Pam Silberman, DrPH

North Carolina Rural Health Research and Policy Analysis Center

Phone: 919.401.6599
Fax: 919.966.5764
E-mail: silber@ncio.org

Rural Health Research and Policy Analysis Center
University of North Carolina - Chapel Hill
725 Airport Road CB 7590
Chapel Hill, NC 27599-7590

Completed Projects

Impact of The Medicaid Budget Crisis on Rural Communities: A 50-State Survey
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Medicaid and S-CHIP
The impact of the Medicaid budgetary crisis on rural communities across the US will be assessed through a 50-state survey of state Medicaid agencies, state Offices of Rural Health and state rural health associations.

Medicaid Managed Care in Rural Areas: Innovative Case Management Strategies, Lead researcher
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Medicaid and S-CHIP

Premium Assistance Programs: Exploring Public-Private Partnerships as a Vehicle for Expanding Health Insurance to Rural Uninsured
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Health insurance and the uninsured
This project examines the experience of states that have implemented premium assistance programs in rural areas to determine whether there are certain design features or certain types of rural communities where these programs may be more feasible.

State Facts about Medicaid: Rural Specific Data
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Medicaid and S-CHIP, Rural statistics and demographics
This project will develop state-specific fact sheets which will include information on the groups covered (and income eligibility), structure of the state’s SCHIP program, services covered, delivery system, some provider payment information for certain safety net providers, and percentage of the state’s rural and urban population that are enrolled in Medicaid. Additional information comparing urban and rural areas of the state will be provided, when available. The rural and urban comparisons will include total numbers of Medicaid recipients, Medicaid expenditures, and enrollment in different types of managed care plans.

Tracking the Implementation of Medicaid Managed Care in Rural Areas
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Medicaid and S-CHIP

Publications

• Design of Enhanced Primary Care Case Management Programs Operating in Rural Communities: Lessons Learned from Three States
  Author(s): Stephanie Poley, Pam Silberman, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topic: Medicaid and S-CHIP
  Date: 03 / 2003
  Discusses state programs that provide enhanced benefits to Medicaid beneficiaries such as enhanced primary care case management (PCCM). Examples from three states: Florida, North Carolina and Oklahoma.
• Effect of Market Reform on Rural Public Health Departments
  Author(s): Rebecca Slifkin, Pam Silberman, Susan Reif
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topic: Public health
  Date: 01 / 2000
  This study seeks to determine how rural health departments and populations they serve have been affected by recent health system changes, especially Medicaid managed care.
• Impact of Medicaid Cuts on Rural Communities
  Author(s): Pam Silberman, Matt Rudolf, Laura Brogan, Stephanie Poley, Rebecca Slifkin, Charity Moore
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Medicaid and S-CHIP, Poverty
  Report Number: Working Paper No. 82
  Date: 08 / 2005
  Medicaid is a critical program in both urban and rural areas, but it is particularly important in rural areas because of high levels of poverty and less access to employer-sponsored insurance. This study assesses the perception of state Medicaid staff and individuals from State Offices of Rural Health (SORH) and Rural Health Associations (RHA) regarding the impact on rural areas of state Medicaid policy changes that occurred between 2002 and 2004. Despite the importance of this program to rural communities, our study suggests that few people are specifically concerned with the unique challenges Medicaid changes may pose to rural communities. This study presents insight to the potential rural impact of Medicaid policy changes, especially those that could adversely affect the ability of rural residents to access services or that might potentially affect the overall rural health infrastructure.
• Impact Of The Medicaid Budgetary Crisis On Rural Communities
  Author(s): Pam Silberman, Matthew Rudolf, Cammie D'Alpe, Randy Randolph, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topic: Medicaid and S-CHIP
  Report Number: Working Paper No. 77
  Date: 08 / 2003
  Provides an overview of the Medicaid program and options states have to reduce program costs. Steps states have proposed or taken to reduce Medicaid costs and the potential impact of these changes on rural areas are discussed. The potential impact on rural communities of federal proposals to redesign Medicaid is assessed.
• Innovative Primary Care Case Management Programs Operating in Rural Communities: Case Studies of Three States
  Author(s): Pam Silberman, Stephanie Poley, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topic: Medicaid and S-CHIP
  Report Number: Working Paper No. 76
  Date: 01 / 2003
  Medicaid managed care programs have been continually growing in the past decade, but this system has posed some problems to rural areas. In order to address these problems, some states have developed alternative managed care strategies, including enhanced primary care case management (PCCM). This study examines three states that have implemented PCCM and provides an overview of each program including their strengths and weaknesses. The states studied are Florida, North Carolina, and Oklahoma.
• Premium Assistance Programs for Low Income Families: How Well Does it Work in Rural Areas?
  Author(s): Pam Silberman, Laura Brogan, Charity Moore, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty
  Report Number: Working Paper No. 85
  Date: 01 / 2006
  Reports results of a study on the viability in rural areas of premium assistance programs use Medicaid or State Children's Health Insurance (SCHIP) funding to subsidize the premium costs of employer-sponsored insurance or private non-group policies for eligible individuals. Because of the characteristics of rural residents and their employment markets, many stand to benefit from premium assistance programs, but there are also reasons to believe that these programs may be less successful in rural communities. Findings form the telephone survey of Medicaid or SCHIP officials in 14 of the 16 states with at least one premium assistance program indicate that premium assistance programs have not lived up to their potential. Enrollment in most of the states' programs has been small, and while positive in concept, these programs have inherent limitations that may preclude more widespread enrollment. Of particular concern is that rural residents are more likely to work for small employers who do not offer health insurance or have higher premiums or less comprehensive benefits. However, with creative program design, premium assistance programs may be a useful tool for states to expand health insurance coverage to the rural uninsured.
• State Profiles of Medicaid and SCHIP in Rural and Urban Areas
  Author(s): Jennifer King, Leslie Geiger, Pam Silberman, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Medicaid and S-CHIP, Rural statistics and demographics
  Report Number: Final Report No. 91
  Date: 08 / 2007
  This final report is one component of a larger project that includes the development of web-based State Profiles of Medicaid and SCHIP in Rural and Urban Areas. The report provides national data comparing Medicaid enrollment and expenditures in rural and urban counties. A summary of these and other data found in the State Profiles is included.
• Tracking Medicaid Managed Care in Rural Communities: A Fifty-State Follow-Up
  Author(s): Pam Silberman, Stephanle Poley, Kerry James, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topic: Medicaid and S-CHIP
  Citation: Health Affairs, 21(4), 255-263
  Date: 08 / 2002
  Updates a 1997 study examining implementation of rural Medicaid managed care programs. Among its findings are that there have been significant state-level changes in the types of programs offered; there has been an overall increase in the percentage of urban and rural counties with Medicaid managed care programs; and SCHIP expansion has had little impact on the operation of fully capitated Medicaid managed care programs in rural areas because the increased number of children covered has not been large enough to affect health plans' participation. Concludes that looking only at the increase in rural Medicaid managed care since 1997 could lead to a false impression. While the number of rural counties with fully capitated programs has increased, states' more recent experiences suggest that health plans are pulling out of rural areas just as they are pulling out of urban ones. States may find it difficult to find commercial HMOs willing to participate in Medicaid managed care at prices that states can afford.