The role of state Medicaid policies in treatment for opioid use disorder in the criminal justice population: Evidence from the Treatment Episode Datasets

州医疗补助政策在刑事司法人群阿片类药物使用障碍治疗中的作用：来自治疗事件数据集的证据

• 批准号: 10352607
• 负责人: Fatema Ahmed
• 金额: $ 5.33万
• 依托单位: UNIVERSITY OF CENTRAL FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-15 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10352607
• 关键词: Address; Admission activity; Adult; Affect; Affordable Care Act; Criminal Justice; Data; Data Set; Decision Making; Enrollment; Epidemic; Exclusion; Face; Funding; Geographic state; Geography; Health Services; Health Services Accessibility; Imprisonment; Improve Access; Individual; Insurance; Insurance Coverage; Intervention; Jail; Justice; Laws; Literature; Low income; Medicaid; Medicaid eligibility; Medical; Mental Health; Outcome; Pharmaceutical Preparations; Police; Policies; Policy Making; Population; Prisons; Privatization; Quasi-experiment; Research; Role; Services; Severities; Societies; Subgroup; Suspensions; System; Time; Treatment outcome; Uninsured; United States; United States Dept. of Health and Human Services; behavioral health; burden of illness; detention center; evidence base; experience; health care availability; interest; intravenous drug use; mortality; opioid epidemic; opioid overdose; opioid use disorder; parity; polysubstance use

PROJECT SUMMARY/ABSTRACT While the opioid epidemic affects all levels of society, there are evident disparities in opioid use disorder (OUD), as well as access to treatment for OUD, including medications for opioid use disorder (MOUDs). Adults involved with the criminal justice system are disproportionately affected by OUD and are more likely to go untreated for OUD. Insurance coverage is important for access to healthcare, including OUD treatment. Under the Affordable Care Act (ACA), some states expanded access to Medicaid to cover more low-income individuals, including childless adults. The majority of incarcerated individuals are low-income and uninsured and are, therefore, likely to be Medicaid eligible. Additionally, access to Medicaid for some criminal justice involved individuals is regulated by a federal law, commonly referred to as “inmate exclusion,” which prohibits Medicaid from covering health services for those in a jail, prison, detention center, or other penal facility. Some states terminate Medicaid for incarcerated individuals, while others suspend Medicaid coverage, which does not require re-enrollment upon release. While research has shown that ACA Medicaid expansion is associated with increased access to and utilization of MOUD in the overall population, little is known about the effects on criminal justice involved individuals. Moreover, little is known about the effects of state Medicaid suspension policies on OUD treatment outcomes in this population. To address this gap, my dissertation will use a difference-in-difference framework to estimate the effect of Medicaid expansion and Medicaid suspension policies on outcomes of interest using the Treatment Episode Datasets from 2000-2017. My aims are two-fold: 1) to describe OUD treatment outcomes for individuals referred to treatment by the criminal justice system over time, by geography, and by Medicaid policy status; and 2) to estimate the effects of Medicaid expansion and Medicaid suspension policies on treatment outcomes for criminal-justice referred admissions including: a) the proportion of criminal justice referred admissions with OUD with Medicaid coverage, private insurance coverage, and no insurance; b) the proportion of criminal justice referred admissions with OUD receiving MOUD overall and by insurance status; and 3) the proportion of criminal justice referred admissions with OUD completing treatment overall and by insurance status and MOUD utilization status. For each of these outcomes of interest, I will also explore these relationships by subgroups to capture OUD severity (i.e., primary substance, polysubstance use, intravenous drug use). Given the disproportionate OUD disease burden and lack of access to care for criminal justice involved individuals, it is critical to understand what types of policy interventions may be effective in addressing these disparities. This research will provide important and timely information to support evidence-based policy- and decision-making to improve access to treatment for justice- involved individuals.

项目摘要/摘要 虽然阿片类药物流行影响社会的所有层面，但阿片类药物使用障碍存在证据差异 （OUD），以及获得OUD治疗的机会，包括阿片类药物使用障碍药物（MOUDS）。成年人 与刑事司法系统有关的涉及OUD的影响不成比例，更有可能去 未经治疗的Oud。保险范围对于获得包括OUD治疗在内的医疗保险很重要。在下面 《平价医疗法案》（ACA），一些州扩大了获得医疗补助的访问权限，以覆盖更多的低收入 个人，包括无子女成年人。大多数继承的人是低收入和没有保险的 因此，很可能是有资格的。此外，获得一些刑事司法的医疗补助 相关个人受联邦法律的监管，通常称为“犯人排除”，该法律禁止 医疗补助为监狱，监狱，拘留中心或其他刑罚设施中的医疗服务提供医疗服务。一些 各州终止了为被监禁的人终止医疗补助，而其他人则暂停医疗补助覆盖范围 不需要在发布时重新注册。虽然研究表明ACA医疗补助的扩展是相关的 随着在整体人口中获得和利用穆德的访问和利用，对对影响的影响知之甚少 刑事司法涉及个人。此外，对国家医疗补助暂停的影响知之甚少 该人群中的OUD治疗结果政策。为了解决这个差距，我的论文将使用 差异差异框架以估计医疗补助扩展和医疗补助暂停的影响 从2000 - 2017年开始，使用治疗情节数据集就感兴趣的结果做出了政策。我的目标是两个方面： 1）描述针对刑事司法系统提到治疗的个人的OUD治疗结果 时间，地理和医疗补助政策状况； 2）估计医疗补助扩张的影响和 关于刑事司法治疗结果的医疗补助暂停政策提到了录取，包括：a） 刑事司法的比例提到了接受医疗补助，私人保险的OUD的招生 承保范围，没有保险； b）刑事司法的比例提到了Oud接受的录取 穆德总体和保险状态； 3）刑事司法的比例提到了与Oud的接纳 完成整体治疗，按保险状态和MOUD利用状态。对于每个结果 值得一提的是，我还将通过子组探索这些关系以捕获OUD的严重性（即主要 物质，多物质使用，静脉药使用）。考虑到伯恩伯恩和 缺乏涉及个人的刑事司法的关怀，了解哪些类型的政策是至关重要的 干预措施可能有效解决这些分布。这项研究将提供重要而及时的 提供支持基于证据的政策和决策的信息，以改善司法治疗的机会 - 涉及个人。