Effectiveness of a prison system-based Medicaid enrollment program

基于监狱系统的医疗补助计划的有效性

• 批准号: 8890211
• 负责人: DAVID L ROSEN
• 金额: $ 38万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-10 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8890211
• 关键词: Address; Administrator; Adoption; Adult; Affect; Attitude; Back; Behavioral; Caring; Characteristics; Chronic; Communities; Community Health; Community Hospitals; Cost Savings; Data; Effectiveness; Eligibility Determination; Enrollment; Evaluation; Family; Focus Groups; General Population; HIV; Health; Health Insurance; Health Services Accessibility; Healthcare; Hepatitis C; High Prevalence; Imprisonment; Improve Access; Individual; Information Systems; Inpatients; Intervention; Low Income Population; Medicaid; Mental disorders; Methods; Mission; North Carolina; Outcome; Participant; Patient Self-Report; Performance; Persons; Play; Policies; Policy Maker; Population; Prisoner; Prisons; Process; Program Effectiveness; Risk; Risk Factors; Role; Savings; Societies; Source; Substance Addiction; Surveys; System; Systems Analysis; Time; base; cost effectiveness; experience; health disparity; improved; mortality; programs; response; socioeconomics

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.

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。许多使人面临监禁风险的社会经济、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性健康状况的比例异常高，并且全因死亡率过高也就不足为奇了。每年有 700,000 名囚犯获释，这些人的健康对其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，对于那些患有严重和慢性疾病的人来说更具挑战性，其中大多数人没有医疗保险。医疗补助是贫困人口和低收入人群医疗保健覆盖的重要来源，并已被证明可以增加常规医疗保健的使用并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刑满释放囚犯可能有资格获得医疗补助，但能否加入取决于他们能否成功完成既困难又耗时的申请流程；因此，入学率相对较低。几乎所有州监狱系统都将联邦医疗补助政策解释为强制在监禁期间终止医疗补助福利，并禁止在监禁期间加入医疗补助，从而为加入医疗补助造成了额外的障碍。然而，近年来，联邦医疗补助高级管理人员已澄清，囚犯在监禁期间可以参加医疗补助，尽管只是为了支付监狱系统外（例如社区医院）提供的住院医疗费用。针对这一澄清，约 1/3 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，在监禁期间参加医疗补助的囚犯可以在重新进入社区后立即恢复医疗补助。因此，监狱医疗补助登记援助计划 (PBMEAP) 可能在囚犯出狱后获得医疗服务及其健康方面发挥关键作用。此外，在北卡罗来纳州 (NC) 和其他 24 个医疗补助未扩展的州，PBMEAP 将成为患有慢性疾病的监狱人员参加医疗补助的最佳机会之一。尽管这些计划具有潜在影响，但 PBMEAP 的基本评估尚未进行。在此应用中，我们提出了一种混合方法来检查 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、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。我们的研究结果将为州政策制定者、监狱官员和医疗补助管理者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。