Medicaid

The study of Anderson and Mitchell (1997) examined whether the AIDS-specific home and community-based waiver program, which was implemented in Florida in 1990 as an alternative to institutional care, was effective in reducing Medicaid expenditures per beneficiary during its first 2 years of operation. Therefore, the authors used Medicaid claims data and country information to estimate the effect of the waiver on expenditures controlling for nonrandom program selection. Their results indicate that persons with AIDS who used waiver services incurred monthly expenditures that were on average 22-27% lower than otherwise similar nonparticipants. The authors concluded that home and community-based care for AIDS patients resulted in lower expenditures per beneficiary. 

Anderson KH, Mitchell JM (1997) Expenditures on services for persons with acquired immunodeficiency syndrome under a Medicaid home and community-based waiver program are selection effects important Med Care 35 425 39... 

Moatti JP, Spire B, Kazatchkine M (2004) Drug resistance and adherence to HIV/AIDS antiretroviral treatment against a double standard between the north and the south, AIDS I8 S55-S6I Moore RD, Chaisson RE (1997) Costs to Medicaid of advancing immunosuppression in an urban HIV-infected patient population in Maryland, J Acquir Immune Defic Syndr Hum Retrovirol 16 223-231... 

Solomon DJ, Hogan AJ (1992) HIV infection treatment costs under Medicaid in Michigan. Public Heaith Reports 197 461-468... 

Nightengale BS, Crumly JM, Liao J, et al (1998). Economic outcomes of antipsychotic agents in a medicaid population traditional gents vs risperidone. PsyehopharmacBullltAy 373—82. 

McCombs JS, Nichol MB, Stimmel GL, et al (1990). The cost of antidepressant drug therapy failure a study of antidepressant use patterns in a Medicaid population. J Clin Psychiatry (6, suppL), 60—9. 

The Centers for Medicare and Medicaid Services has incorporated pneumococcal and influenza immunization rates into some of their quality standards. Patients admitted to a hospital for community-acquired pneumonia should be screened for, offered, and vaccinated with pneumococcal and influenza vaccines prior to discharge if not previously administered. In physicians office practice, all persons over 65 years of age who have been hospitalized in the past year should be screened for, offered, and vaccinated with pneumococcal and influenza vaccines if not previously administered. Both of these standards will affect payment if the standard is not met. The Joint Commission on Accreditation of Healthcare Organizations has also incorporated these standards into their accreditation reviews of health care facilities. 

Opolka etal. (2003) examined Texas Medicaid claims for patients with schizophrenia or schizoaffective disorder during the period of January 1996 to August 1998. These patients had been initiated to treatment with either haloperi-dol or olanzapine and had no previous use of these medications in the year prior (total, n = 2601 haloperidol, n = 726 olanzapine, n = 1875). 

Opolka, J. L., Rascati, K. L., Brown, C. M., Barner, J. C. et al. (2003). Ethnic differences in use of antipsychotic medication among Texas Medicaid clients with schizophrenia. /. Clin. Psychiatry, 64, 635-9. 

One trend in the managed care market is the relatively recent increase of managed care in Medicaid... 

HMO-PPO/Medicare-Medicaid Digest. Kansas City, MO Hoechst Marion Roussel, 1999. 

AA Nelson, CE Reeder, WM Dickson. The effect of a Medicaid copayment program on the utilization and cost of prescription services. Med Care 22(8) 724-736, 1984. 

CE Reeder, AA Nelson. The differential impact of copayment on drug use in a Medicaid population. Inquiry 22(4) 396-403, 1985. 

CDC recommends that states develop a plan to find children who may be exposed to lead and have their blood tested for lead. They make basic recommendations for states to follow. These include testing children at ages 1 and 2. Children who are 3 to 6 years old should be tested if they have never been tested for lead before and they receive services from public assistance programs for the poor such as Medicaid or the Supplemental Food Program for Women, Infants and Children (WIC) if they live in a building or frequently visit a house built before 1950 if they visit a home (house or apartment) built before 1978 that has been recently remodeled or if they have a brother, sister, or playmate who has had lead poisoning. 

Medicaid programme in the USA, differential co-payment for cheaper drugs, also applied in the USA, and the system based on the lowest-cost alternative in British Columbia (Canada). 

Soumerai, S.B., D. Ross-Degnan, J. Avom,T.J. McLaughlin and I. Choodnovskiy (1991), Effects of Medicaid drug-payment limits on admissions to hospitals and nursing homes , New England Journal of Medicine, 325, 1072-77. 

Centers for Medicare and Medicaid Services Guidelines for Monitoring Medication Use... 

From Center for Medicaid and Medicare Services Unnecessary Medication Use (Tag B29) 2007, http //mM.cms.hhs.gov/... 

The level of care also may be inadequate. Many uninsured individuals receive their care through "safety net" providers such as community health centers and public hospitals, which usually have limited budgets and are facing competition from Medicaid managed care providers. Many who are on Medicaid today will be ineligible in the short term and will become uninsured (Lewin and Altman, 2000). 

A few studies have examined the impacts of Medicaid and non-Medicaid copayments on drug utilization and health care costs. In a 1993 study, Reeder et al. noted an 11% decrease in prescription use after South Carolina established a 50-cent per prescription copayment. This increase was significantly greater than in Tennessee, a comparison state with no copayments (Reeder et al., 1993). Another study using survey data from the 1992 Medicare Beneficiary Survey found that elderly and disabled Medicaid beneficiaries who live in states with prescription drug copayments have lower prescription drug utilization than their counterparts in states without copayment, and three-fourths of the difference was directly attributed to copayment policies. The study predicted that Medicaid copayments... 

Most of the implications for low-income people under Medicaid will probably be negative. In light of current practices under Medicaid, the following may be potential implications of pharmacogenomics. 

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