Julia Paradise - Academia.edu (original) (raw)

Papers by Julia Paradise

Today, over 1,100 federally funded community health centers play a vital role in ensuring access ... more Today, over 1,100 federally funded community health centers play a vital role in ensuring access to health care for a predominantly low-income population in medically underserved communities. Health centers’ ability to provide comprehensive primary care and improve access to high-quality care while holding down health care cost growth has been well-documented. As health reform spurs coverage expansion and efforts to improve quality, the nation’s reliance on health centers is likely to grow.

Reviews the literature on the impact of Medicaid and State Children's Health Insurance Progra... more Reviews the literature on the impact of Medicaid and State Children's Health Insurance Programs on the coverage, access to care, and health outcomes for low-income children, as well as remaining challenges in preventive, primary, and dental care

Mathematica Policy Research Reports, 2013

This brief, the last of three case studies examining key operational aspects of coordinated care ... more This brief, the last of three case studies examining key operational aspects of coordinated care initiatives in Medicaid, focuses on Rhode Island's Chronic Care Sustainability Initiative. This multi-payer, patient-centered medical home initiative includes the one Medicaid health plan in the state and commercial health plans.

Community health centers are the nation’s largest source of comprehensive primary care for medica... more Community health centers are the nation’s largest source of comprehensive primary care for medically underserved communities and populations. Under the Affordable Care Act (ACA), increased patient revenues due to the expansion of Medicaid and private health insurance, along with substantially increased direct federal investment in the program, have led to growth in the number of health centers and their capacity to provide services. This brief draws on 2015 federal data on health centers and our 2016 Survey of Health Centers’ Experiences and Activities under the Affordable Care Act to provide a snapshot of health centers and their patients, analyze recent changes, and compare the experience of health centers in Medicaid expansion and non-expansion states. This information is germane to the impending debate on the ACA and the potential impact of changes on coverage and access to care for low-income Americans and financing for safety-net providers. Key findings include:

Mathematica Policy Research Reports, 2013

Mathematica health experts collaborated with staff at the Kaiser Commission for Medicaid and the ... more Mathematica health experts collaborated with staff at the Kaiser Commission for Medicaid and the Uninsured to author this brief, the second of three case studies examining key operational aspects of coordinated care initiatives in Medicaid, which focuses on the Transitional Care Program conducted by Community Care of North Carolina (CCNC). CCNC is a medical home program that serves 83 of all North Carolina Medicaid beneficiaries. The Transitional Care Program identifies high-risk enrollees when they are admitted to a hospital, and plans, coordinates, and arranges their transition back to the community.

Providing Outreach and Enrollment Assistance: Lessons Learned from Community Health Centers in Ma... more Providing Outreach and Enrollment Assistance: Lessons Learned from Community Health Centers in Massachusetts EXECUTIVE SUMMARY Six years ago, Massachusetts implemented a broad expansion of health coverage to the uninsured population in the state. Understanding that outreach and enrollment assistance would be essential to the success of the expansion, state policymakers provided for public education campaigns, but also for person-to-person, handson assistance, especially in communities with large numbers of uninsured people. Community health centers play a central role in this effort. As states and communities gear up to provide outreach and enrollment assistance under the ACA, the experience of the Massachusetts health centers offers lessons that can help inform current efforts to reach and enroll millions of low-income, uninsured Americans in health insurance. Recent interviews conducted with a sample of Massachusetts health centers point to four key findings:

This issue brief focuses on Colorado's Medicaid reform initiative, the Accountable Care Colla... more This issue brief focuses on Colorado's Medicaid reform initiative, the Accountable Care Collaborative, and one of its three core components, the Statewide Data Analytics Contractor. This component supports primary care providers networked to seven regional care collaboratives and provides data to support care management and improvement. Mathematica health experts collaborated with staff at the Kaiser Commission for Medicaid and the Uninsured to author the brief, the first of three planned studies.

With three years of expanded coverage under the ACA in place, many states have shifted focus from... more With three years of expanded coverage under the ACA in place, many states have shifted focus from outreach and enrollment to strengthening delivery systems and enhancing access to care to meet the needs of their growing covered populations. Based on case studies and focus groups, this brief reviews delivery systems and access to care for Medicaid enrollees in Colorado, Connecticut, Kentucky, and Washington as of Spring 2016. Each of these states expanded Medicaid and experienced large gains in Medicaid enrollment. The findings provide an on-the-ground view of Medicaid delivery systems and enrollees’ experiences accessing care three years after implementation of the Medicaid expansion. This brief builds on previous reports that examined states’ preparation for implementation prior to the initial ACA open enrollment period and their experiences after completion of the first and second open enrollment periods. Together, this work provides an in-depth understanding of ACA implementation...

Mathematica Policy Research Reports, 2012

This brief summarizes issues discussed at a recent roundtable on Medicaid risk-based managed care... more This brief summarizes issues discussed at a recent roundtable on Medicaid risk-based managed care, convened by the Kaiser Commission on Medicaid and the Uninsured and moderated by senior fellow Marsha Gold. Topics covered included provider networks, care delivery, and payment arrangements; expanding managed care to people with disabilities and Medicare/Medicaid dual eligible beneficiaries; and the impact of health reform on managed care organizations.

Medicaid, the nation’s public health insurance program for low-income children, adults, seniors, ... more Medicaid, the nation’s public health insurance program for low-income children, adults, seniors, and people with disabilities, covers 1 in 5 Americans, including many with complex and costly needs for medical care and long-term services. Most people covered by Medicaid would be uninsured or underinsured without it. The Affordable Care Act (ACA) expanded Medicaid to reach low-income adults previously excluded from the program and provided federal funding to states for the vast majority of the cost of newly eligible adults.

This brief presents findings from a recent study conducted by the Kaiser Family Foundation to exa... more This brief presents findings from a recent study conducted by the Kaiser Family Foundation to examine how racial/ethnic disparities in access among Medicaid-enrolled children compare with disparities among privately insured and uninsured children. The analysis is based on data for a pooled sample of 15,280 African American, Latino, and White children aged 1-18, from the 2003 and 2004 Medical Expenditure Panel Survey (MEPS). We analyze data on four indicators of access to care-two that examine entry into the health care system and two measures of perceived ability to obtain access. We identify a racial/ethnic difference as a disparity only if statistically significant at p<0.05. Key findings are as follows: • While the vast majority of children fared well on the indicators examined, access problems persist for some children. In 2003-2004, about 8.6% of children lacked a usual source of care (USC), 27.1% had no ambulatory medical visit in the prior year, 9.6% of children with a prior medical visit reported problems getting necessary care, and 22.0% of children needing specialty care reported problems seeing a specialist. • Medicaid was on par with private insurance with regard to racial/ethnic disparities in children's access. Racial/ethnic disparities in access were no more likely among children in Medicaid than among privately insured children on these four indicators of access. • The presence and magnitude of disparities varied by the combination of a child's race/ethnicity and insurance group, and by the access measure examined. African American and Latino children lagged behind White children on the usual source of care measure in all three insurance groups; the disparity was largest-nearly threefold between uninsured Latino and White children. Privately insured African Americans and Latinos fared worse than Whites on the ambulatory visit measure, but in the Medicaid group, Latinos experienced no disadvantage, and in the uninsured group, African Americans experienced no gap. Evidence of racial/ethnic disparities

Based on focus group discussions, examines how the loss of jobs and employer-sponsored health ins... more Based on focus group discussions, examines how the loss of jobs and employer-sponsored health insurance affects families. Explores the limitations of COBRA and private insurance and the role of Medicaid and State Children's Health Insurance Programs

The number of rural hospital closures has increased significantly in recent years. This trend is ... more The number of rural hospital closures has increased significantly in recent years. This trend is expected to continue, raising questions about the impact the closures will have on rural communities’ access to health care services. To investigate the factors that contribute to rural hospital closures and the impact those closures have on access to health care in rural communities, the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute conducted case studies of three hospital closures that took place in 2015: Mercy Hospital in Independence, Kansas; Parkway Regional Hospital in Fulton, Kentucky; and Marlboro Park Hospital in Bennettsville, South Carolina. Two of these hospitals were in states that did not adopt the Medicaid coverage expansion under the Affordable Care Act (ACA) (Kansas and South Carolina), while one of the hospitals was located in a Medicaid expansion state (Kentucky). Key findings include the following:

The views expressed are those of the authors, and should not be interpreted as being those of the... more The views expressed are those of the authors, and should not be interpreted as being those of the Congressional Budget Office. Acknowledgments Special thanks to Steve Machlin from the Agency for Healthcare Research and Quality for his statistical assistance and helpful comments. Introduction Since the mid-1980s, Medicaid has become an increasingly important source of health coverage for low-income children under age 19 in all racial/ethnic groups. The means-tested program plays an especially large role for children of color because they are more likely to be low-income compared with White children. In 2007, Medicaid and the smaller Children's Health Insurance Program (CHIP) covered nearly 1 of every 5 White children, but roughly 2 of every 5 African American and Hispanic children. 1 Because Medicaid is such a significant source of coverage for children of color, it is important to know whether the program is helping to improve equity in access to care across racial/ethnic groups...

The Washington Post, Jun 23, 1991

Mathematica Policy Research Reports, 2013

Mathematica Policy Research Reports, 2012

The Washington Post, Jun 23, 1991