Affordable Care Act: Examining Policies & Implementation with State & Local Public Health Departments

On behalf of the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within the Department of Health and Human Services (HHS), NORC conducted this study to examine how expanded insurance coverage and enhanced coverage of clinical preventive services has changed how individuals seek healthcare services, shifts where preventive services are obtained, and affects the role of state and local health departments within their communities.

Project activities included case studies to ten states, and ongoing consultation with a Technical Advisory Group (TAG). Qualitative data were collected via interviews with staff from state health departments and select local health departments (LHDs). Interviewees included the state health officer, program staff, Medicaid staff, and LHD staff. Participating states varied in terms of geography, provision of clinical services, population served, and Medicaid expansion status. This study was a follow-on to the FY2012 study “Implications of the Affordable Care Act for HHS Public Health Programs” that NORC conducted for ASPE.

The study identified how health departments have responded to health reform and the anticipated future changes to public health practice. Findings show that health departments have seen reductions in client volume for some public health programs (e.g., immunizations, breast and cervical cancer screening) since the implementation of health reform. While states are expanding their capacity to bill for services, they report that billing is unlikely to fully replace program revenue should program funds be reduced. Many study respondents discussed that some health departments may need to continue providing preventive services, especially in areas where there is an insufficient number of providers.

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