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From this page you can view our recent publications, listed below with the most recent at the top of the list.

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Geographic Variation in ACA Coverage Expansion Populations and the Healthcare Workforce
Publication Year: 2013

As states plan for and implement the Affordable Care Act (ACA), estimates of the state and local geographic distribution of the ACA coverage expansion populations and the healthcare workforce are necessary for identifying areas where the size of the insurance expansion population, relative to the supply of health care professionals, indicates the potential for access-to-care problems.

Dr. John Graves, Assistant Professor at Vanderbilt University, is leading a SHARE-funded project to model these distributions in order to help states prepare for the change in demand for health care services under the ACA. Dr. Graves will present findings from this modeling work on a June 14th SHARE webinar during which he will discuss both demand- and supply- side issues that affect whether access-to-care problems will arise in a given area.

Demand-side questions include:

  • How much care will the newly insured use?
  • How many uninsured will be eligible for coverage?
  • How can we construct county estimates of coverage availability?

Supply-side questions include:

  • How can we identify primary care providers in local areas?
  • How can we identify non-physician providers who could provide primary care?
  • How can we construct accurate geographic measures of provider supply? For example, how do population-to-physician ratios compare to spatial models?  

Dr. Graves will bring all these issues together, discussing his overall findings and the implications of these finding for states as they consider their policy options in preparation for the ACA coverage expansions and the resulting increased pressure on the health care delivery system.

Joining Dr. Graves for this discussion will be Dr. Peter Buerhaus, Director of the Center for Interdisciplinary Heatlh Workforce Studies at Vanderbilt University Medical center, who is a co-investigator on the project and an expert in workforce issues.

For further information about this event, please contact Carrie Au-Yeung at butle180@umn.edu or 612-625-2492.

Fact Sheet and Questionnaires from Minnesota Medicaid Enrollee Survey
Publication Year: 2013

The Affordable Care Act provides for the expansion of Medicaid to new segments of the population. The extent to which this coverage expansion will meaningfully increase access to health care services is, however, unclear. Surveys of the Medicaid population are one way to examine access to services and experiences with care.  

In 2008, SHADAC was contracted by the Minnesota Department of Human Services (DHS) to survey enrollees in the Minnesota Health Care Program (which includes the state’s Medicaid program and its Medicaid/CHIP waiver program) with the goal of developing recommendations for improving the delivery of health care services to enrollees and reducing disparities in access and quality. 

In a new fact sheet meant to survey as a resource for states as they consider ways to evaluate access to care among those newly eligible for Medicaid, SHADAC researchers outline the survey’s purpose, content, and administration; the sample design; and the community-based approach used for survey development and analysis. 

Accompanying the new fact sheet are copies of the adult and child versions of the 2008 questionnaire.

The full report on the 2008 survey is available here.

Translating Modified Adjusted Gross Income (MAGI) to Current Monthly Income
Publication Year: 2013

The ACA specifies a standard definition of income--Modified Adjusted Gross Income (MAGI)--that will be used to determine eligibility for both Medicaid and the Exchange-based premium tax credits and cost-sharing reductions.  The adoption of MAGI, which measures income annually, creates a number of issues for states, particularly when applying MAGI to eligibility determination for Medicaid, which measures income on a monthly basis.  

In this SHARE brief, Dr. John Czajka brief reviews the income that is included in MAGI and how income is currently counted in determining Medicaid eligibility.  Issues related to measuring MAGI on a monthly basis for Medicaid eligiblity determination are discussed, and Dr. Czajka offers some thoughts on how states might begin to address these issues in their application of MAGI to determine eligibility for Medicaid.

Income Eligibility for Assistance under the ACA: The Question of Monthly vs. Annual Income
Publication Year: 2013

Under the ACA, Medicaid eligibility is determined based on monthly income, while Exchange-based subsidy eligibility is based on annual income.  As a result, monthly income instability among low-income adults could result in subannual loss of Medicaid eligibility without any gain in eligibility for subsidized Exchange-based coverage because of lower-than-required annual income, leading to periodic coverage gaps.

In this issue brief, Dr. John Czajka presents findings from his SHARE-funded analysis of monthly income volatility among the population likely to be newly eligible for Medicaid under the ACA.  According to Dr. Czajka's analysis, more than a fifth of nonelderly adults with family incomes between 50 and 138 percent of poverty are likely to experience significant swings in monthly family income. This will lead to significant numbers of people gaining and then losing eligibility for Medicaid within the course of a given year while not being able to take advantage of subsidized coverage through the Exchange.

Minnesota Comprehensive Health Association Enrollee Survey: Assessing the Results (Chartbook)
Publication Year: 2013

This chartbook summarizes the findings of the 2012 Minnesota Comprehensive Health Association (MCHA) Enrollee Survey based on demographics; health characteristics; access and utilization of health coverage; experience with MCHA; topics in health reform; and potential outreach avenues for program administrators. 

The charts in this report are designed to provide snapshots first of the overall MCHA population and then by more specific subpopulations such as income level, geographic residence, and plan deductible.

The figures in this report were created to present a more complete picture of the characteristics of the MCHA population and to aid program administrators in outreach efforts as enrollees transition from MCHA and into other insurance vehicles.