Reports

This New Jersey case study provides insights into the daunting challenges states face in seeking to address the home care worker shortage, which has become more acute as New Jersey and other states have striven to “re-balance” Medicaid long-term services and supports use and spending away from institutional care toward home and community-based services.

Direct care workers (DCWs) such as nursing assistants, home health aides, and personal care assistants play an essential role in the health and well-being of over 20 million Americans. Yet DCW wages are not enough to make jobs competitive with entry level positions in other industries with similar job requirements which exacerbates the challenges in recruitment and retention of these workers.

People living with dementia often have complex health and social support needs that can best be met by health care and community-based providers working together. This brief examines promising practices for bridging community-based organizations and health care systems in the providing comprehensive dementia care.

March-in authority allows the federal government to grant licenses on privately owned patents for inventions developed with federal funding provided certain statutory requirements are met. It was designed to ensure that the benefits of the American taxpayers’ investment in research and development are reasonably accessible to the public.

During the pandemic period, telehealth utilization increased among both urban and rural enrollees in Medicaid, with urban enrollees sustaining greater gains in telehealth utilization at the end of 2021. This Issue Brief is part of a series of ASPE Issue Briefs examining changes in Medicaid utilization of services delivered via telehealth by enrollee and provider characteristics.

The Centers for Medicare & Medicaid Services (CMS) Innovation Center is in the process of developing the Medicare $2 Drug List (M2DL) Model. This would allow Part D plan sponsors to offer a standardized list of generic drugs for a copayment of $2 or less for a month’s supply that would not be subject to prior authorization, quantity limits, or other utilization management restrictions.

In this Report, we matched a sample of Part D drugs and biological products that had price changes between January 2011 and October 2023 to FDA’s January 2023 list of drug shortages database. Then we analyzed price changes that occurred before and after the shortage, overall and by select drug characteristics of interest.

In this Report, we matched a sample of Part B drugs and biological products that had price changes between January 2011 and October 2023 with the FDA’s January 2023 list of drug shortages database. Then we analyzed price changes that occurred before and after the shortage, overall and by select drug characteristics of interest.

Individuals returning to the community from prisons and jails face numerous barriers to reentry, and securing safe, stable housing is often the most immediate challenge. Housing is a vital element of successful reentry.

This study examined the extent therapist practices and nursing homes adopted telehealth services for physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP); explored the major challenges and facilitators in adopting telerehabilitation services, and whether these services were effective in addressing patient care and staffing needs during the public health emergenc

Recruiting and retaining a talented workforce requires employers to implement supports for family caregivers who are balancing the dual roles of working and caregiving.

The recent designation of the three-digit “988” dialing code is intended to improve public awareness of an immediate means to behavioral health crisis services, resulting in both a diversion of behavioral health calls from 911 as well as increased utilization of call services among people in crisis who are not currently getting help.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has recently developed guidelines for establishing a comprehensive crisis response system for behavioral health. Per these guidelines, a comprehensive system should provide individuals in crisis with “someone to call,” “someone to respond,” and “a place to go” to receive crisis response services.

This issue brief examines trends related to market size measured via sales revenues and volume of prescription drug use between the U.S. and other countries between 2017 and 2023. Specifically, we compare the U.S. to the rest of the world (excluding the U.S.) and the other OECD countries (excluding the U.S.).

Inpatient psychiatric facilities (IPFs) stabilize patients in a mental health crisis and provide services to patients with serious mental illnesses and those who may cause harm to themselves or others, including people living with dementia who have severe behavioral and psychological symptoms.

In 2020, Congress designated the new 988 dialing code to be operated through the existing National Suicide Prevention Lifeline. The 988 Suicide and Crisis Lifeline was established to improve access to immediate support to meet the behavioral health crisis needs in the United States.

This brief examines the timing of Medicaid and Children’s Health Insurance Plan (CHIP) enrollment relative to timing of engagement with child welfare services for children in Florida and Kentucky. The analysis covers children involved in child welfare systems from 2017-2021.

Recovery support services (RSS) are non-clinical services that assist individuals and families in attaining and sustaining recovery from substance use disorders.

This brief describes the relationship between employment and formal educational experiences of refugees prior to resettling in the U.S., and their socioeconomic situation within their first five years in the country.Key Points

People with co-occurring mental health and substance use disorders (SUDs) benefit from integrated treatment to address both disorders concurrently. For several decades, policymakers and behavioral health systems have worked to overcome the historical separation between mental health and SUD treatment to improve care for people with co-occurring disorders.

Health Information Technology (HIT) was identified as a critical component of the HHS Roadmap for Behavioral Health Integration. To support the implementation of the Roadmap, an ASPE study was conducted to provide an overview of HIT adoption and utilization among behavioral health providers.

Since March 2020, HHS and DEA have allowed health care practitioners to initiate controlled medications via a telehealth visit without first conducting an in-person medical evaluation, representing a substantial change in how these medications, and the conditions they are used to treat, can be managed.

This brief summarizes findings from a research project that examined access to and use of tele-mental health services among individuals with serious mental illness (SMI) and children with serious emotional disturbance (SED) and behavioral health consumer and provider perceptions of the optimal balance of telehealth and in-person services for people with SMI and SED.

Insufficient access to behavioral health (BH) care and the inability to get timely care are significant problems in the United States. Concerns about BH network adequacy have been prompted by evidence of narrow networks for BH, variation in network adequacy across plans, and evidence that network adequacy impacts access to certain specialties.

Prescription drug prices are a top concern for policymakers and the public, but little data is available on prescription drug prices or other costs that contribute to premiums for commercial drug coverage.

People experiencing homelessness often have complex health care and social service needs which present significant care challenges to hospitals, such as longer lengths of stays, higher readmission rates, and complicated chronic illnesses.

IntroductionMeans-tested benefits are designed to support basic needs such as food, health insurance, and child care for households with low incomes. When considering whether to take a new job opportunity that will increase their income, recipients of these benefits may be forced to consider trade-offs. For example:

This project explored how workers with low incomes who receive federal benefits weigh factors including marginal tax rates, benefit loss, ease of resuming benefits once lost, and job instability when deciding whether to accept an earnings increase.

Infographic: Earnings, Benefit Loss, and Job Instability: What Do People Receiving TANF Consider When Offered a Higher-Paying Job?Related Products:

State Medicaid programs have the option to cover supported employment services, but use of these services by the Medicaid population has not been widely studied.

In November 2024, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Program; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly proposed rule.

Childhood development experts recommend specific practices for afterschool and youth development programs to promote well-being and healthy development, including positive relationships; rich learning experiences and knowledge development; environments filled with safety and belonging; the development of skills, habits, and mindsets; and integrated support systems.

This second report focuses largely on updating pre-NSA trends in claims data presented in the first report.

The pipeline and commercial market for novel antimicrobial drugs is insufficient to address current and future patient needs or mitigate the loss of effective treatments as antimicrobial resistance spreads. The U.S. Government implements a range of efforts to ensure sustainable availability of antimicrobial treatments, supporting research, product development, and appropriate use.

National estimates indicate that streamlined renewal options for Medicaid beneficiaries with incomes below 100 percent of the federal poverty level and without an ex parte income data source would provide timely and accurate eligibility determinations.

This study of national retail pharmacy data from 2013 to 2022, found an overall increase in buprenorphine dispensed to women of reproductive age and a marked increase in fills that were prescribed by nurse practitioners/physician assistants.

This report presents findings of an environmental scan and semi-structured interviews with key contributors, including governmental and non-governmental contributors, such as researchers, clinicians, advocates, service provider/payers, and policy experts. The findings included in this report are organized by specific domains and themes found within the peer-reviewed and grey literature.

This report outlines a feasibility study focused on obtaining identifiers for self-directed Home and Community-Based Services (HCBS) users within Medicaid claims data. Financial Management Services (FMS) entities assist individuals in managing the financial aspects of self-directed care, including payroll and billing.

In order to support state and local outreach efforts, ASPE has developed state, county, and local estimates of the number of U.S. residents without health insurance and their demographic characteristics, using the most recent Census data available from the 2023 American Community Survey (ACS).

The Affordable Care Act Marketplace has led to substantial coverage gains among small business owners and self-employed individuals. The enhanced premium tax credits introduced by the American Rescue Plan and the Inflation Reduction Act have contributed to further increases in Marketplace coverage among small business owners and self-employed workers.  

This research report describes patterns in insurance coverage and uninsurance rates in rural and urban areas, reviews non-financial challenges in accessing care faced by many rural residents, and describes disparities in health outcomes between urban and rural areas.

The final summary report on “Developing and Piloting a Federal Evaluation Approach for Complex Cross-Agency Initiatives: The Overdose Prevention Test Case” lays out the findings of HHS effort to test a cross-departmental methodology.

This issue brief shows coverage gains among young adults under the Affordable Care Act, the American Rescue Plan, and the Inflation Reduction Act. The uninsured rate among this group declined by more than half, from 31.5 percent in 2009 to 13.1 percent in 2023, as employer-sponsored dependent coverage increased by over 20 percent.

This report outlines the major issues faced by the U.S. health care workforce. It addresses medical, dental and behavioral health components of the workforce as well as direct care workers. The report also describes opportunities for progress to address these issues and existing activities supported by the Department to address these issues.

The Inflation Reduction Act established a limit on out-of-pocket spending (“the 2024 cap”) for enrollees with very high prescription drug spending in Medicare Part D, for the first time in the history of the program.

This guidance, originally published in 2003, contains the following introduction:

Rare cancer clinical trials appear to enroll less diverse participants than clinical trials more broadly and therefore may require additional considerations or unique solutions to diversify participant recruitment. These differences persisted within both NIH and non-NIH funded trials.

The purpose of this research was to understand the relationship between state Medicaid payment rates to nursing homes and those facilities’ costs of providing care to Medicaid residents.

It is anticipated that extreme weather events due to climate change will increase the prevalence of a number of acute and chronic diseases. As a result, the demand for drugs to prevent or treat those conditions is likely to increase.

The cost of bringing a medical product to the U.S. market has been increasing and clinical trials constitute a large portion of these costs. In drug development, the clinical phase lasts an average of around 95 months compared to 31 months for the non-clinical phase and accounts for 69 percent of overall R&D costs (DiMasi, et al., 2016).