Bandara Sachini, Saloner Brendan, Maniates Hannah, Song Minna, Krawczyk Noa
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Baltimore, MD, 21205, USA.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Baltimore, MD, 21205, USA.
Health Justice. 2025 Jan 9;13(1):1. doi: 10.1186/s40352-024-00311-7.
Medicaid expansion via the Affordable Care Act, more recent legislation and Medicaid 1115 waivers offer opportunity to increase health care access among individuals involved in the carceral system. Effective enrollment of new beneficiaries and temporary suspension and reactivation of existing Medicaid benefits upon release is key to the success of these efforts. This study aims to characterize how jails, prisons and Medicaid agencies are implementing Medicaid suspension and enrollment programs and identifies barriers and facilitators to implementation.
We conducted 19 semi-structured interviews with 36 multi-state leaders in carceral facilities, Medicaid agencies, local health departments and national policy experts from 2020 to 2021. Interviews covered 4 domains: (1) the role of policy in influencing carceral and reentry Medicaid practices, (2) implementation strategies to suspend and enroll incarcerated individuals into Medicaid, (3) barriers and facilitators to successful implementation, and (4) variation in implementation between jails and prisons.
Participants identified logistical challenges with suspension and enrollment, including limited infrastructure for data sharing between carceral facilities and Medicaid agencies, burdensome bureaucratic requirements, and challenges with Medicaid renewal, particularly in the jail environment. They offered opportunities to overcome barriers, such as the creation of specialized incarcerated Medicaid benefit categories and provision of in-reach services via managed care organizations. Participants also called for improvements to Medicaid reactivation processes, as even when facilities successfully suspended benefits, individuals faced significant challenges and delays reactivating benefits upon release. Participants also called for further loosening of the Medicaid Inmate Exclusion Policy.
Findings highlight the need to update data sharing infrastructure, which will be critical to the implementation of the 1115 waivers, as carceral facilities will be subject to Medicaid billing and reporting requirements. In addition to investing in the ability to newly enroll and suspend Medicaid benefits, attention towards improving timely reactivation practices is needed, particularly given the highly elevated risk of mortality immediately after release. Participants calls for further reforms to the Medicaid Inmate Exclusion Policy are consistent with proposed legislation.
Findings can critically inform the successful implementation of Medicaid-based reforms to improve the health of incarcerated and formerly incarcerated people.
通过《平价医疗法案》、近期立法以及医疗补助1115豁免权来扩大医疗补助计划，为增加参与监狱系统人员的医疗保健可及性提供了机会。新受益人的有效登记以及释放时现有医疗补助福利的临时中止和重新激活是这些努力取得成功的关键。本研究旨在描述监狱、看守所和医疗补助机构如何实施医疗补助中止和登记计划，并确定实施过程中的障碍和促进因素。
2020年至2021年，我们对来自监狱设施、医疗补助机构、地方卫生部门和国家政策专家的36位多州领导人进行了19次半结构化访谈。访谈涵盖4个领域：（1）政策在影响监狱和重新进入社会时的医疗补助实践中的作用，（2）将被监禁人员中止和登记加入医疗补助的实施策略，（3）成功实施的障碍和促进因素，以及（4）监狱和看守所之间实施情况的差异。
参与者指出了中止和登记方面的后勤挑战，包括监狱设施与医疗补助机构之间数据共享的基础设施有限、繁琐的官僚要求以及医疗补助续保方面的挑战，特别是在监狱环境中。他们提供了克服障碍的机会，例如设立专门的被监禁人员医疗补助福利类别，以及通过管理式医疗组织提供内部服务。参与者还呼吁改进医疗补助重新激活流程，因为即使设施成功中止了福利，个人在释放后重新激活福利时仍面临重大挑战和延误。参与者还呼吁进一步放宽医疗补助囚犯排除政策。
研究结果凸显了更新数据共享基础设施的必要性，这对于1115豁免权的实施至关重要，因为监狱设施将受到医疗补助计费和报告要求的约束。除了投资于新登记和中止医疗补助福利的能力外，还需要关注改善及时重新激活的做法，特别是考虑到释放后立即出现的高死亡风险。参与者呼吁对医疗补助囚犯排除政策进行进一步改革，这与拟议的立法一致。
研究结果可为成功实施基于医疗补助的改革提供关键信息，以改善被监禁人员和曾经被监禁人员的健康状况。
