The role of state Medicaid policies in treatment for opioid use disorder in the criminal justice population: Evidence from the Treatment Episode Datasets

州医疗补助政策在刑事司法人群阿片类药物使用障碍治疗中的作用：来自治疗事件数据集的证据

• 批准号: 10352607
• 负责人: Fatema Ahmed
• 金额: $ 5.33万
• 依托单位: UNIVERSITY OF CENTRAL FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-15 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10352607
• 关键词: Address; Admission activity; Adult; Affect; Affordable Care Act; Criminal Justice; Data; Data Set; Decision Making; Enrollment; Epidemic; Exclusion; Face; Funding; Geographic state; Geography; Health Services; Health Services Accessibility; Imprisonment; Improve Access; Individual; Insurance; Insurance Coverage; Intervention; Jail; Justice; Laws; Literature; Low income; Medicaid; Medicaid eligibility; Medical; Mental Health; Outcome; Pharmaceutical Preparations; Police; Policies; Policy Making; Population; Prisons; Privatization; Quasi-experiment; Research; Role; Services; Severities; Societies; Subgroup; Suspensions; System; Time; Treatment outcome; Uninsured; United States; United States Dept. of Health and Human Services; behavioral health; burden of illness; detention center; evidence base; experience; health care availability; interest; intravenous drug use; mortality; opioid epidemic; opioid overdose; opioid use disorder; parity; polysubstance use

PROJECT SUMMARY/ABSTRACT While the opioid epidemic affects all levels of society, there are evident disparities in opioid use disorder (OUD), as well as access to treatment for OUD, including medications for opioid use disorder (MOUDs). Adults involved with the criminal justice system are disproportionately affected by OUD and are more likely to go untreated for OUD. Insurance coverage is important for access to healthcare, including OUD treatment. Under the Affordable Care Act (ACA), some states expanded access to Medicaid to cover more low-income individuals, including childless adults. The majority of incarcerated individuals are low-income and uninsured and are, therefore, likely to be Medicaid eligible. Additionally, access to Medicaid for some criminal justice involved individuals is regulated by a federal law, commonly referred to as “inmate exclusion,” which prohibits Medicaid from covering health services for those in a jail, prison, detention center, or other penal facility. Some states terminate Medicaid for incarcerated individuals, while others suspend Medicaid coverage, which does not require re-enrollment upon release. While research has shown that ACA Medicaid expansion is associated with increased access to and utilization of MOUD in the overall population, little is known about the effects on criminal justice involved individuals. Moreover, little is known about the effects of state Medicaid suspension policies on OUD treatment outcomes in this population. To address this gap, my dissertation will use a difference-in-difference framework to estimate the effect of Medicaid expansion and Medicaid suspension policies on outcomes of interest using the Treatment Episode Datasets from 2000-2017. My aims are two-fold: 1) to describe OUD treatment outcomes for individuals referred to treatment by the criminal justice system over time, by geography, and by Medicaid policy status; and 2) to estimate the effects of Medicaid expansion and Medicaid suspension policies on treatment outcomes for criminal-justice referred admissions including: a) the proportion of criminal justice referred admissions with OUD with Medicaid coverage, private insurance coverage, and no insurance; b) the proportion of criminal justice referred admissions with OUD receiving MOUD overall and by insurance status; and 3) the proportion of criminal justice referred admissions with OUD completing treatment overall and by insurance status and MOUD utilization status. For each of these outcomes of interest, I will also explore these relationships by subgroups to capture OUD severity (i.e., primary substance, polysubstance use, intravenous drug use). Given the disproportionate OUD disease burden and lack of access to care for criminal justice involved individuals, it is critical to understand what types of policy interventions may be effective in addressing these disparities. This research will provide important and timely information to support evidence-based policy- and decision-making to improve access to treatment for justice- involved individuals.

项目总结/摘要 虽然类阿片流行病影响到社会各阶层，但在类阿片使用障碍方面存在明显差异。 (OUD)以及获得OUD治疗，包括阿片类药物使用障碍（MOUD）的药物。成年人 参与刑事司法系统的人受到OUD的影响不成比例， 未经治疗的OUD。保险覆盖对于获得医疗保健，包括OUD治疗很重要。下 根据《平价医疗法案》（ACA），一些州扩大了医疗补助的范围，以覆盖更多的低收入人群。 包括无子女的成年人。大多数被监禁者是低收入和没有保险的人 因此，他们很可能符合医疗补助标准。此外，获得医疗补助的一些刑事司法 涉及的个人受联邦法律的管制，通常被称为“囚犯排除”，该法律禁止 医疗补助从涵盖那些在监狱，监狱，拘留中心，或其他刑罚设施的医疗服务。一些 州终止了对被监禁个人的医疗补助，而其他州则暂停了医疗补助， 不需要在释放时重新登记。虽然研究表明ACA医疗补助的扩张与 随着MOUD在总人口中的获得和使用的增加，人们对MOUD的影响知之甚少。 刑事司法涉及个人。此外，人们对州医疗补助暂停的影响知之甚少 在这一人群中的OUD治疗结果。为了弥补这一差距，我的论文将使用一个 差异中的差异框架，以估计医疗补助扩大和医疗补助暂停的影响 使用2000-2017年治疗事件数据集的关注结局政策。我的目标有两个： 1)描述由刑事司法系统转诊治疗的个人的OUD治疗结果， 时间，地理位置和医疗补助政策状态; 2）估计医疗补助扩张的影响， 医疗补助暂停政策对治疗结果的刑事司法介绍入院，包括：a） 有医疗补助、私人保险的OUD刑事司法转诊入院比例 覆盖面，没有保险; B）刑事司法转介的比例与OUD接收 MOUD整体和保险状况;以及3）刑事司法转介的OUD入院比例 完成整体治疗，并按保险状态和MOUD使用状态分类。对于每一个结果 感兴趣的是，我还将通过子组探索这些关系以捕获OUD严重性（即，初级 物质、多种物质使用、静脉注射毒品使用）。鉴于不成比例的OUD疾病负担， 由于缺乏获得刑事司法照顾的机会，因此了解哪些类型的政策至关重要 干预措施可能会有效地解决这些差距。这项研究将提供重要和及时的 信息，以支持循证政策和决策，改善获得公正待遇的机会- 参与的个人。