1. states of medicaid

Medicaid has had an increasing amount of changes since its creation in terms of execution and implementation. Programmatic changes driven primarily at the state-level are important in providing adequate care  that also need to be recognized to fully understand its current position in the U.S. healthcare system and in the millions of Americans who depend on Medicaid to receive health care. As such, it is imperative to critically examine programs in each state to gain a better understanding of the extent to which the programs are fulfilling the legislative intent of Medicaid. In this report, we conducted a comprehensive review of Medicaid programs across all 50 states and the District of Columbia. In accordance with the guidelines set forth by CBO, we evaluated each program according to the level of access provided, the sustainability of each program, and the value regarding the cost of each program compared with metrics of health for the Medicaid population in each state. Our objective in this report is to provide a thorough and timely analysis of the performance of Medicaid across the US. In doing so, we hope that our findings will inform policy conversations moving forward and incite state-level legislature to consider opportunities for improvement in their respective programs.

HELPR Lab Project Leader(s) -  Aderike Anjorin, Ridhi Patel, Marissa Alvarez, Sydney Williams

2. Social Determinant of Health Community Phenotypes

Studies have consistently shown social determinants of health (SDH) to be significant factors shaping the health and longevity of individuals. Although SDH rarely exist in isolation, the body of literature regarding SDH largely examines the effects of individual SDH on communities. The objective of this study was to design a model that identifies community phenotypes based on combinations of co-existing SDH that span five categories outlined by Healthy People 2020: economic stability, education, health care, built environment, and social context. Our main data source was the U.S. Census American Community Survey from 2012-2016. We retrospectively compiled a database of SDH variables for all Virginia counties and cities. Each SDH was standardized and assigned a score: 5 for highest performers and 1 for lowest performers. The scores were sorted and averaged across the five categories and used as inputs for the cluster analysis. We used a two-step cluster analysis to reveal community phenotypes, and the resulting clusters were compared to each other and to demographic factors. The cluster analysis resulted in five phenotypes in Virginia, without any visible correlation to geographic location. Clusters A and C have low to median scores in all five SDH categories, Clusters B and D have different mixes of high and low scores, while Cluster E has generally high performance across all SDH categories. The clusters were found to be significantly different from each other based on SDH and demographic factors including age and foreign-born population. We concluded that social determinants of health exert their impact in the context of broader environmental and social factors. Characterizing the relationship between combinations of SDH and health outcomes may be the next step towards encouraging counties with similar profiles to collaborate to augment the influence of these SDH.

HELPR Lab Project Leader(s) - Himika Rahman, Alexandra Pentel 

3. Tipping Point: Medicaid Expansion, Provider Shortages, and ED Utilization

At present, 33 states have expanded their Medicaid programs to cover individuals with incomes up to 138% of the federal poverty level. The states still opposing expansion often cite the risk of increased costs through the program that state budgets cannot bear. Through this project, we investigate the relationship between Medicaid expansion and provider shortages (Both Health Professions Shortage Areas and Medicaid acceptance rates) to increased Emergency Department utilization (and costs). The objective of the project is to identify in which communities does expansion lead to higher costs, and are provider shortages central to the issue?

HELPR Lab Project Leader(s) - Virginia Wright, Jessica Grubbs, Erica Stephens, Julia Gilliam

4. Health Policy Priorities Index

Each year, healthcare remains among the most critical policy issues facing citizens and legislators alike. Despite an abundance of interest, it is difficult to align the current state of issues in healthcare cost, quality and access locally with the most advantageous policy interventions. Through the development of the Health Policy Priorities Index we will be compiling data on the current state of healthcare by zip code and county to help prioritize key health policy strategies to serve constituents. This project will look at health policy issues that can be quantified such as but not limited to uninsured rates, out of pocket healthcare spending per capita, healthcare utilization, number of primary care physicians, health insurance premium rates and other factors. 

HELPR Lab Project Leader(s) - Joseph Leonard, Maitri Patel 

5. Requirements and Risk: Virginia Medicaid Work Requirements Modeling

Virginia’s Medicaid expansion was signed into law in June, but it came at a political cost. The imposition of work requirements for Medicaid beneficiaries was the only way to ensure the necessary votes to expand Medicaid to up to 400,000 Virginians. As the Department of Medical Assistance Services (DMAS) prepares to design the Training, Education, Employment and Opportunity Program (TEEOP), this study will model out the populations most at-risk of losing Medicaid coverage in the setting of new work requirements, to assist the Department in planning to avoid this negative impact.

Collaborator(s) -  Department of Medical Assistance Services (DMAS)

HELPR Lab Project Leader(s) - John Han