This study sought to examine whether Supplemental Nutrition Assistance Program (SNAP) participation and benefit levels are associated with reduced subsequent hospital and emergency department utilization in low-income older adults. Study participants were 68,956 Maryland residents aged ≥65 years who were dually enrolled in Medicare and Medicaid (2009–2012). Annual inpatient hospital days and costs and emergency department visits were modeled as a function of either 1-year lagged SNAP participation or lagged SNAP benefit amounts, controlling for sociodemographic characteristics, autoregressive effects, year, health status, and Medicaid participation. SNAP participation (adjusted odds ratio [aOR] = 0.96, 95% confidence interval [CI]: 0.93, 0.99), and, among participants, each $10 increase in monthly benefits (aOR = 0.99, 95% CI: 0.99–0.99) are associated with a reduced likelihood of hospitalization, but not emergency department use. The authors estimate that enrolling the 47% of the 2012 population who were eligible nonparticipants in SNAP could have been associated with $19 million in hospital cost savings. Accounting for the strong effects of health care access, this study finds that SNAP is associated with reduced hospitalization in dually eligible older adults. Policies to increase SNAP participation and benefit amounts in eligible older adults may reduce hospitalizations and health care costs for older dual eligible adults living in the community.

A substantial proportion of nursing home residents receives presumptively inappropriate medications to treat medical conditions. Selecting persons prescribed large numbers of medications for further review may be the most efficient method for nursing home or pharmacy personnel to identify residents at high risk of receiving inappropriate medications. Extensive additional information on residents' characteristics, although widely available through the Minimum Data Set, does not significantly improve the ability to identify residents receiving inappropriate medications for medical conditions. State-specific policies or provider practices also influence the likelihood of presumptively inappropriate medication use among nursing home residents and deserve further investigation.

BackgroundAlthough it has long been known that a broad range of factors beyond medical diagnoses affect health and health services use, it has been unclear whether additional income can decrease health service use. We examined whether Supplemental Nutrition Assistance Program (SNAP) receipt is associated with subsequent nursing home entry among low income older adults.MethodsWe examined the 77,678 older adults dually eligible for Medicaid and Medicare in Maryland, 2010–2012. Zero inflated negative binomial regression, adjusting for demographic and health factors, tested the association of either lagged SNAP enrollment or lagged benefit amount with nursing home admission. We used Heckman two-step model results to calculate potential savings of SNAP enrollment through reduced nursing home admissions and reduced duration.ResultsOnly 53.4% received SNAP in 2012, despite being income-eligible. SNAP participants had a 23% reduced odds of nursing home admission than nonparticipants (95% CI: 0.75–0.78). For SNAP participants, an additional $10 of monthly SNAP assistance was associated with lower odds of admission (OR = 0.93, 95% CI: 0.93–0.93), and fewer days stay among those admitted (IRR = 0.99, 95% CI: 0.98–0.99). Providing SNAP to all 2012 sample nonparticipants could be associated with $34 million in cost savings in Maryland.ConclusionsSNAP is underutilized and may reduce costly nursing home use among high-risk older adults. This study has policy implications at the State and Federal levels which include expanding access to SNAP and enhancing SNAP amounts.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-017-0553-x) contains supplementary material, which is available to authorized users.

We evaluate the change in length-of-stay and charges for vaginal and cesarean deliveries before and after the implementation of a law establishing a minimum maternity stay in Maryland. Using discharge abstract data collected by the Maryland Health Services Cost Review Commission, we find that after the law was enacted, Maryland's average length-of-stay and average charges for both types of deliveries increased, but the increase in charges was less than the cost of an average hospital day. Multivariate analysis shows that the implementation of the law reduced the sources of variation among mothers' length-of-stay and hospital charges. Overall, we estimate that the law cost payers an additional $5.5 million for maternity stays.

Background: Chlamydia, gonorrhea, and syphilis are common, treatable sexually transmitted infections (STIs) that are highly prevalent in the general US population. Costs associated with diagnosing and treating these conditions for individual states' Medicaid participants are unknown. The purpose of this study was to estimate the cost of screening and treatment for 3 common STIs for state Medicaid program budgets in Maryland and South Carolina.Methods: A retrospective, cross-sectional study was conducted using Medicaid administrative claims data over a 2-year period. Claims were included based on the presence of one of the 3 study conditions in either diagnosis or procedure codes. Descriptive analyses were used to characterize the participant population and expenditures for services provided.