Access to Mental Health Services among Released State Prisoners

描述（由申请人提供）：被监禁者承受着慢性和严重健康状况的沉重负担：囚犯中艾滋病毒的流行率是一般人口的五倍，25%-50%的囚犯有精神健康问题。在入狱前，一些最残疾和最贫困的囚犯，包括那些患有严重精神疾病的囚犯，能够通过参加医疗补助计划获得医疗保健。人们对这些人的确切医疗需求知之甚少，但他们获得医疗补助的资格以及与刑事司法系统的关系表明，他们面临着社会、经济和健康相关问题的大漩涡。在这些人过渡到他们的社区时，继续获得医疗保健对于保护他们自己的健康和他们返回的社区的健康特别重要。然而，美国大部分地区的现行政策阻碍了在监狱释放时恢复医疗补助。在大多数州，医疗补助登记在入狱后终止；囚犯可以在出狱后重新申请医疗补助，但批准通常需要几个月的时间。在恢复医疗补助之前，最近释放的慢性病囚犯必须艰难地过渡到社区生活，通常没有办法支付医疗服务费用。医疗补助方面这些疏漏的影响尚不清楚，但现有证据表明，对于患有慢性和严重疾病的获释囚犯，疏漏导致健康状况恶化、疾病传播、再次入狱和更高的医疗费用。为了缩小医疗差距，纽约州在2008年开始暂停（而不是终止）监禁时的医疗补助，允许释放的囚犯立即恢复医疗补助。尽管人们认为，与终止医疗补助计划相比，暂停医疗补助计划可以改善医疗服务的连续性，但这项政策的实际效果尚不清楚。为了评估医疗补助政策对前囚犯使用医疗保健的影响，我们将构建并分析一个连接州监狱记录和医疗补助记录的新数据库。我们将把纽约（NY）和北卡罗来纳（NC） 2007-2009年的记录联系起来。比较纽约州政策变化前后的数据，我们将研究医疗补助政策（终止与暂停）是否对在监禁前注册医疗补助的释放囚犯在释放后恢复医疗补助资助服务的速度有影响。使用来自纽约州和北卡罗来纳州的数据，我们还将研究恢复医疗补助资助的护理的差距是否会影响医疗补助资助的护理使用量（例如住院天数）、护理成本和再监禁。除了拟议的分析之外，在这一试点项目中建立的数据库将导致未来若干政策方向的重大研究，以改善获释囚犯的健康和心理健康。

DESCRIPTION (provided by applicant): Incarcerated persons bear a heavy burden of chronic and severe health conditions: the prevalence of HIV among prisoners is five times that of the general population, and 25%-50% of prisoners have a mental health condition. Before incarceration, some of the most disabled and impoverished prisoners, including those with severe mental illness, are able to access healthcare through enrollment in Medicaid. Little is known about the exact healthcare needs of these individuals, but their eligibility for Medicaid and involvement with the criminal justice system suggest a maelstrom of social, economic, and health-related problems. The continued access to healthcare as these individuals transition to their community is particularly important to protect their own health and the health of the communities to which they return. Yet current policies in much of the US impede resumption of Medicaid at prison release. In most states, Medicaid enrollment is terminated upon admission to prison; prisoners may re-apply for Medicaid following their release from prison, but approval often takes months. Until they resume Medicaid coverage, recently released chronically ill prisoners must navigate the difficult transition back to community life typically with no means to pay for health services. The effects of these lapses in Medicaid are not well understood, but existing evidence suggests that for released prisoners with chronic and severe disorders, gaps in care lead to worsened health, disease transmission, re-incarceration, and higher healthcare costs. To diminish gaps in care, New York in 2008 began suspending, rather than terminating, Medicaid benefits upon imprisonment, allowing released prisoners to immediately resume Medicaid coverage. Although it is assumed that Medicaid suspension-compared to termination-improves continuity of care, the actual effect of this policy is unknown. To assess the effect of Medicaid policy on former prisoners' use of healthcare, we will construct and analyze a novel database linking state prison records with Medicaid records. We will link records for the years 2007-2009 for New York (NY) and North Carolina (NC). Comparing data from before and after the policy change in NY, we will examine whether Medicaid policy (termination vs. suspension) had an effect on how quickly released prisoners who were enrolled in Medicaid prior to their incarceration resumed Medicaid-funded services after their release. Using data from NY and NC, we will also examine whether gaps in resuming Medicaid-funded care affects the amount of Medicaid-funded care used (e.g. hospitalization days), the costs of that care, and re-incarcerations. In addition to the proposed analyses, the database constructed in this pilot project will lead to several future lines of policy-significant research to improve the health and mental health of released prisoners.