Effectiveness of a prison system-based Medicaid enrollment program

描述(由申请人提供)：解决被监禁人口的健康问题是减少美国健康差距的必要步骤。许多同样的社会经济、行为和社区层面的风险因素，使一个人面临监禁的风险，也与健康不良的风险有关。因此，前囚犯的慢性病和致残性疾病的患病率高得不成比例，而且不出所料，各种原因造成的死亡率过高。每年有70万名囚犯获释，这些人的健康对他们返回的社区和家庭的健康具有普遍影响。从监狱到社区的过渡尤其困难，对于那些患有严重和慢性疾病的人来说，挑战要大得多，因为他们中的大多数人没有医疗保险。医疗补助是为贫困者和低收入人口提供医疗保险的重要来源，已被证明增加了常规医疗保健的使用，并改善了自我报告的健康结果。尽管患有严重和慢性健康状况的获释囚犯可能有资格获得医疗补助，但登记取决于他们能否成功导航申请过程，这既困难又耗时；因此，登记相对罕见。几乎所有的州监狱系统都将联邦医疗补助政策解读为强制要求在监禁时终止医疗补助福利，并禁止在监禁期间参加医疗补助，从而为医疗补助的登记制造了额外的障碍。然而，近年来，最高联邦医疗补助管理人员澄清，囚犯可以在监禁期间登记医疗补助，尽管只支付监狱系统外提供的住院医疗费用(例如，社区医院)。作为对这一澄清的回应，约三分之一的州监狱系统制定了促进囚犯加入医疗补助计划的计划。重要的是，在监狱期间登记参加医疗补助的囚犯可以在重新进入社区后立即恢复其医疗补助覆盖范围。因此，以监狱为基础的医疗补助登记援助计划(PBMEAP)可能在囚犯获释后获得医疗服务以及因此他们的健康方面发挥关键作用。此外，在北卡罗来纳州(北卡罗来纳州)和其他24个未扩大医疗补助的州，PBMEAP将是患有慢性健康状况的监狱涉案人员登记参加医疗补助的最佳机会之一。尽管这些计划具有潜在的影响，但即使是对多国环境和环境保护项目的基本评估也尚未进行。在这一应用中，我们提出了一种混合方法方法来检查PBMEAP在NC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参保率、他们出狱后的结果，以及他们对医疗保健服务的态度。我们还将研究该计划为监狱系统节省的成本以及影响计划绩效的因素。我们的发现将为州政策制定者、监狱官员和医疗补助管理人员提供数据驱动的了解，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.