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Objective: To assess the relationship between recent changes in Medicaid eligibility and preconception insurance coverage, pregnancy intention, health care use, and risk factors for poor birth outcomes among first-time parents. Data Source: This study used individual-level data from the national Pregnancy Risk Assessment Monitoring System (2006-2017), which surveys individuals who recently gave birth in the United States on their experiences before, during, and after pregnancy. Study Design: Outcomes included preconception insurance status, pregnancy intention, stress from bills, early prenatal care, and diagnoses of high blood pressure and diabetes. Outcomes were regressed on an index measuring Medicaid generosity, which captures the fraction of female-identifying individuals who would be eligible for Medicaid based on state income eligibility thresholds, in each state and year. Data Collection/Extraction Methods: The sample included all individuals aged 20-44 with a first live birth in 2009-2017. Principal Findings: Among all first-time parents, a 10-percentage point (ppt) increase in Medicaid generosity was associated with a 0.7 ppt increase (P = 0.017) in any insurance coverage and a 1.5 ppt increase (P < 0.001) in Medicaid coverage in the month before pregnancy. We also observed significant increases in insurance coverage and early prenatal care and declines in stress from bills and unintended pregnancies among individuals with a high-school degree or less. Conclusions: Increasing Medicaid generosity for childless adults has the potential to improve insurance coverage in the critical period before pregnancy and help improve maternal outcomes among first-time parents. KEYWORDS maternal and perinatal care and outcomes, Medicaid, patient protection and affordable care act, preconception care, pregnancy, unplanned, prenatal care, state health policies, 1 | INTRODUCTION The United States continues to lag behind all other high-income countries in rates of maternal morbidity and mortality. Rates of maternal mortality reached 17.4 deaths per 100 [...]

Objective: To examine changes in access to dental care in states using Section 1115 waivers to implement healthy behavior incentive (HBI) programs in their Medicaid expansion under the ACA, compared to traditional expansion states and non-expansion states. Data sources: Behavioral Risk Factor Surveillance System from 2008 to 2018. Study design: We used difference-in-differences analysis to compare changes in three Medicaid expansion states with HBI (Iowa, Indiana, Michigan) to traditional expansion (Minnesota, North Dakota, Ohio) and nonexpansion states (Nebraska, South Dakota, Wyoming) in the same mid-Western region of the country. The sample included 32 556 low-income adults. Data collection/extraction methods: NA. Principal findings: We found no significant changes in dental visits associated with HBI or traditional expansion relative to nonexpansion states. HBI expansion was associated with an increase of 2.2 percentage points in reporting a dental visit in the past year for adults in urban areas (P < 0.05) while the traditional expansion was associated with a reduction of 8.5 percentage points (P < 0.01) in utilization in rural areas relative to nonexpansion states. However, after adjustment for preexisting trends, the coefficients were no longer significant, suggesting that these differences are likely due to preexisting trends. Conclusions: We did not find evidence of increased utilization of routine dental care associated with HBI programs. KEYWORDS dentistry/dental care, healthy behavior incentives, Medicaid, Medicaid expansion, observational data/quasi-experiments, 1 | INTRODUCTION Adult dental benefits in Medicaid are an optional health benefit that varies by state, (1) and an estimated 9.8 million adults have gained dental insurance since the [...]

Policy responses to the March 31, 2023, expiration of the Medicaid continuous coverage provision need to consider the difference between self-reported Medicaid participation on government surveys and administrative records of Medicaid enrollment. The difference between the two is known as the “Medicaid undercount.” The size of the undercount increased substantially after the continuous coverage provision took effect in March 2020. Using longitudinal data from the Current Population Survey, we examined this change. We found that assuming that all beneficiaries who ever reported enrolling in Medicaid during the COVID-19 pandemic public health emergency remained enrolled through 2022 (as required by the continuous coverage provision) eliminated the worsening of the undercount. We estimated that nearly half of the 5.9 million people who we projected were likely to become uninsured after the provision expired, or “unwound,” already reported that they were uninsured in the 2022 Current Population Survey. This finding suggests that the impact of ending the continuous coverage provision on the estimated uninsurance rate, based on self-reported survey data, may have been smaller than anticipated. It also means that efforts to address Medicaid unwinding should include people who likely remain eligible for Medicaid but believe that they are already uninsured.

Objectives: To estimate the effect of Medicaid expansion under the Affordable Care Act (ACA) on the frequency and payment source for Emergency Department (ED) visits for dental care. Study Design: Retrospective, quasi-experimental study. Data Sources/Study Setting: We used the State Emergency Department Database to compare changes in ED visit rates and payment source for dental conditions among patients from 33 states. These states represent four distinct policy environments, based on whether they expanded Medicaid and whether their Medicaid programs provide dental benefits. We first assessed the number of ED dental visits before (2012) and after (2014) the ACA. Then, we used differences-in-differences regression to estimate changes in insurance for dental visits by nonelderly adults. Principal Findings: Our sample contained 375 944 dental ED visits. In states that expanded Medicaid and offered dental coverage, dental ED visits decreased by 14.1 percent (from 19 443 to 16 709, for a net difference of 2734). By contrast, in the remaining three state groups, dental ED visits rose. Meanwhile, the expansion significantly increased Medicaid coverage and decreased the rate of self-pay for ED dental visits. Conclusions: Medicaid expansion, combined with adult dental coverage in Medicaid, was associated with a reduction in ED utilization for dental visits. KEYWORDS dentistry/dental care, emergency service, health policy/politics/law/regulation, hospital, medicaid, observational data/quasi-experiments, 1 | INTRODUCTION Emergency Department (ED) services are a significant contributor to health care costs in the United States. (1,2) ED visits for dental care alone cost the health system [...]

Objective: To test whether a change from a telephone to mail and Internet survey in January 2018 affected the sample composition and uninsured estimates in the Gallup-Sharecare Well-Being Index. Data Sources: Gallup-Sharecare Well-Being Index (2013-2018). Study Design: Regression discontinuity analysis identified changes after the survey redesign in the estimated U.S. uninsured rate (adults 18-64) and in the sample's demographic composition. Principal Findings: After the survey redesign, the estimated uninsured rate fell 5.3 percentage points (P < 0.001), respondents were older and disproportionately white, more likely to have a college degree, and had higher average incomes. These changes were modestly reduced by survey weights. Conclusions: The shift to a mail survey (with a web option) led to an older, more educated sample with fewer minorities, and a significant break in trend in the estimated uninsured rate. KEYWORDS insurance, survey methods, 1 | INTRODUCTION After the passage of the Affordable Care Act (ACA), the Gallup-Sharecare Well-Being Index (WBI--previously the Gallup-Healthways Well-Being Index) served as a valuable source of timely data on [...]

Objective. To examine the patterns of insurance coverage among nine Latino sub groups and assess heterogeneous effects of the Affordable Care Act (ACA) among these groups. Data Sources. American Community Survey (2010-2014). Study Design. We examined pre-ACA disparities in coverage using linear probability models. Then, we used interrupted time series and triple-difference models to evaluate coverage changes associated with the ACA and Medicaid expansion, respectively. Principal Findings. Pre-ACA coverage disparities between Latino subgroups were nearly 30 percentage points--larger than the gap between whites and Latinos as a whole. Coverage changes associated with the ACA and Medicaid expansion differed significantly between subgroups, with the largest gains among South Americans, Central Americans, and Mexicans. Conclusions. Latino subgroups show marked heterogeneity in baseline coverage rates and responses to the ACA. Key Words. Insurance, racial/ethnic disparities, health reform, Hispanics and Latinos make up the largest minority group in the nation, totaling 17.6 percent of the population, and they have the highest uninsured rates of any major racial or [...]