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The SSRC Library allows visitors to access materials related to self-sufficiency programs, practice and research. Visitors can view common search terms, conduct a keyword search or create a custom search using any combination of the filters at the left side of this page. To conduct a keyword search, type a term or combination of terms into the search box below, select whether you want to search the exact phrase or the words in any order, and click on the blue button to the right of the search box to view relevant results.

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  • Individual Author: Kenney, Genevieve M.; Ruhter, Joel; Selden, Thomas M.
    Reference Type: Journal Article
    Year: 2009

    The current health reform debate is greatly concerned with “bending the curve” of cost growth and containing costs, particularly in public programs. Our research demonstrates that spending in Medicaid and the Children’s Health Insurance Program (CHIP) is highly concentrated, particularly among children with chronic health problems. Ten percent of enrollees (two-thirds of whom have a chronic condition) account for 72 percent of the spending; 30 percent of enrolled children receive little or no care. These results highlight the importance of cost containment strategies that reduce avoidable hospitalizations among children with chronic problems and policies that increase preventive care, particularly among African American children. (author abstract)

    The current health reform debate is greatly concerned with “bending the curve” of cost growth and containing costs, particularly in public programs. Our research demonstrates that spending in Medicaid and the Children’s Health Insurance Program (CHIP) is highly concentrated, particularly among children with chronic health problems. Ten percent of enrollees (two-thirds of whom have a chronic condition) account for 72 percent of the spending; 30 percent of enrolled children receive little or no care. These results highlight the importance of cost containment strategies that reduce avoidable hospitalizations among children with chronic problems and policies that increase preventive care, particularly among African American children. (author abstract)

  • Individual Author: Holahan, John; Ghosh, Arunabh
    Reference Type: Journal Article
    Year: 2005

    Growth in Medicaid spending averaged 10.2 percent per year between 2000 and 2003, resulting in a one-third increase in program spending. Spending growth was lower from 2002 to 2003 because of slower growth in enrollment and in spending per enrollee, particularly for acute care services, and declines in disproportionate-share hospital (DSH) payments and upper payment limit (UPL) programs. For the entire 2000–2003 period, Medicaid spending increases were largely driven by enrollment growth, much of which was attributable to the economic downturn. Increases in spending per enrollee over the period were faster than inflation but slower than increases in private insurance spending.

    Medicaid spending (federal and state) grew by about one-third, from $205.7 billion to $275.5 billion, between fiscal years 2000 and 2003. This explosive growth has caused fiscal problems for state governments faced with depressed revenues. At the federal level, Medicaid spending is potentially a major target in the 2005 budget debate. It is expected that the Bush administration will propose policies...

    Growth in Medicaid spending averaged 10.2 percent per year between 2000 and 2003, resulting in a one-third increase in program spending. Spending growth was lower from 2002 to 2003 because of slower growth in enrollment and in spending per enrollee, particularly for acute care services, and declines in disproportionate-share hospital (DSH) payments and upper payment limit (UPL) programs. For the entire 2000–2003 period, Medicaid spending increases were largely driven by enrollment growth, much of which was attributable to the economic downturn. Increases in spending per enrollee over the period were faster than inflation but slower than increases in private insurance spending.

    Medicaid spending (federal and state) grew by about one-third, from $205.7 billion to $275.5 billion, between fiscal years 2000 and 2003. This explosive growth has caused fiscal problems for state governments faced with depressed revenues. At the federal level, Medicaid spending is potentially a major target in the 2005 budget debate. It is expected that the Bush administration will propose policies to sharply curtail the growth in Medicaid spending. The nation’s governors, in anticipation of federal Medicaid cutbacks, have written to congressional leaders arguing against dramatic action. Efforts to constrain program growth require understanding of the reasons why this growth occurred.

    This paper explores changes that took place during the 2000–2003 period. Over this period spending grew by 10.2 percent annually, with growth in spending on medical services of 11.3 percent. Between 2000 and 2002 Medicaid spending increased at annual rates of 11.8 percent, resulting in an increase in spending of $51.5 billion. Medicaid spending growth slowed from 2002 to 2003, increasing by 7.1 percent or $18.3 billion. The increase for medical services (excluding disproportionate-share hospital [DSH] payments, administrative expenses, and adjustments) alone was 8.2 percent from 2002 to 2003, following annual increases of 12.9 percent in the previous two years. The reduction in spending growth between 2002 and 2003 was attributable to somewhat lower rates of growth in enrollment, in spending per enrollee for most services (primarily nursing home care and prescription drug costs), and in DSH payments. (author abstract)

  • Individual Author: Joseph, Lawrence B.
    Reference Type: Report
    Year: 2004

    Medicaid enrollment trends for low-income children in both Illinois and the U.S. as a whole have been shaped by a series of major policy developments at the national level: federal mandates for gradual expansion of Medicaid coverage to all children in families below the federal poverty line, federal welfare reform legislation “delinking” Medicaid from family income assistance, and the State Children’s Health Insurance Program (SCHIP) giving states new options for extending health care coverage beyond federal mandates. By 2001, the convergence of these policy changes had resulted in a “quiet revolution” in health care coverage for children — a shift from welfare-based to income-based eligibility. Many more children are now eligible for either Medicaid or SCHIP, and the composition of medical assistance caseloads has changed dramatically. This report examines Medicaid enrollment for low-income children, the largest and most “visible” group eligible for Medicaid, in Illinois since 1991 and compares trends in Illinois with nation-wide trends and with those in other states. The...

    Medicaid enrollment trends for low-income children in both Illinois and the U.S. as a whole have been shaped by a series of major policy developments at the national level: federal mandates for gradual expansion of Medicaid coverage to all children in families below the federal poverty line, federal welfare reform legislation “delinking” Medicaid from family income assistance, and the State Children’s Health Insurance Program (SCHIP) giving states new options for extending health care coverage beyond federal mandates. By 2001, the convergence of these policy changes had resulted in a “quiet revolution” in health care coverage for children — a shift from welfare-based to income-based eligibility. Many more children are now eligible for either Medicaid or SCHIP, and the composition of medical assistance caseloads has changed dramatically. This report examines Medicaid enrollment for low-income children, the largest and most “visible” group eligible for Medicaid, in Illinois since 1991 and compares trends in Illinois with nation-wide trends and with those in other states. The comparative analysis, based on data from the federal Centers for Medicare and Medicaid Services, involves five other midwestern states and five states with the largest Medicaid programs. The report indicates that Illinois has not typically been at the forefront in moving beyond minimum federal mandates, but the state has made considerable progress in expanding eligibility for children in low-income families, especially in the past several years. The state also faces some ongoing policy challenges, which include reducing disparities in coverage of children and parents and closing the gap between eligibility and actual enrollment. (author abstract)

  • Individual Author: Quint, Janet; Widom, Rebecca; Moore, Lindsay
    Reference Type: Report
    Year: 2001

    Medicaid and food stamps are important potential sources of support for low-wage workers, including those who have recently received Temporary Assistance for Needy Families (TANF) welfare. Yet many former welfare recipients are not getting these benefits, despite the fact that the vast majority of TANF recipients who find employment are eligible for transitional Medicaid and that, depending on their income, they may be eligible for food stamps as well. While many explanations for declines in the Medicaid and food stamp rolls have been offered, this report focuses on what happens in welfare offices as eligibility workers put policies into practice and interact with agency clients. This report is part of the Project on Devolution and Urban Change (“Urban Change” for short), which is being undertaken by the Manpower Demonstration Research Corporation (MDRC). The report is based on research conducted in early 2000 in welfare offices located in the four large urban counties participating in the project: Cuyahoga County (Cleveland, Ohio); Los Angeles County (California); Miami-Dade...

    Medicaid and food stamps are important potential sources of support for low-wage workers, including those who have recently received Temporary Assistance for Needy Families (TANF) welfare. Yet many former welfare recipients are not getting these benefits, despite the fact that the vast majority of TANF recipients who find employment are eligible for transitional Medicaid and that, depending on their income, they may be eligible for food stamps as well. While many explanations for declines in the Medicaid and food stamp rolls have been offered, this report focuses on what happens in welfare offices as eligibility workers put policies into practice and interact with agency clients. This report is part of the Project on Devolution and Urban Change (“Urban Change” for short), which is being undertaken by the Manpower Demonstration Research Corporation (MDRC). The report is based on research conducted in early 2000 in welfare offices located in the four large urban counties participating in the project: Cuyahoga County (Cleveland, Ohio); Los Angeles County (California); Miami-Dade County (Florida); and Philadelphia County (Pennsylvania). The findings are based primarily on 67 interviews with line staff members (referred to here as “workers”) and their supervisors, and on 28 observations of worker-client meetings. The authors drew also on quantitative data from surveys administered to 615 line staff members at all sites except Los Angeles (where the surveys were fielded too late for the data to be included here). Finally, they analyzed the contents of in-depth interviews with 50 welfare recipients in Cuyahoga and Los Angeles Counties that were conducted as part of the Urban Change project’s ethnographic study. This report contains the findings of that research and, based on those findings, recommendations to state and local welfare agencies and to the Food and Nutrition Service (FNS, the agency within the U.S. Department of Agriculture that administers the Food Stamp Program). The authors shared a draft of the report with FNS as well. On November 18, 2000, as the report was made into its final form, President Clinton announced new rules governing the administration of food stamps that could substantially address some of the problems observed. (Author abstract)

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