Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, Nebraska.
Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984335 Nebraska Medical Center, Omaha, Nebraska.
J Adolesc Health. 2024 Jan;74(1):148-154. doi: 10.1016/j.jadohealth.2023.08.051. Epub 2023 Oct 22.
The Promise of Adolescence: Realizing Opportunity for All Youth report recommends several Medicaid policies to increase insurance coverage among adolescents: approve Medicaid expansion; eliminate the 5-year Medicaid waiting period for lawfully present adolescent immigrants; increase Medicaid reimbursement rates for adolescent health services to the level of Medicare; and ensure coverage and sufficient reimbursement of comprehensive health services. We designed this study to identify key advocates and factors relevant to adoption and implementation of the recommended Medicaid policies in Nebraska to highlight opportunities for additional advocacy.
We conducted semistructured interviews January 2022 with 28 adolescent health and health-care access experts in Nebraska, including representatives from health care, education, government, and nonprofit sectors. We recorded the interviews and transcribed them verbatim, then coded data using NVivo software and identified key themes.
Participants were unable to identify any Medicaid advocates or advocacy work focused on adolescents, but they did identify 35 organizations working to improve insurance coverage in Nebraska. Coordinated multisector, statewide coalitions secured the adoption of Medicaid expansion through a citizen-supported ballot initiative. Barriers to successful implementation include limited Medicaid outreach to citizens and lawfully present immigrants. Low state government support for increasing Medicaid reimbursement rates and providing comprehensive health services, coupled with the absence of coordinated advocacy, hinder the adoption of these recommendations.
Advocacy efforts should be implemented to increase adoption and implementation of Medicaid policies recommended to increase adolescents' insurance coverage. These efforts must be built on a foundation of knowledge of state government practices and must utilize sustained partnership among multisector advocates, including adolescent-serving professionals.
《青春期的承诺：实现所有青年的机会》报告建议了几项医疗补助政策，以增加青少年的保险覆盖范围：批准医疗补助扩大范围；取消合法现居的青少年移民的 5 年医疗补助等待期；将青少年健康服务的医疗补助报销率提高到医疗保险水平；并确保全面健康服务的覆盖和充足报销。我们设计这项研究是为了确定在内布拉斯加州采纳和实施建议的医疗补助政策的关键倡导者和相关因素，以突出进一步倡导的机会。
我们于 2022 年 1 月对内布拉斯加州的 28 名青少年健康和医疗保健获取专家进行了半结构化访谈，包括来自医疗保健、教育、政府和非营利部门的代表。我们记录了访谈并逐字转录，然后使用 NVivo 软件对数据进行编码，并确定了关键主题。
参与者无法确定任何专注于青少年的医疗补助倡导者或倡导工作，但他们确实确定了 35 个组织致力于改善内布拉斯加州的保险覆盖范围。协调多部门、全州范围的联盟通过公民支持的投票倡议获得了医疗补助扩大的通过。成功实施的障碍包括有限的医疗补助向公民和合法现居移民的宣传，以及州政府对提高医疗补助报销率和提供全面健康服务的支持有限，加上缺乏协调一致的倡导，阻碍了这些建议的采纳。
应实施倡导工作，以增加采纳和实施建议的医疗补助政策，以增加青少年的保险覆盖范围。这些努力必须建立在了解州政府做法的基础上，并必须利用包括青少年服务专业人员在内的多部门倡导者的持续伙伴关系。
