At the time of the study, Julia Zur and Ramin Mojtabai were with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
Am J Public Health. 2013 Nov;103(11):2007-13. doi: 10.2105/AJPH.2013.301283. Epub 2013 Sep 12.
We assessed whether homeless adults entering substance abuse treatment in Massachusetts were less likely than others to enroll in Medicaid after implementation of the MassHealth Medicaid expansion program in 1997.
We used interrupted time-series analysis in data on substance abuse treatment admissions from the Treatment 0Episode Data Set (1992-2009) to evaluate Medicaid coverage rates in Massachusetts and to identify whether trends differed between homeless and housed participants. We also compared Massachusetts data with data from 17 other states and the District of Columbia combined.
The percentage of both homeless and housed people entering treatment with Medicaid increased approximately 21% after expansion (P = .01), with an average increase of 5.4% per year over 12 years (P = .01). The increase in coverage was specific to Massachusetts, providing evidence that the MassHealth policy was the cause of this increase.
Findings provide evidence in favor of state participation in the Medicaid expansion in January 2014 under the Affordable Care Act and suggest that hard-to-reach vulnerable groups such as substance-abusing homeless adults are as likely as other population groups to benefit from this policy.
我们评估了马萨诸塞州在 1997 年实施 MassHealth 医疗补助扩展计划后，进入药物滥用治疗的无家可归成年人与其他人相比，是否更不可能参加医疗补助。
我们使用 Treatment 0 期数据集中（1992-2009 年）关于药物滥用治疗入院的数据，采用中断时间序列分析来评估马萨诸塞州的医疗补助覆盖率，并确定无家可归者和有住房者参与者之间的趋势是否存在差异。我们还将马萨诸塞州的数据与其他 17 个州和哥伦比亚特区的数据进行了比较。
在扩张后，有医疗保险进入治疗的无家可归者和有住房者的比例大约增加了 21%（P=0.01），12 年内每年平均增长 5.4%（P=0.01）。这种覆盖率的增加是马萨诸塞州特有的，这为 MassHealth 政策是导致这种增加的原因提供了证据。
研究结果为支持 2014 年 1 月《平价医疗法案》下各州参与医疗补助扩大提供了证据，并表明，难以接触到的弱势群体，如滥用药物的无家可归成年人，与其他人群一样，有可能从这一政策中受益。
