcomes among immigrant children. Data Sources: Restricted use 2000–2016 National Health Interview Survey (NHIS). Study Design: We used a difference‐in‐differences design that compared changes in CHIPRA expansion states to changes in non‐expansion states. Data Collection: Our sample included immigrant children who were born outside the US, aged 0–18 with family income below 300% of the Federal Poverty Level (FPL). Subgroup analyses were conducted across states that did and did not have a similar state‐funded option prior to CHIPRA (state‐funded vs. not state‐funded), by the length of time in the US (5 years vs. 5–14 years), and global region of birth (Latin American vs. Asian countries). Principle Findings: We found that CHIPRA was associated with a significant 6.35 percentage point decrease in uninsured rates (95% CI: −11.25, −1.45) and an 8.1 percentage point increase in public insurance enrollment for immigrant children (95% CI: 1.26, 14.98). However, the effects of CHIPRA became small and statistically not significant 3 years after adoption. Effects on public insurance coverage were significant in states without state‐funded programs prior to CHIPRA (15.50 percentage points; 95% CI:8.05, 22.95) and for children born in Asian countries (12.80 percentage points; 95% CI: 1.04, 24.56). We found no significant changes in health care access and utilization, and health outcomes, overall and across subgroups due to CHIPRA. Conclusions: CHIPRA's eligibility expansion was associated with increases in public insurance coverage for low‐income children, especially in states where CHIPRA represented a new source of coverage versus a substitute for state‐funded coverage. However, we found evidence of crowd‐out in certain subgroups and no effect of CHIPRA on access to care and health. Our results suggest that public coverage may be an important tool for promoting the well‐being of immigrant children but other investments are still needed. [ABSTRACT FROM AUTHOR] more...

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