Variation in state-run Medicaid programs provides a natural laboratory for studying how policies affect health outcomes and costs. However, the historical lack of a nationwide Medicaid dataset previously restricted Medicaid researchers’ ability to conduct cross-state studies. CHSE received support through the OHSU and Silver Family Foundations to be among the first institutions to acquire CMS’ Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) national Medicaid dataset. The TAF dataset allows for cross-state comparisons of Medicaid policies and outcomes, offering unprecedented opportunities for national studies that until recent years were unfeasible.

Current CHSE studies with TAF data focus on reproductive health, home and community-based services, and Medicaid waivers for residential opioid use disorder treatment. The first round of manuscripts from this new work are under review at multiple journals.

Select publications:

• Postpartum Contraceptive Use Among US Medicaid Recipients

Oregon transformed its Medicaid program by creating coordinated care organizations (CCOs), regional networks that are responsible for health care access and quality among their members. Our team has undertaken extensive work to understand the impacts of this novel policy experiment, including comparison of health care quality and spending trends among Oregon's Medicaid members with trends in Colorado and Washington State, which carried out more limited reforms.

Select publications:

• Increased use of complementary and alternative therapies for back pain following statewide Medicaid coverage changes in Oregon. Journal of General Internal Medicine, 2021
• Health Care Expenditures Among Adults With Diabetes After Oregon’s Medicaid Expansion. Diabetes Care, 2020
• Access to Primary, Mental Health, and Specialty Care: A Comparison of Medicaid and Commercial Insured Populations in Oregon. Journal of Internal Medicine, 2020
• Addressing Social Determinants of Health through Medicaid: Lessons from Oregon. Journal of Health Politics, Policy and Law, 2019
• Oregon Medicaid efforts to reduce health disparities
• Decomposition of Medicaid Spending Changes 
• Decomposing Medicaid Spending During Health System Reform and ACA Expansion: Evidence from Oregon. Medical Care, 2018 
• Oregon's Emphasis On Equity Shows Signs Of Early Success For Black And American Indian Medicaid Enrollees. Health Affairs, 2018
• Early Performance in Medicaid Accountable Care Organizations: A Comparison of Oregon and Colorado. JAMA Intern Med, 2017
• Oregon's Medicaid Reform And Transition To Global Budgets Were Associated With Reductions In Expenditures. Health Affairs, 2017
• Oregon's Medicaid Coordinated Care Organizations. JAMA, 2016

Medicaid is the largest single payer of obstetric and contraceptive services in the US. CHSE researchers along with CHSE affiliate faculty Dr. Maria Rodriguez use national Medicaid data to examine how variations in Medicaid policy and coverage influence the initiation and use of effective contraception across local, state and national levels.

Select publications:

• Association of Pharmacist Prescription of Contraception With Breaks in Coverage, 2022
• Association of Prenatal Care Expansion with Use of Antidiabetic Agents during Pregnancies among Latina Emergency Medicaid Recipients with Gestational Diabetes, 2022
• Disparities in postpartum contraceptive use among immigrant women with restricted Medicaid benefits, 2022
• Postpartum Contraceptive Use Among US Medicaid Recipients, 2022
• Analysis of Contraceptive Use Among Immigrant Women Following Expansion of Medicaid Coverage for Postpartum Care, 2021
• Association of Expanded Prenatal Care Coverage for Immigrant Women with Postpartum Contraception and Short Interpregnancy Interval Births, 2021

States are asking a variety of questions about the best ways to improve behavioral health care service delivery for Medicaid enrollees. CHSE research evaluates potential solutions to behavioral health workforce shortages, access to care (particularly among people of color, tribal communities and other historically marginalized groups) and integration with physical health care. Medicaid also covers health care for almost 40 percent of people with OUD, and state Medicaid programs provide a variety of treatment services. Through multiple NIH-funded studies as well as state agency evaluations, CHSE provides critical information about the effectiveness of Medicaid policies and interventions aimed at addressing behavioral health needs.

Select publications:

• Conversion to Persistent or High-Risk Opioid Use After a New Prescription From the Emergency Department: Evidence From Washington Medicaid Beneficiaries. Annals of Emergency Medicine, 2019
• Opioid prescribing patterns after dental visits among beneficiaries of Medicaid in Washington state in 2014 and 2015. Journal of the American Dental Association, 2019
• Effect of Automated Prescription Drug Monitoring Program Queries on Emergency Department Opioid Prescribing. Annals of Emerg Med, 2018
• Does Prescription Opioid Shopping Increase Overdose Rates in Medicaid Beneficiaries? Annals of Emerg Med, 2017
• Impact of Hospital "Best Practice" Mandates on Prescription Opioid Dispensing After an Emergency Department Visit. Academic Emerg Med, 2017

Value-based payment (VBP) models aim to improve the value of medical care and are increasingly the focus of delivery reform in Medicaid and Medicare programs. CHSE’s definitive studies on the Comprehensive Care for Joint Replacement (CJR) model — Medicare's first mandatory bundled payment program— follow the outcomes of this model, with a focus on its differential effects on racial and ethnic minorities as well as on beneficiaries with Alzheimer’s Disease and related dementias.

Select publications:

• Association of Medicare Mandatory Bundled Payment Program With the Receipt of Elective Hip and Knee Replacement in White, Black, and Hispanic Beneficiaries. Jama, 2021
• Accuracy of Hospital Discharge Codes in Medicare Claims for Knee and Hip Replacement Patients. Medical Care, 2020
• Level of Reconciliation Payments by Safety-Net Hospital Status Under the First Year of the Comprehensive Care for Joint Replacement Program. JAMA Surgery, 2018
• The CMS Comprehensive Care Model and Racial Disparity in Joint Replacement. JAMA, 2016