Health Services Access, Quality, and Financing

Examining MaineCare’s Coverage Options Under the Affordable Care Act

Abstract: 

This Brief was prepared by Erika Ziller and Trish Riley of the Muskie School of Public Service to inform an April 8, 2013 colloquium convened to explore options and implications of the Affordable Care Act (ACA) for Maine.

Highlights: In addition to increased Medicaid funding, in January 2014, the ACA will provide federally subsidized health care coverage for individuals with incomes up to 400% for Medicaid in a state, coverage will be subsidized by federally funded tax credits through health insurance exchanges, now known as the “Marketplace.” Those under 100% FPL are not eligible for Marketplace subsidies but could be eligible for Medicaid, depending upon state decisions.

Even if Maine does not choose to cover all those newly eligible under the ACA, beginning in 2014, MaineCare must extend eligibility for children aging out of foster care until they are 26, regardless of income. An estimated 46,000 uninsured individuals, nearly all of whom will be adults without children, would be newly eligible for Medicaid should Maine decide to participate in the ACA optional Medicaid coverage.

If Maine chooses not to participate in the ACA optional Medicaid program, the 14,000 uninsured childless adults with incomes between 100% and 138% FPL referenced above would be eligible to participate in subsidized coverage through the federal Marketplace, although there is disagreement over the affordability of these plans for this group. The 32,000 uninsured childless adults with incomes below 100% FPL would be ineligible for any subsidy through the Marketplace.

Continued coverage for currently eligible populations in Maine is uncertain. Maine must comply with a significant number of ACA provisions related MaineCare. These new requirements must be in place in all states, whether or not states extend eligibility in the Medicaid program or operate a health insurance Marketplace.

Publication Type: 
Research and Policy Brief
Publish Date: 
March 20, 2013
Author: 
URL: 
http://muskie.usm.maine.edu/Publications/HealthPolicy/Brief-Examining-MaineCares-Coverage-Options-Under-the-Affordable-Care-Act.pdf

Federal Health Care Reform: An Overview [Policy Brief]

Abstract: 

This policy brief discusses three of the main components of the Patient Protection and Affordable Care Act (ACA), also known as "Obamacare".  These components are health insurance coverage, delivery system improvement, and cost containment.  The policy brief highlights some of the provision of the law that have already been implemented and those where importnat implementation decisions will have to be made.  The brief is authored by Dr. Andrew Coburn, PhD, Professor of Public Health and Director of the Population Health and Health Policy program at the USM Muskie School, and was presented at the Maine Policy Leaders Academy Health Care Forum breakfast session, Feb. 26, 2013 at the Senator Inn in Augusta,sponsored by the Maine Health Access Foundation.

For more information, please direct questions and comments to coburn@maine.edu

Publication Type: 
Research and Policy Brief
Publish Date: 
February 26, 2013
URL: 
http://muskie.usm.maine.edu/Publications/PHHP/Federal-Health-Care-Reform-Overview2013.pdf

Behavioral Risk Factor Surveillance System (BRFSS) Data Management & Analysis 2012-2013

Duration: 
10/1/2012 - 9/30/2013
Collaborators: 
Maine CDC
Abstract: 

Behavioral Risk Factor Surveillance System is one of Maine’s standard health behavior surveillance systems, data from which informs policy development, program planning, and other public health interventions for chronic disease prevention. This project will assist the Maine BRFSS coordinator and the Maine CDC to achieve BRFSS objectives. Muskie School staff will update the BRFSS interactive web query as well as maintain multiple-year standardized datasets, add the most recent year of data, and update documentation. Muskie staff will also perform other analyses as necessary, including multivariate and trend analyses to help the Maine CDC better understand prevalence, risk factors and disease management for health behaviors and conditions (such as diabetes, asthma, and cardiovascular disease) that impose a heavy burden on the residents of Maine and its health care system.

Start Date: 
Mon, 2012-10-01
End Date: 
Mon, 2013-09-30
Legacy Muskie ID: 
8003

Rural Implementation and Impact of Medicaid Expansions

Duration: 
7/1/2012 - 6/30/2013
Director: 
Erika Ziller
Principal Investigator: 
Andrew Coburn
Erika Ziller
Research Staff: 
Andrew Coburn
Erika Ziller
Jennifer Lenardson, MHS
Zachariah Croll
Abstract: 

A project funded by State Health Access Reform Evaluation (SHARE) to inform federal and state implementation of the Medicaid expansions under the ACA by estimating the size and characteristics of rural residents likely to be newly eligible. The study will provide nationally representative information that identifies the extent to which rural residents live in states that have already expanded coverage to low-income adults; how many eligible individuals have participated; the characteristics of the remaining pool of the rural uninsured; and the potential impact of Medicaid expansions on rural primary care and delivery system capacity.

Start Date: 
Sun, 2012-07-01
End Date: 
Sun, 2013-06-30
Legacy Muskie ID: 
0

Maine Patient Centered Medical Home (PCMH) Pilot: Implementation Evaluation

Unpublished
Abstract: 

The purpose of this Maine Patient Centered Medical Home (PCMH) Pilot is to improve quality of care, efficiency, and patient/family satisfaction provided by primary care practices. Its premise is that the resources provided to practices through the Pilot (including enhanced payments, training, consultation, and learning collaborative) will help them transform themselves and reach a higher level of functionality as medical homes, which in turn will lead to improvements in quality of care, efficiency, and patient/family satisfaction. The three-year Pilot was convened by MaineCare, the Maine Quality Forum, and Quality Counts. The participating payers are MaineCare (Maine Medicaid), Aetna, Anthem, and Harvard Pilgrim Health Care. Three aspects of the Pilot are being evaluated by the Muskie School of Public Service: 1) patient’s experiences; 2) the implementation process and interim results during Year 1; and 3) changes in the quality and efficiency of primary care. This report focuses on findings from the implementation evaluation. The objectives of the implementation evaluation are to
• Profile the characteristics of the Pilot practices
• Describe the practices’ objectives and strategies for implementing the Pilot
• Describe the implementation process during Year 1
• Provide practical guidance to the practices, the Pilot conveners, and MaineCare
• Develop profiles of the Pilot practices for use in the quality and efficiency evaluation
• Make recommendations for use by evaluators of other PCMH pilots

Publication Type: 
Report
Publish Date: 
May 4, 2011
Author: 
URL: 
http://muskie.usm.maine.edu/Publications/Maine-PCMH-Implementation-Evaluation.pdf

Use of Critical Access Hospital Emergency Rooms by Patients with Mental Health Symptoms

Unpublished
Abstract: 

Background: National data demonstrate that mental health visits to the emergency room (ER) comprise a small, but not inconsequential, proportion of all visits; however, we lack a rural picture this issue. Purpose: This study investigates the use of Critical Access Hospital (CAH) ERs by patients with mental health problems to understand the role these facilities play in rural mental health needs, and the challenges they face. Methods: We collected primary data through the combination of a telephone survey and ER visit logs. Our sampling frame was the universe of CAHs at the time the survey was fielded.

Key Findings: 43% of CAHs surveyed operate in communities with no mental health services, while 9.4% of all logged visits were by patients identified as having some type of mental health problem. The most common problems identified were substance abuse, anxiety and psychotic disorders. Only 32% of CAHs have access to onsite detoxification and 2% have inpatient psychiatric services, meaning that patients in need of these services typically must leave their communities to gain treatment. Conclusions: The lack of community resources may impact CAHs ability to assist patients with mental health problems. Among those with a primary mental health condition 21% left the ER with no or unknown treatment, as did 51% of patients whose mental health condition was secondary to their emergent problem. Patients in need of detoxification or inpatient psychiatric services often must travel over an hour to obtain these services, potentially creating significant issues for themselves and their families.

Suggested Citation: Hartley D, Ziller E, Loux S, Gale J, Lambert D, Yousefian AE. Use of Critical Access Hospital Emergency Rooms by Patients with Mental Health Symptoms. J Rural Health. 2007;23(2):108-115.

Publication Type: 
Journal Article
Publish Date: 
September 1, 2005

Quality Indicators for Home and Community-based Services

Unpublished
Abstract: 

This report includes a final list of recommended core quality measures for use in assessing the quality of home and community-based services (HCBS) Waiver services. The indicators are organized according to the HCBS Quality Framework, a document developed by the Centers for Medicare & Medicaid (CMS) to provide a common frame of reference for conducting productive dialogue among stakeholders. The report also includes recommendations for implementing the core quality indicators, lessons learned throughout the three-year grant, and a plan for sustaining the work of this grant.

Suggested Citation: Fralich, J., & Bratesman, S. (2004). Quality indicators for home and community-based services. Portland, ME: University of Southern Maine, Edmund S. Muskie School of Public Service.

Publication Type: 
Report
Publish Date: 
November 30, 2004
URL: 
http://nasuad.org/sites/nasuad/files/hcbs/files/71/3548/HCBS_Quality_Report_final.pdf

Pages

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