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The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
October 10, 2019
WASHINGTON, D.C. (Oct. 17, 2019) — Most states that transition to block grant funding for Medicaid – in which the federal government provides a fixed annual sum – would see lower revenue for their community health centers that care for Medicaid beneficiaries and other residents. Under a block grant, total health center revenues generated by the Medicaid expansion population would drop 92 percent and 58 percent for traditional enrollees by 2024, according to a study published today in the Milbank Quarterly.
In non-expansion states, block grants would reduce health center revenues for traditional Medicaid enrollees by 38 percent. The percentage drop is higher for expansion populations because the federal government has covered 100 percent of the cost of the expansion population since the expansion went into effect in 2014 and its share will dip to 90 percent starting in 2020.
Anne Rossier Markus, PhD, MHS, JD, an associate professor of health policy and management at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University, found that another fixed-funding approach, per-capita caps, which limit average spending per person, would decrease health center revenues from the expansion population by 78 percent, and by 3 percent for traditional Medicaid enrollees. In non-expansion states, the per-capita cap would reduce health center revenues generated by traditional Medicaid enrollees by 2 percent.
Accounting for inflation of medical costs and applying federal contributions to each state using 2016 expenditures as the baseline, Markus and her colleagues at Milken Institute SPH found that both approaches would lead to diminished capacity at health centers in most states unless states are able to offset the financial shortfalls. Projected health center revenue reductions vary by state, but the study shows that either a block grant or per-capita caps would have very similar effects on individual states.
“When we assumed no cuts in Medicaid enrollment but some adjustments in scope of benefits, projected losses in revenues by 2024 amounted to over $7 billion under a block grant scenario and close to $6 billion under a per-capita scenario,” Markus said. “So both approaches would be devastating for health centers and their ability to maintain their current level of medical service to the community.”
The current administration has encouraged states to submit block grant waivers to the Centers for Medicare and Medicaid Services, and in 2017, Congress considered block grants and per-capita cap proposals as a way to reduce federal Medicaid expenditures. Last month, Tennessee made public its plan to convert federal financing for its Medicaid program to a “hybrid” block grant in which funding would be adjusted upward if enrollment grows.
The Milken Institute SPH researchers used a mixed-methods approach to 1) test a model simulating the effect of block grants and per-capita caps on health centers’ total revenues and general service capacity, and 2) use information collected from official Medicaid documents and interviews with health center leadership staff.
The study, “Predicting the Impact of Transforming the Medicaid Program on Health Centers’ Revenues and Capacity to Serve Medically Underserved Communities,” was published Oct. 17 in the Milbank Quarterly.
December 11, 2017
Very little population-based research has examined health and access to care among transgender populations. In a new study in the December 2017 issue of The Milbank Quarterly, researchers who compared barriers to care between cisgender, transgender, and gender nonconforming adults found that transgender and gender nonconforming adults experience barriers to health care for a variety of reasons, including discrimination and lack of awareness among health care providers on transgender-related health issues.
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How is it that Medicaid has become a major point of contention during the intensive efforts by Republican leaders to repeal and replace the Affordable Care Act? Studies of Medicaid’s policy evolution over time note its surprising resilience to retrenchment. The surprise is based on its origins and the fact that most means-tested programs in the United States are stigmatizing. However, Medicaid has expanded dramatically over the years. Today, over 60% of Americans are connected to the program. This raises a crucial question: has Medicaid pivoted closer to politics resembling a middle-class entitlement program? If so, Medicaid would no longer be stigmatized, and, regardless of political partisanship, people connected to the program would fight to protect its benefits. In a new study in the December issue of The Milbank Quarterly, researchers examined these questions.
September 12, 2017
Promoting healthy food choices is a critical component of any public health strategy designed to reduce the risk of nutrition-related chronic diseases. Nutrition labels are one tool that support consumers in making sound choices. But to what extent do consumers respond to labelling, in particular, to a simple, standardized on-shelf nutrition labelling system in supermarkets? A new study in The Milbank Quarterly has found that the use of a simple, at-a-glance nutritional summary of the product that is located on retail shelf tags in supermarkets resulted in small but significant shifts towards consumers purchasing food with higher nutritional ratings.
Medical software has become an increasingly critical component of health care, with the hacking of medical devices a growing concern. And yet the regulatory landscape for digital health is inconsistent and controversial. In a new study in The Milbank Quarterly, Jay G. Ronquillo of Western Michigan University Homer Stryker M.D. School of Medicine and Diana M. Zuckerman of the National Center for Health Research have found that software problems in medical devices are not rare and have the potential to negatively influence medical care.
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