RISE looks at recent headlines concerning social determinants of health (SDoH).
Medicare eligibility linked to reduction in racial disparities in health care coverage
Eligibility for Medicare may reduce racial and ethnic disparities in insurance coverage and advance health equity, according to a recent study published by JAMA Internal Medicine.
In fact, researchers found Medicare eligibility to be associated with a 53 percent reduction in health care coverage disparities between Black individuals and white individuals. Prior to Medicare eligibility, there was 5.7 percent disparity between Black and white individuals, whereas after eligibility, it dropped to 2.7 percent.
The study, which used the Behavioral Risk Factor Surveillance System and the U.S. Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Data from 2008 to 2018, examined more than 2.4 million seniors. Of the total study participants, more than 192,000 were Black individuals and over 104,000 were Hispanic.
In addition to a link between Medicare eligibility and a reduction in racial coverage disparities, researchers found additional changes in racial and ethnic disparities after age 65 years. At a national level, individuals were significantly more likely to have health insurance immediately after turning 65 compared to just before. Further, access to care improved across all racial and ethnic groups at 65 years of age. When it came to self-reported health, the number of individuals in poor self-reported health decreased for Black participants and Hispanic participants 65 years of age.
The greatest reduction in health care coverage disparities were seen in states with the largest racial and ethnic disparities.
“The results highlight an underappreciated aspect of Medicare: it is associated with sharp reductions in racial and ethnic disparities at age 65 years,” wrote study authors. “However, racial and ethnic disparities were not eliminated by Medicare, supporting the view that disparities are shaped not only by policy decisions but also other social determinants of health, such as structural racism, that persist among elderly individuals.”
NYC pilot program takes new response approach to mental health crises, garners better outcomes than police
New York City has launched a pilot program that dispatches mental health specialists and paramedics in place of police to mental health emergency calls, according to the NYC Mayor’s Office of Community Mental Health. The new approach has led to more people accepting assistance and fewer people being transported to the hospital.
The Behavioral Health Emergency Assistance Response Division (B-HEARD) program, which launched in June, aims to provide an alternative response to mental health emergency calls and improved care for mental health issues and emergencies such as suicide attempts, substance misuse, and serious mental illness.
The B-HEARD teams responded to calls in Northern Manhattan, an area that receives the city’s highest number of mental health emergency calls. Within the first month of the program, they received around 16 mental health calls each day.
Other program findings after the first month of operation include:
- Approximately 25 percent of mental health emergency calls made to 911 were routed to B-HEARD teams, and the number is expected to increase to 50 percent in coming months
- The B-HEARD teams responded to 80 percent of calls routed by 911, with the remaining 20 percent of calls received by traditional response teams
- In 95 percent of cases, people accepted assistance from B-HEARD teams, compared to 82 percent who accepted assistance from traditional 911 response
- Fewer people assisted by B-HEARD teams were transported to hospitals (25 percent) compared to those assisted by traditional response (82 percent)
- B-HEARD teams offered follow-up care to all respondents
Uninsured rates increase among Latino children
Latino children are twice as likely to be uninsured compared to their non-Latino peers, according to a recent report from the Georgetown University Center for Children and Families (CFF).
While health coverage improved from 2008-2016 for Latino children, and even reached an all-time low in 2016, the uninsured rate for children in general has progressively increased from 2016-2019, with Latino children disproportionately impacted. Indeed, the uninsured rate for Latino children in 2019 reached 9.3 percent, a 1.6 percent point increase. The uninsured rate for non-Latino children increased 0.7 percent in the same period.
Although 95 percent of Latino children are U.S. citizens, many Latino families avoid enrolling them in Medicaid or CHIP out of fear of immigration consequences, said researchers.
Uninsured rates varied considerably by state, ranging between 1.8 percent in Massachusetts to 19.2 percent in Mississippi. The five states with the highest uninsured rates among Latino children were Mississippi (19.2 percent), Texas (17.7 percent), Tennessee (17.7 percent), Georgia (16.3 percent), and Arkansas (15.5 percent).
The uninsured rate for Latino children was also higher in states that had not implemented Medicaid expansion by 2019 compared to those that did (14.9 percent to 5.8 percent respectively).
The researchers made recommendations at the federal and state level to improve health coverage among Latino children.
Federal recommendations include:
- Conduct robust outreach programs to reach uninsured Latino children eligible for Medicaid or CHIP
- Share clear and consistent messaging regarding the reversal of the Trump-era Public Charge Rule (which previously penalized adults for using public programs prior to gaining citizenship)
- Eliminate all citizenship-based eligibility criteria from Medicaid and CHIP
Their state recommendations include:
- Expand Medicaid coverage
- Streamline and linguistically customize enrollment and renewal processes
- Collaborate with a community-based groups to target outreach and enrollment efforts
- Fund community health worker programs