Medicaid Coverage for Podiatric Care: A National Survey.

OBJECTIVES: Medicaid provides health insurance for low-income people meeting specific eligibility requirements. It is funded and administered by both the federal and state governments; this decentralization leads to vastly different programs across the country. The objective of this legal surveillance project was to describe state-by-state differences in podiatric care coverage for nonelderly adults across Medicaid programs. METHODS: We used policy surveillance, a form of advanced legal mapping. It is the systematic collection and analysis of written policies across jurisdictions. Policy surveillance captures the important features of law through a rigorous scientific process to turn these policies into structured, quantitative legal data that are suitable for further evaluation or modeling. Data for the 51 jurisdictions were current as of September 1, 2020. RESULTS: The vast majority of jurisdictions (82%) covered podiatric services for all classes of Medicaid beneficiaries, but the rules, restrictions, and limitations around coverage differed. Twenty-five jurisdictions had no limits on the number of podiatric visits during a specified period; 26 jurisdictions indicated a cap. Ten jurisdictions had no explicit limitations on coverage of routine foot care, whereas 33 jurisdictions covered routine foot care only when medically necessary or with a triggering condition. Eight jurisdictions did not cover routine foot care at all, and 28 jurisdictions required prior authorizations. CONCLUSIONS: Podiatric care coverage, which is often preventive, varies greatly by state. This variability in coverage, which has not been previously tracked at the level of detail provided in our study, has implications for cost and health outcomes. The value of podiatric care is especially apparent in Medicaid populations. The compilation of these data can serve as a valuable resource for clinicians, researchers, and policy makers.

State Laws Governing Syringe Services Programs and Participant Syringe Possession, 2014-2019.

OBJECTIVE: Law is an important factor in the diffusion of syringe services programs (SSPs). This study measures the current status of, and 5-year change in, state laws governing SSP operations and possession of syringes by participants. METHODS: Legal researchers developed a cross-sectional data set measuring key features of state laws and regulations governing the possession and distribution of syringes across the 50 US states and the District of Columbia in effect on August 1, 2019. We compared these data with previously collected data on laws as of August 1, 2014. RESULTS: Thirty-nine states (including the District of Columbia) had laws in effect on August 1, 2019, that removed legal impediments to, explicitly authorized, and/or regulated SSPs. Thirty-three states had 1 or more laws consistent with legal possession of syringes by SSP participants under at least some circumstances. Changes from 2014 to 2019 included an increase of 14 states explicitly authorizing SSPs by law and an increase of 12 states with at least 1 provision reducing legal barriers to SSPs. Since 2014, the number of states explicitly authorizing SSPs nearly doubled, and the new states included many rural, southern, or midwestern states that had been identified as having poor access to SSPs, as well as states at high risk for HIV and hepatitis C virus outbreaks. Substantial legal barriers to SSP operation and participant syringe possession remained in >20% of US states. CONCLUSION: Legal barriers to effective operation of SSPs have declined but continue to hinder the prevention and reduction of drug-related harm.

Mapping Housing Laws in the United States: A Resource for Evaluating Housing Policies' Impacts on Health.

CONTEXT: Safe, stable housing is essential to good health. Housing hazards, including mold, vermin, and lead, can contribute to the development or exacerbation of chronic illnesses such as asthma and neurological disorders. In addition, eviction has been associated with poor physical and mental health outcomes. There are many laws aimed at maintaining healthy housing, or protecting access to stable housing, but their impacts are mostly unknown. POLICY: Using scientific legal mapping, the Center for Public Health Law Research (the Center) created legal data sets on state landlord-tenant laws, state fair housing laws, and city nuisance property ordinances. These data sets track the incidence and key features of these laws, creating legal data that can be used for evaluation. Some important elements of these laws include property maintenance duties; protections against retaliation; protected classes under state fair housing laws; discriminatory acts prohibited by state fair housing laws; types of conduct that constitute nuisance activity; and required nuisance abatement actions. IMPLEMENTATION AND/OR DISSEMINATION: As of August 1, 2017, all 50 states and the District of Columbia have a state landlord-tenant law; all states except Mississippi have a state fair housing law; and 37 of the 40 most populous US cities have a local nuisance property ordinance. EVALUATION: Evaluation of these laws is needed to determine their effectiveness and impacts and to spread the use of evidence-based policies. The creation of these legal data sets is the first step toward evaluation. DISCUSSION: Law can play an important role in promoting healthy housing, but evaluating the law is essential to determining its impact. Tracking the prevalence and key elements of laws is an important first step in conducting evaluation. The legal data created by the Center can be used to evaluate the efficacy and impacts of state landlord-tenant laws, state fair housing protections, and city nuisance property ordinances.