Research Roundup: Work Requirements; Emergency Department Denials; Children’s Homelessness

Commonwealth Fund: Work Requirements And Insurance Coverage In Kentucky Medicaid
Adding a new administrative hurdle in the form of work requirements in Kentucky would double the number of enrollees who disenroll from the program over a two-year period. We estimate that as many as 118,000 adults enrolled in Medicaid would either become uninsured for an extended period of time or experience a gap in insurance over a two-year period. These findings should be of concern to policymakers: research has found that adults who experience coverage gaps report problems getting health care or paying medical bills at rates nearly as high as those who are uninsured continuously. (Collins, Glied and Jackson, 10/22)

JAMA Internal Medicine: Analysis Of A Commercial Insurance Policy To Deny Coverage For Emergency Department Visits With Nonemergent Diagnoses
If commercial insurers retrospectively deny coverage for emergency department (ED) visits based on diagnoses determined to be nonemergent, what visits will be denied coverage? Findings: This cross-sectional study found that 1 insurer’s list of nonemergent diagnoses would classify 15.7% of commercially insured adult ED visits for possible coverage denial. However, these visits shared the same presenting symptoms as 87.9% of ED visits, of which 65.1% received emergency-level services. Meaning: A retrospective diagnosis-based policy is not associated with accurate identification of unnecessary ED visits and could put many commercially insured patients at risk of coverage denial. (Chou et al., 10/19)

Urban Institute: Rapid Re-Housing Can Help End Children’s Homelessness
What is it like to sleep squeezed in the backseat of a car? What is it like for a 4-year-old? Darlene, a mom who has spent many months homeless, told me about her experience living in a car with her 4-year-old son. Each night, they would drive around San Francisco looking for places to park—places where they would go unnoticed but that weren’t so isolated that they would be at risk of harm. Sometimes, when they could afford to, they stayed in cheap motels. But most nights, they had to sleep in the car. (Cunningham, 10/16)

Health Affairs: Provider Payments And The Receipt Of Human Papillomavirus Vaccine Among Privately Insured Adolescents
Financial concerns such as high vaccine purchase costs and inadequate insurance reimbursement are cited as a key barrier to human papillomavirus (HPV) vaccination of adolescents who are covered by private health insurance. Statistical evidence on the relationship between payments to providers for HPV vaccination and HPV vaccine uptake is limited. This study used data for 2008–14 from the MarketScan Commercial Claims and Encounters database and included adolescents ages 11–17 who had been continuously enrolled in the same noncapitated private insurance plan. Our estimates showed that a $1 increase in median provider payments in a state was associated with a 0.48-percentage-point increase in the probability of initiating the HPV vaccine series and a 0.25-percentage-point increase in the probability of receiving two or more doses. These numbers translated to an average increase of 49,435 adolescents initiating the series and 25,314 adolescents receiving two or more doses. The association between provider payments and HPV vaccine uptake was stronger among adolescents ages 11–12 than among older adolescents, and among adolescents who lived in a Metropolitan Statistical Area than those who did not. (Tsai et al, 10/1)

JAMA Internal Medicine: Effect Of Community Health Worker Support On Clinical Outcomes Of Low-Income Patients Across Primary Care Facilities: A Randomized Clinical Trial
Question: Is a standardized intervention delivered by community health workers effective for improving clinical outcomes across a Veterans Affairs medical center, a federally qualified health center, and an academic family practice clinic? Findings: In this multicenter randomized clinical trial of 592 adults, self-rated health was similar among the intervention and control groups, but the patients in the intervention group were more likely to report high-quality primary care and a reduction in total hospital days. (Kangovi et al, 10/22)

JAMA Internal Medicine: Association Of Frequency Of Organic Food Consumption With Cancer Risk: Findings From The NutriNet-Santé Prospective Cohort Study
In a population-based cohort study of 68 946 French adults, a significant reduction in the risk of cancer was observed among high consumers of organic food. ... A higher frequency of organic food consumption was associated with a reduced risk of cancer; if the findings are confirmed, promoting organic food consumption in the general population could be a promising preventive strategy against cancer. (Baudry et al, 10/22)

The Henry J. Kaiser Family Foundation: Medicaid Enrollment & Spending Growth: FY 2018 & 2019
A stronger economy was a primary factor driving lower Medicaid enrollment growth and relatively steady spending growth as states finished state fiscal year (FY) 2018 and adopted budgets for FY 2019. This brief analyzes Medicaid enrollment and spending trends for FY 2018 and FY 2019 based on interviews and data provided by state Medicaid directors as part of the 18th annual survey of Medicaid directors in all 50 states and the District of Columbia. The methodology used to calculate enrollment and spending growth as well as additional information about Medicaid financing can be found at the end of the brief. Key findings are described below and in a companion report. (Rudowitz, Hinton and Antonisse, 10/25)