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Trends in Medicaid and CHIP Eligibility Over Time

Appendix A

Table 1: States by Region, Medicaid Expansion Status, and Health Ranking
State Region Medicaid Expansion Status Health Ranking
Alabama South Has Not Adopted Low
Alaska West Implemented Middle
Arizona West Implemented Low
Arkansas South Implemented Low
California West Implemented Middle
Colorado West Implemented High
Connecticut Northeast Implemented High
Delaware South Implemented Low
DC South Implemented Not Ranked
Florida South Has Not Adopted Low
Georgia South Has Not Adopted Low
Hawaii West Implemented High
Idaho West Has Not Adopted Middle
Illinois Midwest Implemented Low
Indiana Midwest Implemented Low
Iowa Midwest Implemented Middle
Kansas Midwest Has Not Adopted Middle
Kentucky South Implemented Low
Louisiana South Has Not Adopted Low
Maine Northeast Has Not Adopted Middle
Maryland South Implemented Middle
Massachusetts Northeast Implemented High
Michigan Midwest Implemented Low
Minnesota Midwest Implemented High
Mississippi South Has Not Adopted Low
Missouri Midwest Has Not Adopted Low
Montana West Implemented Middle
Nebraska Midwest Has Not Adopted High
Nevada West Implemented Low
New Hampshire Northeast Implemented High
New Jersey Northeast Implemented High
New Mexico West Implemented Low
New York Northeast Implemented Middle
North Carolina South Has Not Adopted Low
North Dakota Midwest Implemented High
Ohio Midwest Implemented Low
Oklahoma South Has Not Adopted Low
Oregon West Implemented High
Pennsylvania Northeast Implemented Middle
Rhode Island Northeast Implemented Middle
South Carolina South Has Not Adopted Low
South Dakota Midwest Has Not Adopted Middle
Tennessee South Has Not Adopted Low
Texas South Has Not Adopted Low
Utah West Has Not Adopted High
Vermont Northeast Implemented High
Virginia South Has Not Adopted Middle
Washington West Implemented High
West Virginia South Implemented Low
Wisconsin Midwest Has Not Adopted Middle
Wyoming West Has Not Adopted Middle
Sources: Regions based on U.S. Census Bureau, Medicaid expansion based on KCMU analysis, health ranking based on “America’s Health Ranking state health scores, 2015.

Appendix B: Overview of America’s Health Rankings

America’s Health Ranking is produced annually by United Health Foundation, the American Public Health Association and the Partnership for Prevention (http://www.americashealthrankings.org/). The health rankings for states are developed based on four groups of health determinants, including: behaviors, community & environment, policy and clinical care, and several measures of health outcomes.

The overall health score is calculated by adding the score of each measure multiplied by the measure weight (see Table 2). The ranking is the order of each state according its overall score; ties in values are assigned equal rankings.

The score for each measure is a representation of the number of standard deviations a state is above or below the national mean. The national mean is set at the average value of the states and DC. It is calculated by:

Score = (State value – National mean)/Standard Deviation of all state values.

This is commonly known as a “Z-score”. The score is stated as a decimal ranging from positive to negative 2. Higher scores mean that a state has a higher value than the national average, while lower scores mean that the state has a lower value than the national average. Table 2 shows whether a higher value has a negative or a positive impact on the health ranking.

Table 2: Measures, Weights, and Sources for America’s Health Rankings Scores, 2015

Name of Measure

% of Score Effect on Score Source
Behaviors 25.0
Smoking (% of adult population) 7.5 Negative Behavioral Risk Factors Surveillance System (BRFSS), 2014
Binge Drinking (% of adult population) 2.5 Negative BRFSS 2014
Drug Deaths (Deaths/100,000) 2.5 Negative National Vital Statistics System, 2011 – 2013
Obesity (% of adult population) 5.0 Negative BRFSS, 2014
Physical Inactivity (%of adult population) 2.5 Negative BRFSS, 2014
High School Graduation (%of incoming 9th graders) 5.0 Positive National Center for Education Statistics, 2012 – 2013
Community & Environment 22.5
Violent Crime (Offenses/100,000) 5.0 Negative Federal Bureau of Investigation, 2013
Occupational Fatalities (Deaths/100,000 workers) 2.5 Negative Census of Fatal Occupational Injuries, 2012 – 2014 P&US Bureau of Economic Analysis
Infectious Disease (Combined score for Chlamydia, Pertussis, and Salmonella cases/100,000) 5.0 Negative Summary of Notifiable Disease, 2013 & NCHHSTP Atlas, 2013
Children in Poverty (% of children) 5.0 Negative 2014 Annual Social and Economic Supplement, 2014
Air Pollution (Micrograms of fine particles/ cubic meter) 5.0 Negative Environmental Protection Agency, 2012 – 2014
Public & Health Policies 12.5    
Lack of Health Insurance (% of population) 5.0 Negative American Community Survey, 2013 – 2014
Public Health Funding (Dollars/person) 2.5 Positive Trust for America’s Health, 2013 – 2014
Immunization – Children (% aged 19 to 35 mos) 2.5 Positive National Immunization Survey, 2014
Immunization – Adolescents (% aged 13 to 17 yrs) 2.5 Positive National Immunization Survey, 2014
Clinical Care 15.0    
Low Birthweight (Percent of live births) 3.75 Negative National Vital Statistics System, 2013
Primary Care Physicians (Number/100,000) 3.75 Positive American Medical Association, 2013
Dentists (Number/100,000) 3.75 Positive American Dental Association, 2013
Preventable Hospitalizations (Number /1,000 Medicare beneficiaries) 3.75 Negative Darmouth Atlas, 2013
Outcomes 25.0    
Diabetes (Percent of adult population) 3.125 Negative BRFSS, 2014
Poor Mental Health Days (Days in previous 30 days) 3.125 Negative BRFSS, 2014
Poor Physical Health Days (Days in previous 30 days) 3.125 Negative BRFSS, 2014
Disparity in Health Status (Percent difference by education level) 3.125 Negative BRFSS, 2014
Infant Mortality (Deaths per 1,000 live births) 3.125 Negative National Vital Statistics System, 2012 – 2013
Cardiovascular Deaths (Deaths/100,000) 3.125 Negative National Vital Statistics System, 2011 – 2013
Cancer Deaths (Deaths/100,000) 3.125 Negative National Vital Statistics System, 2011 – 2013
Premature Deaths (Years lost/100,000) 3.125 Negative National Vital Statistics System, 2013
Conclusion

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