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Expanding Coverage and Addressing Social Determinants of Health in Pennsylvania Medicaid

Hollander, Mara (2020) Expanding Coverage and Addressing Social Determinants of Health in Pennsylvania Medicaid. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Medicaid is the state-federal health insurance program for low-income Americans. A recent expansion of the program made Medicaid available to 800,000 additional enrollees in the Commonwealth of Pennsylvania. This expansion of coverage means that more Pennsylvanians than ever before will have access to medical care. The expansion, while necessary, is not sufficient to ensure that low-income Pennsylvanians get the care they need. Social determinants – conditions under which people live, shaped by the distribution of resources – also impact access to care, and can contribute to racial disparities. After examining the Medicaid expansion in Pennsylvania, this dissertation explores the public health impact of several social determinants impacting Pennsylvania Medicaid enrollees.
Chapter one is an assessment of the health care use of the Pennsylvania Medicaid expansion enrollment population, using group-based multi-trajectory modeling to jointly estimate six trajectories of ambulatory care and emergency department (ED) utilization in the first 12 months of enrollment. The heterogeneity we uncover may partially explain divergent research findings regarding how Medicaid expansion impacted use of the ED. Expansion states now have several years of experience with their Medicaid expansion populations and may be able to adopt our approach to identify subgroups who may benefit from interventions to improve access to ambulatory care and decrease ED use.
Chapter two assesses changes in Medicaid expenditures and utilization associated with receiving Permanent Supportive Housing (PSH), which integrates non-time-limited housing with supportive services for people who are disabled and chronically homeless. Additional state expenditures to expand financing for PSH services may be partially offset by reductions in Medicaid spending when Medicaid enrollees are stably housed, and may shift treatment to outpatient as opposed to acute care settings.
Black and Hispanic patients are significantly less likely than white patients to initiate and continue MOUD. In chapter three, we use data from the Allegheny County Department of Human Services Data Warehouse, which links administrative data from publicly administered health, human services and criminal justice systems, to explore whether this disparity is explained by contact with health and human services and criminal justice systems. We explain between 10% and 20% of the variation by race.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Hollander, Maramhollander@pitt.edumah3270000-0001-7955-7431
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairDonohue,
Committee MemberChang,
Committee MemberCole,
Committee MemberDouaihy,
Committee MemberSabik,
Date: 30 July 2020
Date Type: Publication
Defense Date: 27 April 2020
Approval Date: 30 July 2020
Submission Date: 5 June 2020
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 131
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Health Policy & Management
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: homelessness, housing, Medicaid, Medicaid expansion, Medication treatment for opioid use disorder, Opioid use disorder
Date Deposited: 31 Jul 2020 03:07
Last Modified: 01 Jul 2022 05:16


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