Increasing Medicaid Acquisition and Sustainment among the Uninsured

摘要 未参保的患者承受着灾难性的医疗支出，死亡率更高，甚至更多 获得重要医疗资源的机会有限(例如，预防性或专科护理、康复、精神卫生 健康)与参保患者相比。没有保险的个人通常会推迟护理，直到紧急治疗 这可能会导致虚弱的疾病、失业和高昂的医疗费用。70%以上的 没有保险的患者无法支付医疗费用，美国的医院和各州将首当其冲地承受 无偿护理(420亿美元)。医院推定资格(HPE)，基于医院的紧急情况 医疗补助计划，是解决这些问题的一个成功方案。患者登记参加临时HPE医疗保健 保险(最多60天)，有机会通过申请医疗补助全覆盖来维持保险。 尽管HPE是国家医疗补助要求，但就HPE而言，加州是更具包容性的州之一 资格。在3100万未参保的美国人中，10%的人在世界第五大城市加利福尼亚州 经济舱。 在我们之前通过NIMHD资助的R21期间，我们与加利福尼亚州 医疗保健服务(DHCS)创建一个创新的新数据集，以跟踪全州的HPE参与者 并纵向跟踪他们以评估医疗补助的维持情况。超过100,000人以前未投保 加州人每年参加HPE，其中高达%的人在六个月内维持医疗补助。住院病人，那些 需要手术或出院后健康服务的人更有可能维持保险，少数群体 不太可能持续下去。在所有医院，医疗补助的维持率从33%到97%不等。我们的初步数据 建议患者的社会人口统计、医院人员和县级人员的可用性和培训 参与度有助于在HPE投保后成功维持医疗补助。响应PAR-20-310， 对医疗补助维持的可修改预测因素的研究将指导我们发展长期保健服务医院 以及县利益攸关方知情的“最佳做法”工具包干预，以便在医院间传播， 增加和减少基于保险的差距的目标。 我们将追求三个具体目标：(SA1)量化描述医院之间的维持分配 并确定与HPE后医疗补助支持相关的患者和医院层面的因素(SA2) 定性确定在以下方面促进或限制医疗补助支持成功的医院和县做法 不同的环境，并(SA3)开发一个利益攸关方知情的最佳实践“工具包”，旨在增加医疗补助 跨医院和县的支持。 我们通过制定增加持续保险覆盖面的战略的目标是改善获得护理的机会， 弱势和未参保患者的临床结果和财务健康。

ABSTRACT Uninsured patients are subject to catastrophic health expenditures, have higher rates of mortality, and far more limited access to important healthcare resources (e.g., preventative or specialist care, rehabilitation, mental health) compared to insured patients. Uninsured individuals often defer care until treatment is urgently required, which can lead to debilitating disease, job loss and high medical bills. With more than 70% of uninsured patients unable to pay for their healthcare, U.S. hospitals and states are left to bear the brunt of uncompensated care ($42 billion). Hospital Presumptive Eligibility (HPE), a hospital-based emergency Medicaid program, is a successful solution to these problems. Patients enroll in temporary HPE healthcare coverage (up to 60 days), with an opportunity to sustain insurance by applying for Medicaid full coverage. Although HPE is a national Medicaid requirement, California is among the more inclusive in terms of HPE eligibility. Among the 31 million remaining uninsured Americans, 10% are in California, the world’s 5th largest economy. During our previously funded R21 through the NIMHD, we collaborated with the California Department of Healthcare Services (DHCS) to create an innovative new dataset that tracks HPE enrollees across the state and follows them longitudinally to evaluate for Medicaid sustainment. Over 100,000 previously uninsured Californians enroll in HPE annually, up to 64% of whom sustain Medicaid at six-months. Inpatients, those requiring surgery or post-discharge health services are more likely to sustain insurance, with minority groups less likely to sustain. Across hospitals, Medicaid sustainment ranges from 33-97%. Our preliminary data suggests that patient socio demographics, availability and training of hospital personnel and county-level engagement contribute to success of Medicaid sustainment after HPE enrollment. In response to PAR-20-310, investigation of modifiable predictors of Medicaid sustainment will guide our development of a DHCS, hospital and county-stakeholder informed “best practice” toolkit intervention for dissemination across hospitals, with the goal of increasing reducing insurance-based disparities. We will pursue 3 specific aims: (SA1) quantitatively characterize distribution of sustainment across hospitals and identify patient and hospital-level factors associated with Medicaid sustainment after HPE, (SA2) qualitatively identify hospital and county practices that promote or limit success Medicaid sustainment across diverse settings, and (SA3) develop a stakeholder-informed best practice “toolkit” aimed at increasing Medicaid sustainment across hospitals and counties. Our goal by developing strategies for increasing sustained insurance coverage is to improve access to care, clinical outcomes and financial health among disadvantaged and uninsured patients.