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: 8774029
• 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/8774029
• 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; public health relevance; 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是减少美国健康差异的必要步骤。许多相同的社会经济，行为和社区级别的风险因素，即处于监禁风险的风险因素也与健康不良的风险有关。因此，前囚犯的慢性健康状况的患病率不成比例，毫无疑问，全因死亡率的率过高。每年有70万名囚犯释放，这些人的健康对他们返回的社区和家庭的健康有普遍的影响。从监狱到社区的过渡特别困难，对于那些患有严重和慢性健康状况的人来说，大多数没有健康保险的人都更具挑战性。医疗补助是贫困人口和低收入人群中医疗保健覆盖范围的重要来源，已被证明可以增加使用常规医疗保健的使用并改善自我报告的健康成果。尽管释放患有严重和慢性健康状况的囚犯可能有资格获得医疗补助，但入学率取决于他们成功地导航既困难又消耗的申请过程。结果，注册相对罕见。几乎所有州监狱系统都将联邦医疗补助政策解释为强制终止监禁和禁止在监禁期间招收医疗补助的福利，从而造成了医疗补助入学率的其他障碍。但是，近年来，联邦最高的医疗补助管理人员澄清说，囚犯可以在监禁期间招募医疗补助，尽管只能支付监狱系统以外（例如社区医院）提供的住院医疗保健费用。为了回应这一澄清，大约有1/3的州监狱系统制定了促进囚犯入学医疗补助的计划。重要的是，在监禁期间入学的囚犯可以在重新进入社区后立即恢复其医疗补助范围。因此，以监狱为基础的医疗补助入学援助计划（PBMEAP）可能在囚犯发行后获得卫生服务以及其健康状况中起关键作用。此外，在北卡罗来纳州（NC）和其他24个医疗补助非膨胀州，PBMEAPS将成为患有慢性健康状况的监狱涉及监狱的人的最佳机会之一。尽管这些计划有潜在的影响，但即使对PBMEAP的基本评估也尚未进行。在此应用中，我们提出了一种混合方法，以检查PBMEAP在NC监狱系统中的有效性和成本含义。我们将研究囚犯的医疗补助招生率，他们的释放后结果以及他们对医疗保健访问的态度。我们还将研究该计划对监狱系统的成本节省以及影响计划绩效的因素。我们的调查结果将为国家政策制定者，监狱官员和医疗补助管理人员提供数据驱动的了解，以了解该计划的有效性及其对医疗保健获得和健康的影响。