Our Featured Work

2020 Research Highlights

Topic Area: Medicaid and CHIP Policy

Addressing Social Determinants of Health through Behavioral Health-focused 1115 Waivers: Implementation Lessons from Six States
SHADAC researchers conducted a study to understand how three states—Illinois, Texas, and Washington—were addressing the needs of justice-involved populations through implementation of Section 1115 Medicaid waiver programs. The specific aim of the study was to identify promising practices and lessons learned related to the development, implementation, and management of these innovative behavioral health policies with the purpose of informing policy development in states considering similar 1115 waivers. Funded by the Robert Wood Johnson Foundation.

MACPAC Analysis of Survey Data
SHADAC has served as the on-demand survey analysis vendor for the Medicaid and CHIP Payment and Access Commission (MACPAC) since June 2016. To date, we have successfully executed tasks using a broad range of data (e.g.  ACS, CPS, MEPS-IC, NHIS, HCUP, NHANES, NSDUH, NAMCS, etc.). In this role, we respond to on-demand task order work to produce sound estimates and to develop documentation that supports the reproducibility of results over time. SHADAC’s analysis has contributed to a number of report chapters, briefs, and presentations to the Commission, such as the annually released MACStats Data Book—a comprehensive collection of federal and state data regarding Medicaid and CHIP program eligibility, enrollment, and expenditures, as well as beneficiary health, service use, and access to care. Funded by The Medicaid and CHIP Payment and Access Commission.

Topic Area: Health Coverage and Access to Care

Minnesota Health Access Survey
SHADAC conducts a biennial telephone survey of Minnesota residents and analyzes survey results in partnership with the Health Economics Program at the Minnesota Department of Health. Findings from the survey provide an overview of the state’s uninsured population and changes in their composition over time as well as trends in how Minnesotans obtain health insurance coverage. Funded by the Minnesota Department of Health 

Minnesota’s Uninsured and the Communities in Which They Live
SHADAC used data from the American Community Survey (ACS) to create a new resource consisting of a profile and an interactive map, which provides rates and counts of the uninsured in Minnesota at the ZIP code level (i.e., Census-defined ZIP code) county, economic development region (EDR), and state. The focus of this resource is to (a) support targeted outreach and enrollment activities of health insurance navigators; and (b) provide information about the uninsured to policymakers as they develop strategies to reach the remaining uninsured in Minnesota and reduce geographic disparities in coverage. Funded by Blue Cross Blue Shield of Minnesota Foundation.

Topic Area: Health Equity and Social Determinants

Leveraging American Community Survey (ACS) Data to Address Social Determinants of Health and Advance Health Equity
In this issue brief, SHADAC explores how researchers, policymakers, and state Medicaid programs can use data from the American Community Survey (ACS) to inform and target interventions that seek to address social determinants of health (SDOH) and advance health equity. The brief also provides examples of states that use social determinants of health and health equity measures from the ACS, including which measures are used and what they are used for. Funded by State Health and Value Strategies.

State Approaches to Risk Adjustment Based on Social Factors and Strategies for Filling Data Gaps
A State Health & Value Strategies (SHVS) brief, authored by SHADAC researchers, details three approaches taken by organizations in two states, Minnesota and Massachusetts, to solving a key challenge to risk adjusting based on social factors: Where to find data on social risk factors? The brief’s profiled examples employed three approaches to filling the data gap—using survey data, using claims and administrative data, and using a combination of both. Funded by State Health and Value Strategies.

Race, Ethnicity, and Language Data Collection Assistance
As part of our support to states under our SHVS grant, SHADAC provides technical assistance to states around data collection to advance health equity. Specifically, SHADAC is working with state organizations, such as Medicaid agencies, in order to improve data collection around race, ethnicity, language, disability, sexual orientation and gender. This includes summarizing, sharing and supporting best practices related to data collection, cleaning, analysis, and reporting. For instance, in a recent expert perspective “Exploring Strategies to Fill Gaps in Medicaid Race, Ethnicity, and Language Data,” SHADAC researchers provided overview of current REL data collection standards, as well as positing ideas for increasing completeness in data and suggesting how states could leverage alternative sources of data in order to improve REL data completeness. Funded by State Health and Value Strategies.

Topic Area: Quantitative and Qualitative Evaluation

Impact of Fluoride Varnish at Minnesota Medicaid Youth Check-ups on Dental Caries
SHADAC partnered with the University of Minnesota Dental School to examine the impact of fluoride varnish application at Child and Teen Check-up (C&TC) visits on dental caries. SHADAC tracked five years of claims data for a cohort of Minnesota Medicaid children born in 2010 and 2011 and examined caries outcomes by age group and race/ethnicity. The purpose was to create a baseline understanding of outcomes before mandatory implementation of the C&TC fluoride varnish application policy in 2017, as well as to examine differences in outcomes by race/ethnicity and for Somali children in particular. Funded by the University of Minnesota School of Dentistry.

Medicaid Section 1115 Waiver Demonstration Evaluation Technical Assistance
SHADAC staff provided technical assistance (TA) and expertise to Alaska, Colorado, Illinois, and New Hampshire as these states participated in the Building State Capacity to Evaluate Innovative Medicaid Policies project. SHADAC monitored federal evaluation guidance and helped states develop data-driven approaches to evaluating approved and proposed Medicaid policies under Section 1115 waiver authority. Activities included: reviewing draft request for proposals and planning documents; participating in convenings with state and federal officials; drafting resources to respond to state-specific evaluation needs; and producing a brief of key considerations and promising tactics for states to use in evaluating new Medicaid policies. Funded by National Governors Association.

Topic Area: Population Health

Suicide Rates on the Rise: State and National Trends and Variation in Suicide Deaths from 2000 to 2018
Death rates from suicide in the United States have been increasing at an alarming pace, rising from 10.4 to 14.2 per 100,000 people from 2000 to 2018 (an increase of 37 percent). As part of an analysis aiming to shed more light on this growing public health concern, SHADAC researchers have produced two issue briefs that provide high-level information regarding trends in suicide deaths from 2000 to 2018. Each brief presents historical context for the troubling recent acceleration in the rise of suicide rates and mortality in the United States, and examines trends in suicide-related mortality across the nation and states, and among specific population subgroups. Funded by the Robert Wood Johnson Foundation.  

Minnesota Social Contact Study
A collaborative project between SHADAC, the University of Minnesota School of Public Health, the Humphrey School of Public Affairs, and the Minnesota Department of Health measured the daily social contact patterns of Minnesotans at two points in time during the coronavirus (COVID-19) outbreak. The survey determined the specific ways that state residents connect with each other, such as at work, school and at home during a 24-hour period. Participants were asked both about the number of contacts, location, duration and frequency from the day before as well as finer details on the interactions, including use of masks and other protective equipment, and whether or not they have symptoms of COVID-19. Funded by the University of Minnesota Office of the Vice President for Research COVID-19 Rapid Response Grants and the Minnesota Department of Health.

Topic Area: Health Care Cost and Affordability

Factors in Financial Burdens Related to Health Care for Californians 
In this issue brief prepared for the California Health Care Foundation (CHCF), SHADAC researchers  use a multitude of measures from the California Health Insurance Study (CHIS) to measure affordability of health care coverage in California in 2018. In particular, this brief focuses on health insurance deductibles and who reports the greatest affordability challenges. It also explores what data suggest about the consequences of those challenges, such as taking on credit card debt to pay medical bills and trouble paying for basic necessities, including food and housing.  Funded by the California Health Care Foundation.

State-level Estimates of Medical Out-of-Pocket Spending for Individuals with ESI Coverage
As part of SHADAC’s work monitoring trends in coverage, access, and affordability, this brief highlights the affordability of coverage for those with employer-sponsored health insurance (ESI). Using data from the Current Population Survey (CPS), SHADAC estimated family out-of-pocket costs for people with employer coverage across all 50 states and the District of Columbia (D.C.). Additional analysis looked at family median out-of-pocket costs by state and estimated the high medical cost burden where family out-of-pocket spending is greater than 10% of household income. Funded by the Robert Wood Johnson Foundation.


2020 Responsive Research: COVID-19

The arrival of the novel coronavirus (COVID-19) in 2020 irrevocably impacted and altered the lives of individuals across the United States, though the magnitude of the virus' effects has varied greatly across different states. Like many others, SHADAC, too, altered the focus of our work and research toward providing our audience with information and resources related to COVID-19, with our data experts working around the clock to produce guidance, tools, analyses, and more to inform state response efforts and provide insights on best practices as they seek solutions to address the COVID pandemic and respond to the disparate impacts of COVID-19 on their resident populations.

Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns
A brief authored by SHADAC researchers, funded by the California Health Care Foundation (CHCF), uses data from the U.S. Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) survey to examine flu vaccination rates across multiple years for U.S. adults (age 18 and older) across the 50 states and the District of Columbia as a proxy to identify population subgroups that may be harder to reach with a COVID-19 vaccine. Accompanying 50-state two-page factsheets explore state-level estimates of several demographic categories, including indicators of health and health care access. 

Reduced Access to Health Care due to Coronavirus Pandemic - SHADAC COVID-19 Survey
SHADAC conducted a two-part survey designed by our researchers to measure the impacts of the novel coronavirus on health care access and insurance coverage, as well as COVID-related worries and coping responses, for adults in the United States. The SHADAC COVID-19 Survey was fielded in late April 2020 as part of the AmeriSpeak omnibus survey conducted by NORC at the University of Chicago. The initial portion of the survey results focused on recording changes in health insurance coverage, delays in seeking medical care, and issues of access to and affordability of care due to the pandemic as reported by adult respondents.

SHADAC COVID-19 Survey Visualizations of Coronavirus Impacts on Health Insurance Coverage, Access and Affordability of Care, and Pandemic Stress Levels of U.S. Adults
Using results from the SHADAC COVID-19 Survey, researchers produced two chart books that provide clear, informative visualizations of responses to a variety of individual survey questions from both sections of the survey—health insurance coverage and access to/utilization of care in the first and stress and coping responses second—and include breakdowns by age, gender, race/ethnicity, chronic condition, health status, educational attainment, income level, and metropolitan area.

State-Specific Surveys Encompassing Residents’ COVID-19 Experiences
A new resource from SHADAC catalogues individual states’ efforts to capture information on the coronavirus pandemic through state and local surveys fielded between March 2020 and September 2020. Included within the resource is information on topics covered within the surveys as well as some results of the survey, where available. SHADAC has also produced a clickable state-level map that provides links to the data collection instruments and results identified in the search.

States’ Reporting of COVID-19 Health Equity Data
This expert perspective looks in-depth at which states are reporting health equity data on the impacts of COVID-19 on vulnerable populations, including communities of color, low-income populations, and residents of congregate living facilities. Also included are interactive maps that explore the extent to which states are reporting data breakdowns by age, gender, race, ethnicity, and locational levels (ZIP code), group residence type, and for health care workers.

Studying the Impact of COVID-19: State-Level Data Resources on State Health Compare
Recognizing the importance of access to current, accurate state-level data is important in order to inform state researchers, analysts, and policymakers’ efforts to understand and respond to the disparate impacts of COVID-19 on their resident populations, SHADAC compiled a high-level overview of the range of relevant data measures currently housed in our online data tool, State Health Compare. Estimates are also available for subpopulations (e.g., gender, age, race/ethnicity, etc.), as it becomes increasingly apparent that we must track the disparate impacts of COVID on specific populations. A number of related resources and products that provide more in-depth analysis for certain measures are also included.

University of Minnesota COVID-19 Health Insurance Model estimates that as many as 18.4 million individuals may be at risk of losing their employer-sponsored health insurance coverage (ESI)
Working in collaboration with several professors across the University of Minnesota School of Public Health and Health Policy and Management Division, SHADAC researchers and staff developed the University of Minnesota COVID-19 Health Insurance Model (MN-HIM). The model uses information on ESI coverage rates from survey data (CPS ASEC) and the Bureau of Labor Statistics (employment levels by state and industry), as well as state agency reports of initial unemployment claims by overall and by industry to present new national and state estimates of potential disruptions to ESI coverage resulting from the COVID-19 pandemic job losses.