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

项目摘要/摘要 虽然阿片类药物流行影响到社会各阶层，但在阿片类药物使用障碍方面存在明显的差异。 (OUD)，以及获得OUD治疗，包括阿片类药物使用障碍(Mouds)。成虫 参与刑事司法系统的人不成比例地受到OUD的影响，更有可能离开 未因OUD接受治疗。保险覆盖面对于获得医疗保健很重要，包括我们的治疗。在……下面 平价医疗法案(ACA)，一些州扩大了获得医疗补助的机会，以覆盖更多的低收入者 个人，包括没有子女的成年人。大多数被监禁的人都是低收入和没有保险的人 因此，他们很可能符合医疗补助的条件。此外，一些刑事司法人员可以获得医疗补助 涉案个人受到一项联邦法律的监管，通常被称为“囚犯排斥”，该法律禁止 医疗补助覆盖监狱、监狱、拘留中心或其他惩教设施中的人的医疗服务。一些人 各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覆盖范围，这确实 获释后不需要重新注册。虽然研究表明ACA医疗补助计划的扩大与 随着Moud在整个人口中获得和使用的增加，人们对Moud对 刑事司法涉及个人。此外，人们对暂停州医疗补助的影响知之甚少 关于这一人群的OUD治疗结果的政策。为了解决这一差距，我的论文将使用 评估医疗补助扩大和暂停效果的差值框架 使用2000-2017年的治疗事件数据集就感兴趣的结果制定政策。我的目标有两个： 1)描述刑事司法系统转介的个人在#年接受治疗的结果 时间、地理位置和医疗补助政策状况；以及2)估计医疗补助扩大和 关于刑事司法转介入院治疗结果的医疗补助暂停政策包括：a) 刑事司法转介入院的比例与医疗补助覆盖、私人保险有关 承保范围，没有保险；b)刑事司法将承认与我们的收受有关的比例 Moud总体和保险地位；以及3)刑事司法转介UD的比例 全面完成治疗，并按保险状态和Moud使用情况进行分析。对于这些结果的每一个 有趣的是，我还将按子组探讨这些关系，以捕获OUD严重性(即主要 物质、多物质使用、静脉注射毒品)。考虑到不成比例的疾病负担和 缺乏照顾刑事司法所涉个人的机会，至关重要的是要了解哪些类型的政策 干预措施可能会有效地解决这些差距。这项研究将为我们提供重要和及时的 支持基于证据的政策和决策的信息，以改善获得司法治疗的机会-- 牵涉到个人。

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.