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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

基本信息

批准号：
9039489
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
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-10 至 2019-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9039489
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/HCV Health Health Insurance Health Services Accessibility Healthcare 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 care availability health disparity improved mortality programs response socioeconomics

项目摘要

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）：解决被监禁人口的健康问题是减少美国健康差距的必要步骤。许多相同的社会经济，行为和社区层面的风险因素，使一个人处于监禁的风险也与健康状况不佳的风险有关。因此，刑满释放人员患慢性病和致残性疾病的比例高得不成比例，而且各种原因造成的死亡率极高也就不足为奇了。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，对于那些患有严重和慢性疾病的人来说，挑战性要大得多，因为他们中的大多数人没有健康保险。医疗补助是贫困和低收入人群医疗保健覆盖的重要来源，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释为强制终止监禁时的医疗补助福利，并禁止监禁期间的医疗补助登记，从而为医疗补助登记创造了额外的障碍。然而，近年来，联邦医疗补助计划的高级管理人员已经澄清，囚犯可以在监禁期间参加医疗补助计划，尽管只是为了支付监狱系统以外提供的住院医疗保健费用（例如，社区医院）。作为对这一澄清的回应，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，监狱为基础的医疗补助登记援助计划（PBMEAP）可能会发挥关键作用，囚犯的释放后获得医疗服务，因此，他们的健康。此外，在北卡罗来纳州（NC）和其他24个医疗补助非扩展州，PBMEAP将是监狱参与慢性健康状况的人参加医疗补助的最佳机会之一。尽管这些方案可能产生影响，但甚至还没有对PBMEAP进行基本评价。在这个应用程序中，我们提出了一个混合的方法来检查的有效性和成本影响的PBMEAP在NC监狱系统。我们将研究囚犯的医疗补助登记率，他们的释放后的结果，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服务和健康的影响。