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Medicaid beneficiaries do not have equal access to high-volume centers for complex surgical procedures. We hypothesize there is a large Medicaid Gap between those receiving emergency general vs complex surgery at the same hospital. Using the Nationwide Inpatient Sample, 1998 to 2010, we identified high-volume pancreatectomy hospitals. We then compared the percentage of Medicaid patients receiving appendectomies vs pancreatectomies at these hospitals. Hospital characteristics associated with increased Medicaid Gap were evaluated using generalized estimating equation models. A total of 602 hospital-years of data from 289 high-volume pancreatectomy hospitals were included. Median percentages of Medicaid appendectomies and pancreatectomies were 12.1% (interquartile range: 5.8% to 19.8%) and 6.7% (interquartile range: 0% to 15.4%), respectively. Hospitals that performed greater than or equal to 40 pancreatic resections per year had higher odds of having significant Medicaid Gap (odds ratio 2.3, 95% confidence interval 1.1 to 5.0). Gaps exist between the percentages of Medicaid patients receiving emergency general surgery vs more complex surgical care at the same hospital and may be exaggerated in hospitals with very high volume of complex elective surgeries.

Dental caries is now considered the most prevalent chronic childhood disease. The majority of studies (Cashion et al., 1999; Griffin et al., 2000) that have examined access to care or use of services focus primarily on individual characteristics such as health insurance, race, and income, but Women, Infants, and Children's (WIC) Supplemental Food Program, Head Start (HS), and other programs like them can work on another level to improve access to dental care for young children. Community program staff are well positioned to identify children at high risk for dental caries and make appropriate referrals for early management. Studies of HS programs also suggest that access to dental care and thus use of dental services is limited, despite the federally mandated HS and Medicaid requirements for dental examinations and treatment.

In response to rising health, economic, and equity burdens of suboptimal nutrition, health care stakeholders are increasingly integrating nutritional supports into health care delivery and financing. In January 2023, federal guidance clarified that states may use \"in lieu of services and settings\" (ILOS) authority to address health-related social needs, including nutrition, in Medicaid managed care. However, few data are available regarding ILOS implementation. This analysis reviewed ILOS policies based on managed care documents from forty states as of October 1, 2024. Thirty-five states have authorized ILOS to address behavioral health, and fourteen states have authorized ILOS to address general medical needs. Twelve states use ILOS to address health-related social needs; of these, only ten address nutrition. In addition, fewer than half of the forty states provide robust guidance regarding evaluation or establishment of new ILOSs. We examine the policy implications of these findings and provide recommendations to strengthen the role of ILOS in improving nutrition, health care costs, and health equity.

In 2019, as in prior years, Medicaid physician fees remained well below Medicare and private insurance fees despite growth in Medicaid enrollment. Low Medicaid physician fees have important implications in terms of access to care for Medicaid enrollees and the effects of proposals to expand coverage through a Medicaid buy-in program or a Medicaid-like public option. Medicaid enrollment has grown substantially under the Affordable Care Act (ACA)1 and will likely increase further as a result of coronavirus disease 2019 (COVID-19)-related job losses. Policy makers have also proposed expanding health insurance coverage through a Medicaid buy-in program or a Medicaid-like public option. The costs of these proposals and their effects on enrollees depend, in part, on physician fees paid under the new coverage.5 Prior research shows that private insurance physician fees greatly exceed those in Medicare, whereas Medicaid physician fees have historically been far below those in Medicare. Low physician fees in Medicaid may limit physician participation in the program, reducing access to care for enrollees. This article updates previous studies of Medicaid physician fees8-10 to assess how Medicaid fees compared with Medicare fees in 2019 across states and service types.We find that the Medicaid-to-Medicare physician fee index was similar in 2008,2012, and 2019 (exhibit 1), despite large increases in Medicaid enrollment (data not shown). This index was not significantly associated with state Medicaid expansion decisions.In what is known as the \"primary care fee bump,\" the ACA increased Medicaid primary care physician fees to Medicare levels in 2013 and 2014. The fee bump expired in 2015, but some states fully or partially continued it with state funds.10 Given such attempts to address long-standing concerns that low Medicaid physician fees may impede enrollees' access to care, our analysis aims to provide a baseline for evaluating the effects of increasing Medicaid enrollment or coverage expansions.

Medicare Advantage payment regulations include risk-adjusted capitated reimbursement, which was implemented to discourage favorable risk selection and encourage the retention of members who incur high costs. However, the extent to which risk-adjusted capitation has succeeded is not clear, especially for members using high-cost services not previously considered in assessments of risk selection. We examined the rates at which participants who used three high-cost services switched between Medicare Advantage and traditional Medicare. We found that the switching rate from 2010 to 2011 away from Medicare Advantage and to traditional Medicare exceeded the switching rate in the opposite direction for participants who used long-term nursing home care (17 percent versus 3 percent), short-term nursing home care (9 percent versus 4 percent), and home health care (8 percent versus 3 percent). These results were magnified among people who were enrolled in both Medicare and Medicaid. Our findings raise questions about the role of Medicare Advantage plans in serving high-cost patients with complex care needs, who account for a disproportionately high amount of total health care spending.