Sara E. Wilensky

Existing Medicaid Beneficiaries Left Off The Affordable Care Act’s Prevention Bandwagon

The recent health reform law promotes access to preventive care through new insurance coverage requirements. Most private insurance plans, Medicare, and Medicaid expansion programs are required to cover US Preventive Services Task Force A- and B-rated services without cost sharing. However, because the Affordable Care Act treats newly eligible and existing Medicaid beneficiaries differently, all adult Medicaid beneficiaries within a state might not be eligible for the same preventive services. This study reviewed Medicaid programs across the country and found that most states do not cover all of these recommended services as preventive measures for adults. As a result, existing adult Medicaid beneficiaries might not have coverage of the same important preventive services that most other insured people have. In addition, aspects of how preventive services are defined in many states result in confusion about coverage parameters, potentially creating an additional access barrier for existing Medicaid beneficiaries.

COMMUNITY APPROACHES TO WOMEN'S HEALTH Delivering Preconception Care in a Community Health Center Model

Preconception care has been recognized as an important set of interventions necessary to improve pregnancy outcomes and the overall health of women of childbearing age. Traditionally underserved populations such as the low income, uninsured, racial and ethnic minorities, homeless, and migrant farmworkers have less access to a usual source of primary care and therefore are more at risk for adverse health outcomes. The national network of Community Health Centers was created to break down compounding barriers to care that leads to poor health. Health centers are a vital source of care for low-income women. Almost 60% of health center patients are women, about half of whom are women of childbearing age. In addition, health centers provide care for > 17% of low-income births in the United States. Most health centers offer their patients preconception services, such as HIV/AIDS screening and treatment, weight management, nutrition counseling, and smoking cessation programs, in addition to comprehensive primary care services. Three quarters of health centers provide mental health services and half provide substance abuse treatment services onsite; the rest provide these services in partnership with other providers. Health centers also participate in a number of community-based programs focused on improving womens health and providing preconception care services. As policymakers and public health planners consider options for enhancing the utilization of preconception care, they must also consider options for expanding access to health centers nationwide.

Medicaid reform: implications for the health care safety net.

Governmental budget reductions in Medicaid and other programs will have a highly negative affect on the health care safety net that serves millions of low-income, uninsured, and publicly insured patients. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.