Assessing gaps between policy and practice in Medicaid disenrollment of jail detainees with severe mental illness.
Assessing gaps between policy and practice in Medicaid disenrollment of jail detainees with severe mental illness.
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评估患有严重精神疾病的监狱被拘留者退出医疗补助的政策与实践之间的差距。
DOI：
10.1176/ps.2006.57.6.803
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Cuellar,Alison
中科院分区：
文献类型：
--
作者：
Morrissey,JosephP;Dalton,KathleenM;Steadman,HenryJ;Cuddeback,GaryS;Haynes,Diane;Cuellar,Alison
目的：本前瞻性队列研究在两个大型大都市监狱系统检查是否医疗补助取消登记政策被拘留在监狱。确定了患有严重精神疾病的人在拘留期间失去医疗补助的程度。方法：2000年向各州医疗补助主任邮寄问卷，回复率为95%。董事们回答了有关入选者成为公共机构囚犯后所遵循的程序的问题。此外，还将佛罗里达州金县（西雅图）和皮内拉斯县（克利尔沃特和圣彼得堡）的社区精神卫生服务记录、监狱拘留记录和医疗补助登记记录联系起来，以确定在两年期间（1996-1998年金县和1998-2000年皮内拉斯县）任何时间被监禁的患有严重精神疾病的人。样本包括代表金县4,482次拘留的1,816人和代表皮内拉斯县2,878次拘留的1,210人。拘留被用作分析单位，以确定在监狱监禁期间医疗补助计划被取消登记的频率。结果：包括佛罗里达州和华盛顿州在内的许多州的规定政策是在监禁时终止医疗补助福利，但在每个县，只有3%的在押人员参加了医疗补助计划。在这两个县，97%的被拘留者在进入监狱时就有医疗补助，在出狱时也有。在这两个县，在监狱中失去医疗补助的3%的人的监禁时间更长（3到5个月，而16到30天）。结论：所陈述的政策与实际的医疗补助计划不一致，严重精神疾病患者被监禁。在大多数情况下，短期监禁允许患有严重精神疾病的被拘留者保留他们的医疗补助福利。（精神科服务57:803-808,2006）
Objective: This prospective cohort study in two large metropolitan jail sys-tems examined whether Medicaid disenrollment policies for persons detained in jail were enforced. The extent to which persons with severe mental illness lost their Medicaid benefits while detained was determined.Methods: Mailed questionnaires to state Medicaid directors in 2000 yield-ed a 95 percent response rate. Directors responded to questions about procedures that are followed when enrollees become inmates in public institutions. In addition, community mental health service records, jail detention records, and Medicaid enrollment records were linked in King County (Seattle) and in Pinellas County (Clearwater and St. Petersburg), Florida, to identify persons with severe mental illness who were incarcerated at any time during a two-year period (1996–1998 in King County and 1998–2000 in Pinellas County). The samples consisted of 1,816 persons representing 4,482 detentions in King County and 1,210 persons representing 2,878 detentions in Pinellas County. Detentions were used as the unit of analysis to determine how often Medicaid disenrollment occurred during jail incarceration. Results: The stated policy in many states, including Florida and Washington, is to terminate Medicaid benefits upon incarceration, but termination occurred for only 3 percent of the detainees enrolled in Medicaid in each county. In both counties, in 97 percent of the detentions, persons who had Medicaid at entry also had it upon release. In both counties, the 3 percent who lost Medicaid while jailed had longer jail stays (three to five months compared with 16 to 30 days). Conclusions: Stated policies do not align with actual Medicaid disenrollment of persons with severe mental illness who become incarcerated. In most instances, short jail stays allowed detainees with severe mental illness to retain their Medicaid benefits.(Psychiatric Services 57: 803–808, 2006)
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