Chin Elizabeth T, Liu Yiran E, Ogbunu C Brandon, Basu Sanjay
Johns Hopkins Bloomberg School of Public Health.
Stanford University School of Medicine.
Milbank Q. 2024 Dec;102(4):896-912. doi: 10.1111/1468-0009.12719. Epub 2024 Oct 10.
Policy Points A large population of incarcerated people may be eligible for prerelease and transition services under the new Medicaid Reentry Section 1115 Demonstration Opportunity. We estimated the largest relative population increases in Medicaid coverage from the opportunity may be expected in smaller and more rural states. We found that mental illness, hepatitis C, and chronic kidney disease prevalence rates were sufficiently high among incarcerated populations to likely skew overall Medicaid population prevalence of these diseases when prerelease and transition services are expanded, implying the need for planning of additional data exchange and service delivery infrastructure by state Medicaid plans.
As states expand prerelease and transition services for incarcerated individuals under the Medicaid Reentry Section 1115 Demonstration Opportunity, we sought to systematically inform Medicaid state and plan administrators regarding the population size and burden of disease data available on incarcerated populations in both jails and prisons in the United States.
We analyzed data on eligibility criteria for new Medicaid prerelease and transition services based on incarceration length and health conditions across states. We estimated the potentially eligible populations in prisons and jails, considering various incarceration lengths and health status requirements. We also compared disease prevalence in the incarcerated population with that of the existing civilian Medicaid population.
We found that rural and smaller states would experience a disproportionately large proportion of their Medicaid populations to be eligible for prerelease and transition services if new Medicaid eligibility rules were broadly applied. Self-reported psychological distress was notably higher among incarcerated individuals compared with those currently on Medicaid. The prevalence rates of previously diagnosed chronic hepatitis C and kidney disease were also much higher in the incarcerated population than the existing civilian Medicaid population.
We estimated large volumes of potentially Medicaid-eligible entrants as coverage policy changes take effect over the coming years, particularly impacting smaller and more rural states. Our findings reveal very high disease prevalence rates among the incarcerated population subject to new Medicaid coverage, including specific chronic, infectious, and behavioral health conditions that state Medicaid programs, health plans, and providers may benefit from advanced planning to address.
政策要点 在新的医疗补助重新入狱第1115节示范机会下，大量被监禁人员可能有资格获得提前释放和过渡服务。我们估计，较小和更偏远的州通过该机会获得医疗补助覆盖的人口相对增加幅度可能最大。我们发现，在被监禁人群中，精神疾病、丙型肝炎和慢性肾病的患病率足够高，当扩大提前释放和过渡服务时，可能会使这些疾病在整个医疗补助人群中的总体患病率产生偏差，这意味着各州医疗补助计划需要规划额外的数据交换和服务提供基础设施。
随着各州根据医疗补助重新入狱第1115节示范机会为被监禁人员扩大提前释放和过渡服务，我们试图系统地告知医疗补助州和计划管理人员有关美国监狱和看守所中被监禁人群的人口规模和疾病负担数据。
我们分析了基于各州监禁时长和健康状况的新医疗补助提前释放和过渡服务资格标准的数据。我们估计了监狱和看守所中潜在符合资格的人群，考虑了各种监禁时长和健康状况要求。我们还比较了被监禁人群与现有平民医疗补助人群的疾病患病率。
我们发现，如果广泛应用新的医疗补助资格规则，农村和较小的州将有不成比例的大量医疗补助人群有资格获得提前释放和过渡服务。与目前参加医疗补助的人员相比，被监禁人员自我报告的心理困扰明显更高。在被监禁人群中，先前诊断出的慢性丙型肝炎和肾病的患病率也远高于现有的平民医疗补助人群。
我们估计，随着未来几年覆盖政策的变化，大量潜在符合医疗补助资格的人员将加入，尤其会对较小和更偏远的州产生影响。我们的研究结果显示，在新的医疗补助覆盖范围内的被监禁人群中，疾病患病率非常高，包括特定的慢性、传染性和行为健康状况，各州医疗补助计划、健康计划和提供者可能会从提前规划以应对这些状况中受益。
