Effectiveness of a prison system-based Medicaid enrollment program

描述（由申请人提供）：解决被监禁人群的健康问题是减少美国健康差距的必要步骤。使人面临监禁风险的许多社会经济、行为和社区层面的风险因素也与健康状况不佳的风险有关。因此，前囚犯患有慢性和致残健康状况的比例高得不成比例，毫不奇怪，他们的全因死亡率过高。每年有70万囚犯获释，这些人的健康对他们返回的社区和家庭的健康产生普遍影响。从监狱回到社区的过渡尤其困难，对那些患有严重和慢性疾病的人来说更具挑战性，他们中的大多数人没有医疗保险。医疗补助是向贫困人口和低收入人口提供医疗保健的一个重要来源，并已证明可增加常规医疗保健的使用，改善自我报告的健康结果。虽然患有严重和慢性健康问题的释放囚犯可能有资格获得医疗补助，但是否登记取决于他们是否成功地通过了一个既困难又耗时的申请过程；因此，入学人数相对较少。几乎所有州的监狱系统都将联邦医疗补助政策解释为在监禁期间终止医疗补助福利，并禁止在监禁期间申请医疗补助，从而为申请医疗补助设置了额外的障碍。然而，近年来，联邦医疗补助计划的高级管理人员澄清说，囚犯在监禁期间可以参加医疗补助计划，尽管只是为了支付监狱系统以外提供的住院医疗费用（例如，社区医院）。为了回应这一澄清，大约三分之一的州监狱系统已经制定了促进囚犯加入医疗补助计划的计划。重要的是，在监禁期间加入医疗补助计划的囚犯可以在重新进入社区后立即恢复医疗补助计划。因此，以监狱为基础的医疗补助登记援助计划（PBMEAPs）可能在囚犯释放后获得医疗服务以及健康方面发挥关键作用。此外，在北卡罗来纳州和其他24个没有扩大医疗补助计划的州，pbmeap将是有慢性健康问题的囚犯参加医疗补助计划的最佳机会之一。尽管这些项目具有潜在的影响，但对pbmeap的基本评估尚未开展。在这一应用中，我们提出了一种混合方法来研究PBMEAP在北卡罗来纳州监狱系统中的有效性和成本影响。我们将检查囚犯的医疗补助登记率，他们释放后的结果，以及他们对医疗保健的态度。我们还将研究该项目为监狱系统节省的成本以及影响项目绩效的因素。我们的研究结果将为州政策制定者、监狱官员和医疗补助管理人员提供数据驱动的了解该计划的有效性及其对医疗保健获取和健康的影响。

DESCRIPTION (provided by applicant): Addressing the health of incarcerated populations is a necessary step in reducing U.S. health disparities. Many of the same socioeconomic, behavioral, and community-level risk factors that place one at risk for imprisonment also are associated with risk for poor health. Accordingly, former prisoners have a disproportionately high prevalence of chronic and disabling health conditions and, unsurprisingly, suffer excessively high rates of all-cause mortality. With 700,000 prisoners released annually, the health of these individuals has a pervasive effect on the health of the communities and families to which they return. The transition from prison back to the community is particularly difficult an is considerably more challenging for those with severe and chronic health conditions, most of whom have no health insurance. Medicaid is an important source of health care coverage for the impoverished and among low-income populations and has been shown to increase use of routine healthcare and improve self-reported health outcomes. While released prisoners with severe and chronic health conditions may be eligible for Medicaid, enrollment depends on their successful navigation of an application process that is both difficult and time consuming; as a result, enrollment is relatively uncommon. Nearly all state prison systems have interpreted federal Medicaid policies as mandating the termination of Medicaid benefits upon incarceration and prohibiting Medicaid enrollment during incarceration, thus creating additional barriers to Medicaid enrollment. In recent years, however, top federal Medicaid administrators have clarified that prisoners may enroll in Medicaid during incarceration, albeit only to pay for inpatient healthcare provided outside of the prison system (e.g., a community hospital). In response to this clarification, about 1/3 of state prison systems have created programs to facilitate prisoner enrollment into Medicaid. Importantly, prisoners enrolled in Medicaid during their incarceration can resume their Medicaid coverage immediately upon reentering the community. Therefore, prison-based Medicaid enrollment assistance programs (PBMEAPs) may play a pivotal role in prisoners' post-release access to health services and, consequently, their health. Moreover, in North Carolina (NC) and the 24 other Medicaid non-expansion states, PBMEAPs will be one of the best opportunities for prison-involved persons with chronic health conditions to enroll in Medicaid. Despite the potential impact of these programs, even basic evaluations of PBMEAPs have yet to be conducted. In this application, we have proposed a mixed methods approach to examine the effectiveness and the cost implications of the PBMEAP in the NC prison system. We will examine prisoners' rate of Medicaid enrollment, their post-release outcomes, and their attitudes about healthcare access. We will also examine the program's cost-savings for the prison system and factors that affect program performance. Our findings will provide state policy makers, prison officials, and Medicaid administrators with a data-driven understanding of the program's effectiveness and its impact on healthcare access and health.