Research Methods: Policy Analysis

Adults with Intellectual Disability or Autism Spectrum Disorder. Executive Summary

Abstract: 

Adults with intellectual disability or autism spectrum disorder (ID/ASD) have a variety needs for long term services supports to enable them to live as independently as possible. In Maine, the Office of Aging and Disability Services/Developmental Services provides a wide array of services to adults with ID/ASD, the majority of which are funded through MaineCare. This Chartbook describes Maine’s historical trends in meeting the needs of adults with ID/ASD through institutional and community based services in comparison to other states; a detailed analysis of the population’s utilization of different types of services and their costs in SFY 2010; an analysis of the utilization and cost of services for adults with ID/ASD who were on the waitlists for home and community based waivers services in SFY 2013; the implementation of the Supports Intensity Scale (SIS) as a means of identifying the supports needs of the adults with ID/ASD; and the complement of providers serving this population in Maine.

This Chartbook is unique in its detailing of the service and costs of adults with intellectual disability or austim spectrum disorder (ID/ASD) in Maine. The Chartbook focuses on adults with ID/ASD who are eligible only for MaineCare (Maine's Medicaid system) or who are dually eligible for MaineCare and Medicare.

The Executive Summary provides key findings in the areas of:

  • Historical Trends
  • Claims Analysis of Dually Eligible and MainCare-only Eligible Adults with ID/ASD in 2010
  • MaineCare Claims Analysis of Members on the HCBS Waitlists, SFY 2013
  • Quality Measures, SFY 2010
  • Supports Intensity Scale, 2013
  • ID/ASD Providers in Maine Compared to the Nation, 2005-2010

Click here for the Executive Summary.

Click here for the Executive Summary with Charts. 

Click here for the full Chartbook.

Suggested Citations: Snow KI, Bratesman S, Bowe T, Fralich J. Adults with Intellectual Disability or Autism Spectrum Disorder: Population and Service Use Trends in Maine, 2014 Edition. (Executive Summary). Portland, ME: University of Southern Maine, Muskie School of Public Service;2014.

Snow KI, Bratesman S, Bowe T, Fralich J. Adults with Intellectual Disability or Autism Spectrum Disorder: Population and Service Use Trends in Maine, 2014 Edition. (Chartbook). Portland, ME: University of Southern Maine, Muskie School of Public Service;2014.

Prepared for the Office of Aging and Disability Services, Maine Department of Health and Human Services by the Muskie School of Public Service, University of Southern Maine.

Publication Type: 
Report
Publish Date: 
December 1, 2014
URL: 
http://muskie.usm.maine.edu/Publications/DA/Exec-Sum-Charts-Adults-with-Intellectual-Disability-or-Autism-Maine-2014.pdf

Profile of Rural Residential Care Facilities: A Chartbook

Abstract: 

As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook from the Maine Rural Health Research Center presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF).  Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents.  Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs.  Compared to urban facilities, the policies of rural RCFs appear less likely to support aging in place.

Suggested Citation: Lenardson JD, Griffin E, Croll Z, Ziller EC, Coburn AF. Profile of Rural Residential Care Facilities: A Chartbook. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2014.

Publication Type: 
Report
Publish Date: 
May 20, 2014
URL: 
http://muskie.usm.maine.edu/Publications/rural/Chartbook-Rural-Res-Care-Facilities.pdf

Rural Residents More Likely to be Enrolled in High Deductible Health Plans

Abstract: 

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.

Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.

Full report (Working Paper): High Deductible Health Insurance Plans in Rural Areas

Suggested Citation: Lenardson JD, Ziller EC, Coburn AF. Rural Residents More Likely to Be Enrolled in High Deductible Health Plans. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2014. Research & Policy Brief PB-55.

Publication Type: 
Research and Policy Brief
Publish Date: 
May 13, 2014
URL: 
http://muskie.usm.maine.edu/Publications/rural/PB55-High-Deductible-Health-Plans-Rural.pdf

High Deductible Health Insurance Plans in Rural Areas

Abstract: 

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.

Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.

Associated Research & Policy Brief: Rural Residents More Likely to be Enrolled in High Deductible Health Plans

Suggested Citation: Lenardson JD, Ziller EC, Coburn AF. High Deductible Health Insurance Plans in Rural Areas. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2014. Working Paper #55.

Publication Type: 
Report
Publish Date: 
May 13, 2014
URL: 
http://muskie.usm.maine.edu/Publications/rural/High-Deductible-Insurance-Plans-Rural.pdf

Dementia in Maine: Characteristics, Care, and Cost Across Settings [CHARTBOOK]

Abstract: 

The World Health Organization and Alzheimer’s Disease International have recommended that dementia be considered a public health priority for all nations. The number of people with Alzheimer’s disease in Maine is expected to nearly double from about 26,000 persons in 2010 to nearly 50,000 by 2030. As the oldest state in the nation, Maine faces the impending impact of this disease on its social systems, community resources and its health and long term care systems.  In particular, service and use patterns highlighted in this report indicate that Maine’s long term care system is increasingly becoming a system of care for people with dementia.

This report provides a baseline picture of the current use of services by people with and without dementia in Maine. While this provides a comprehensive view of those accessing services through state funded home care programs or other MaineCare funded long term care services, it does not include the costs of informal care by caregivers, friends and family members. Nor does it include the out-of-pocket costs that many incur with private resources to care for a family member. We hope, however, that this information will be useful to those who are planning for the future of Maine’s long term care system and the needs of people with dementia and their families and caregivers.

Suggested Citation: Fralich J, Bratesman S, Olsen L, et al. Dementia in Maine: Characteristics, Care, and Cost Across Settings. Portland, ME: University of Southern Maine, Muskie School of Public Service; December, 2013.

For more information contact: Julie Fralich Julief@usm.maine.edu; 207-780-4848; Stuart Bratesman sbrates@usm.maine.edu; or  Louise Olsen louiseo@usm.maine.edu

This report was prepared under a Cooperative Agreement between the Muskie School of Public Service, University of Southern Maine and the Maine Department of Health and Human Services, Office of Aging and Disability Services.  This work was funded under Cooperative Agreement number CA-ES-13-251.

Publication Type: 
Report
Publish Date: 
December 31, 2013
URL: 
http://muskie.usm.maine.edu/Publications/DA/Dementia-Maine-Chartbook-2013.pdf

Telemental Health in Today's Rural Health System

Abstract: 

Telemental health has long been promoted in rural areas to address chronic access barriers to mental health care. While support and enthusiasm for telemental health in rural areas remains quite high, we lack a clear picture of the reality of telemental health in rural areas, compared to its promise. This Research & Policy Brief reports on the first part of our study—the online survey of 53 telemental health programs—and describes the organizational setting, services provided, and the staff mix of these programs. We draw from our telephone interviews with 23 of these programs to help describe the organizational context of telemental health programs. 

Key Findings:

  • The scope and volume of services provided are often modest suggesting that the business case for these programs may be weaker than the clinical case.
  • The programs in our study were able to secure funding and other supports to implement services, but their ability to maintain and expand services to address unmet need is less certain.
  • Telemental health primarily addresses issues related to the distribution of providers and travel distances to care. However, there are underlying practice management issues, common to all mental health practices in rural areas, which pose challenges to the scope and sustainability of telemental health, including reimbursement, provider recruitment and retention, practice economies of scale, high rates of uninsurance, and high patient “no show” rates.
  • It is becoming increasingly apparent that telehealth technology, by itself, cannot overcome service delivery challenges without underlying reform to the mental health service system.

Suggested Citation:

Lambert, D., Gale, J., Hansen, A. Y., Croll, Z., & Hartley, D. (2013). Telemental health in today's rural health system. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center.

 

Publication Type: 
Research and Policy Brief
Publish Date: 
December 18, 2013
URL: 
http://muskie.usm.maine.edu/Publications/MRHRC/Telemental-Health-Rural.pdf

Advancing the Use of CBT with Justice-Involved Women

Abstract: 

Forensic CBT: A Handbook for Clinical Practice is an edited collection that represents the first authoritative resource on the utilization of Cognigive Behavioral Therapy (CBT) strategies and techniques for offender clients.

Erica King, Policy Associate at the USM Muskie School of Public Services is co-author with Dr. Marilyn Van Dieten on chapter 16 in Part III of the book, Tailoring CBT to Special Forensic Populations, which looks at cognitive behavioral therapy for justice-involved women.  The authors highlight the differential needs of justice-involved women and discuss how to conduct gener-responsive treatment.

The book features contributions from leaders of the major schools of CBT on the treatment of antisocial personality patterns as well as anger, interpersonal violence, substance abuse, and sexual aggression; Addresses modified CBT approaches for female, juvenile, and culturally diverse forensic populations; Covers emerging areas of forensic practices, including the integration of motivational interviewing and strength-based approaches; and Includes an assortment of worksheets, handouts, and exercises for practitioners to use with their clients.

Suggested Citation:

Van Dieten, M., & King, E. (2013). Advancing the use of CBT with justice-involved women. In R. C. Tafrate & D. Mitchell (Eds.), Forensic CBT: A handbook for clinical practice (pp. 329-353). Hoboken, NJ: Wiley-Blackwell.

Publication Type: 
Book Chapter
Publish Date: 
November 1, 2013
Author: 
URL: 
http://www.wiley.com/WileyCDA/WileyTitle/productCd-1119953286.html

Managing a High-Performance Medicaid Program

Abstract: 

This report discusses key responsibilities that the federal government and states hold for managing the Medicaid program and identifies the key issues and challenges states face as they transform the way they do business and achieve key national goals.  The paper relies on an extensive review of federal and state administrative responsibilities drawn from statute, regulation, and relevant literature, coupled with discussions with six current Medicaid directors.

Key Findings:

  • Federal and state governments share responsibility for administering Medicaid;
  • Medicaid's responsibilities go significantly beyond those of other insurers and programs;
  • Medicaid is evolving and faces a set of new opportunities and challenges;
  • Adequate administrative capacity is key to realizing the goal of running a high performing Medicaid program.

Suggested Citation:

Griffin E, Riley T, Wachino V, Rudowitz R. Managing a High-Performance Medicaid Program. Menlo Park, CA: Kaiser Commission on Medicaid and the Uninsured; October, 2013.

Publication Type: 
Report
Publish Date: 
October 21, 2013
URL: 
http://kaiserfamilyfoundation.files.wordpress.com/2013/10/8476-managing-a-high-performance-medicaid-program.pdf

Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences?

Abstract: 

Adolescent alcohol use is a significant public health problem among U.S. adolescents. Past studies, including our own work, have found that rural adolescents were more likely to use alcohol than urban adolescents. Research suggests that protective factors, such as peer and parental disapproval, may be weaker among youth living in rural areas. This study examines the factors associated with adolescent alcohol use, whether they differ between rural and urban populations, and the extent to which these differences account for rural-urban variations in adolescent alcohol use. This knowledge is crucial to the development of rural-specific prevention strategies, targeted research on rural adolescent alcohol use, and long-term policy interventions. Our findings confirm higher rates of binge drinking and driving under the influence among rural youth than among urban youth. Rural residence is associated with increased odds of binge drinking (OR 1.16, p< .05) and driving under the influence (OR 1.42, p< .001) even when income and protective factors are taken into account. Our findings suggest that adolescents who start drinking at an earlier age are more likely to engage in problem drinking behavior as they get older, leading to a need for interventions that target pre-teens and younger adolescents. Moreover, since we found urban-rural differences in specific protective factors, these may be the most promising for evidence-based, rural-specific prevention strategies targeting parents, schools, and churches. These are the factors that convey and reinforce consistent messages discouraging adolescent alcohol use from an early age.

Suggested Citation:

Gale JA, Lenardson JD, Lambert D, Hartley, D.  Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences. (Working Paper #48).  Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; March 2012.

Publication Type: 
Working Paper
Publish Date: 
March 1, 2012
URL: 
http://muskie.usm.maine.edu/Publications/WP48_Adolescent-Alcohol-Use-Rural-Urban.pdf

Understanding Changes to Physician Practice Arrangements in Maine and New Hampshire

Abstract: 

This report examines trends in the organization and ownership of physician practices in Maine and New Hampshire. The Maine Office of MaineCare Services and the New Hampshire Office of Medicaid Business and Policy observed a trend in the conversion of physicians from private practice to other practice arrangements including Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), hospital-owned practices, and hospital outpatient departments. Faced with increased costs for care provided within these facilities, both Medicaid programs sought to understand more about these changes, including their magnitude, the forces driving them, and their short and longer-term implications.

Suggested Citation:

Lenardson J, McGuire C, Alfreds S, et al.  Understanding Changes to Physician Practice Arrangements in Maine and New Hampshire. Portland, ME: University of Southern Maine, Muskie School of Public Service, Institute for Health Policy; January 2008.

Publication Type: 
Report
Publish Date: 
January 31, 2008
URL: 
http://muskie.usm.maine.edu/Publications/ihp/PhysicanPracticeChanges.pdf

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