Medicaid and the Children’s Health Insurance Program: an overview for the pediatric radiologist

Abstract

In terms of number of beneficiaries, Medicaid is the single largest health insurance program in the US. Along with the Children’s Health Insurance Program (CHIP), Medicaid covers nearly half of all births and provides health insurance to nearly half of the children in the country. This article provides a broad introduction to Medicaid and CHIP for the pediatric radiologist with a special focus on topics relevant to pediatric imaging and population health. This includes an overview of Medicaid’s structure and eligibility criteria and how it differs from Medicare. The paper examines the means-tested programs within the context of pediatric radiology, reviewing pertinent topics such as the rise of Medicaid managed care plans, Medicaid expansion, the effects of Medicaid on child health, and COVID-19. Beyond the basics of benefits coverage, pediatric radiologists should understand how Medicaid and CHIP financing and reimbursement affect the ability of pediatric practices, radiology groups, and hospitals to provide services for children in a sustainable manner. The paper concludes with an analysis of future opportunities for Medicaid and CHIP.

Factors affecting Cost-Related Medication Non-Adherence among US population with Cardiovascular Risk Factors

“…According to the Centers for Disease Control, the residents of the Medicaid non-expansion states were more likely to be uninsured as they are neither eligible for Medicaid nor for other subsidized insurance coverage plans if their income is in the low to moderate range which would potentially affect medication adherence among these populations. 32, 33 Besides insurance, the regional variation in adherence can also be affected by factors like polypharmacy and complex drug regimens involving taking multiple pills at different times of the day, poor access to pharmacies especially in rural areas, and higher out-of-pocket expenses in areas with predominantly low-income populations. 34 These can be rectified by introducing better prescription practice guidelines involving generic fixed-dose drug combinations which will reduce the costs as well as the number of pills, increasing doorstep delivery of medications by switching to mail-order or online pharmacy practices.…”