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Fletcher D, Morgan K, Miller-Hammond K, Johnson S. Access to Surgery and Health Care for Justice-Involved Individuals. Am Surg 2025; 91:928-932. [PMID: 40258600 DOI: 10.1177/00031348251318382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2025]
Abstract
Justice-involved individuals, encompassing those with prior interactions with the correctional system, represent a population with significant unmet healthcare needs. Approximately 95% of incarcerated individuals return to society, often with unresolved chronic conditions or infectious diseases such as HIV and Hepatitis C, and face considerable barriers to accessing healthcare. Institutional constraints, logistical complications, inadequate resources, and cultural biases exacerbate disparities, contributing to suboptimal health outcomes and public health risks. Healthcare access for justice-involved individuals is hindered by multiple factors, including limited availability of medications like opioid use disorder treatments, restricted surgical and preventive care, and systemic challenges in initiating healthcare. The suspension of Medicaid during incarceration, compounded by high uninsurance rates post-release, further exacerbates these inequities. Despite legislative efforts such as the Affordable Care Act and state-level policies addressing restraint use, healthcare services for this population remain inadequate and inconsistent. Recommendations include leveraging correctional facilities to enhance healthcare delivery, incorporating justice-involved populations in hospital design and planning, and fostering collaborations between correctional facilities and healthcare organizations. Training healthcare professionals in correctional medicine and tailoring care programs to justice-involved patients' needs are critical. Research should focus on improving care models, expanding insurance enrollment initiatives, and addressing long-term health outcomes for this vulnerable group. Efforts to integrate justice-involved individuals into broader healthcare frameworks can reduce health disparities, improve public health, and promote equitable access to care. Addressing these systemic issues requires collaborative approaches across healthcare, correctional, and policy sectors.
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Affiliation(s)
- D Fletcher
- Morehouse School of Medicine, Atlanta, GA, USA
| | - K Morgan
- Morehouse School of Medicine, Atlanta, GA, USA
| | | | - S Johnson
- Morehouse School of Medicine, Atlanta, GA, USA
- Meharry Medical College and the Meharry School of Global Health, Atlanta, GA, USA
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2
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Choi S, Stein MD, Raifman J, Rosenbloom D, Clark JA. Estimating the impact on initiating medications for opioid use disorder of state policies expanding Medicaid and prohibiting substance use during pregnancy. Drug Alcohol Depend 2021; 229:109162. [PMID: 34768053 PMCID: PMC8671210 DOI: 10.1016/j.drugalcdep.2021.109162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/15/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Medicaid expansion increased access to addiction treatment services for pregnant women. However, states' imposition of civil or criminal child abuse sanctions for drug use during pregnancy could inhibit access to treatment. We estimated the effects of Medicaid expansion on pregnant women's medications for opioid use disorder (MOUD) use, and its interaction with statutes that prohibit substance use during pregnancy. METHODS Using the Treatment Episode Dataset for Discharge (2010-2018), we identified the initial treatment episode of pregnant women with opioid use disorder (OUD). We described changes in MOUD use and estimated adjusted difference-in-differences and event study models to evaluate differences in changes in MOUD between states that prohibit substance use during pregnancy and states that do not. FINDINGS Among a total of 16,070 treatment episodes for pregnant women with OUD from 2010 to 2018, most (74%) were in states that expanded Medicaid. By one year post-expansion, the proportion of episodes receiving MOUD in states not prohibit substance use during pregnancy increased by 8.7% points (95% CI: 2.7, 14.7) from the pre-expansion period compared to a 5.6% point increase in states prohibiting substance use during pregnancy (95% CI: -3.3, 14.8). In adjusted event study analysis, the expansion was associated with an increase in MOUD use by 15.3% by year 2 in states not prohibiting versus 1.5% percentage points in states prohibiting substance use during pregnancy, respectively. CONCLUSIONS State policies prohibiting substance use during pregnancy may limit the salutary effects of Medicaid expansion for pregnant women who could benefit from MOUD treatment.
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Affiliation(s)
- Sugy Choi
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA 02118, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA.
| | - Michael D. Stein
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Julia Raifman
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - David Rosenbloom
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Jack A Clark
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts 02118, USA
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Reynolds GL, Fisher DG. The Role of the Medicaid Expansion in the Use of Preventive Health Care Services in California Men. Am J Mens Health 2021; 14:1557988320903193. [PMID: 31997707 PMCID: PMC6993173 DOI: 10.1177/1557988320903193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Men’s use of preventive care services may be constrained due to a number of factors including lack of health care insurance. California used the Medicaid expansion provisions of the Affordable Care Act (ACA) to enroll low-income men between the ages of 18 and 64 years in publicly funded health insurance. Most studies on the effect of the ACA on health care services have focused on racial/ethnic differences rather than gender. Data from the California Health Interview Survey for the 2015–2016 survey period were used to model the use of preventive health care services in the year prior to interview. Population weights were used in the analysis which was done using PROC SURVEY LOGISTIC in SAS software, version 9.4. The sample consisted of men between the ages of 18 and 64 years (N = 6,180). Of these 66% (n = 4,088) reporting receiving any preventive care services in the year prior to interview. The largest proportions of respondents fell into the youngest group aged 18–25 (17%) followed by the oldest group aged 60–64 (16.9%); 43% reported they were married, 57% had incomes at greater than 300% of the federal poverty level. There was no effect of race or ethnicity on receiving preventive care services. Having a chronic condition such as hypertension or diabetes was associated with a greater odds of receiving preventive care. Expanding Medicaid to include low-income men below the age of 65 is associated with increased use of preventive health care, especially among those with chronic conditions.
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Affiliation(s)
- Grace L Reynolds
- Department of Health Care Administration, California State University, Long Beach, CA, USA.,Center for Behavioral Research & Services, California State University, Long Beach, CA, USA
| | - Dennis G Fisher
- Center for Behavioral Research & Services, California State University, Long Beach, CA, USA.,Department of Psychology, California State University, Long Beach, CA, USA
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Blackburn J, Norwood C, Rusyniak D, Gilbert AL, Sullivan J, Menachemi N. Indiana's Section 1115 Medicaid Waiver And Interagency Coordination Improve Enrollment For Justice-Involved Adults. Health Aff (Millwood) 2020; 39:1891-1899. [PMID: 33136497 DOI: 10.1377/hlthaff.2019.01823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Timely access to Medicaid coverage offers many potential benefits to justice-involved adults reentering the community. In 2015 Indiana's Section 1115 Medicaid waiver (the Healthy Indiana Plan [HIP]) expanded eligibility for low-income adults. To expedite coverage for justice-involved adults, Indiana subsequently improved interagency coordination in two ways. First, the Indiana Department of Correction began initiating Medicaid applications for those in custody. Second, Medicaid began temporarily suspending coverage for people while they were incarcerated instead of discontinuing it. Prison release data from the Indiana Department of Correction linked to Medicaid enrollment data indicate that before HIP was implemented, approximately 9 percent of justice-involved adults received Medicaid coverage within 120 days of release. After HIP implementation, coverage rates increased by 9 percentage points. After both interagency coordination policies were implemented, an additional 29-percentage-point increase in coverage occurred. Furthermore, coverage effective within seven days of release increased by 14 percentage points after the interagency coordination policies went into effect. These findings support the notion that policies and procedures encouraging interagency coordination are beneficial in increasing timely access to Medicaid coverage for justice-involved people.
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Affiliation(s)
- Justin Blackburn
- Justin Blackburn is an associate professor in the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, in Indianapolis, Indiana
| | - Connor Norwood
- Connor Norwood is the chief data officer in the Indiana Family and Social Services Administration, in Indianapolis, Indiana
| | - Dan Rusyniak
- Dan Rusyniak is the chief medical officer in the Indiana Family and Social Services Administration
| | - Amy Lewis Gilbert
- Amy Lewis Gilbert is the chief science officer in the Indiana Family and Social Services Administration
| | - Jennifer Sullivan
- Jennifer Sullivan is the secretary of the Indiana Family and Social Services Administration
| | - Nir Menachemi
- Nir Menachemi is the Fairbanks Endowed Chair, a professor, and head of the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health and a scientist at the Regenstrief Institute, in Indianapolis, Indiana
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Winkelman TNA, Ford BR, Shlafer RJ, McWilliams A, Admon LK, Patrick SW. Medications for opioid use disorder among pregnant women referred by criminal justice agencies before and after Medicaid expansion: A retrospective study of admissions to treatment centers in the United States. PLoS Med 2020; 17:e1003119. [PMID: 32421717 PMCID: PMC7233523 DOI: 10.1371/journal.pmed.1003119] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/22/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Criminal justice involvement is common among pregnant women with opioid use disorder (OUD). Medications for OUD improve pregnancy-related outcomes, but trends in treatment data among justice-involved pregnant women are limited. We sought to examine trends in medications for OUD among pregnant women referred to treatment by criminal justice agencies and other sources before and after the Affordable Care Act's Medicaid expansion. METHODS AND FINDINGS We conducted a serial, cross-sectional analysis using 1992-2017 data from pregnant women admitted to treatment facilities for OUD using a national survey of substance use treatment facilities in the United States (N = 131,838). We used multiple logistic regression and difference-in-differences methods to assess trends in medications for OUD by referral source. Women in the sample were predominantly aged 18-29 (63.3%), white non-Hispanic, high school graduates, and not employed. Over the study period, 26.3% (95% CI 25.7-27.0) of pregnant women referred by criminal justice agencies received medications for OUD, which was significantly less than those with individual referrals (adjusted rate ratio [ARR] 0.45, 95% CI 0.43-0.46; P < 0.001) or those referred from other sources (ARR 0.51, 95% CI 0.50-0.53; P < 0.001). Among pregnant women referred by criminal justice agencies, receipt of medications for OUD increased significantly more in states that expanded Medicaid (n = 32) compared with nonexpansion states (n = 18) (adjusted difference-in-differences: 12.0 percentage points, 95% CI 1.0-23.0; P = 0.03). Limitations of this study include encounters that are at treatment centers only and that do not encompass buprenorphine prescribed in ambulatory care settings, prisons, or jails. CONCLUSIONS Pregnant women with OUD referred by criminal justice agencies received evidence-based treatment at lower rates than women referred through other sources. Improving access to medications for OUD for pregnant women referred by criminal justice agencies could provide public health benefits to mothers, infants, and communities. Medicaid expansion is a potential mechanism for expanding access to evidence-based treatment for pregnant women in the US.
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Affiliation(s)
- Tyler N. A. Winkelman
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Becky R. Ford
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
| | - Rebecca J. Shlafer
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Anna McWilliams
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
| | - Lindsay K. Admon
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Stephen W. Patrick
- Vanderbilt Center for Child Health Policy, Departments of Pediatrics and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
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Madras BK, Ahmad NJ, Wen J, Sharfstein JS. Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers within the Treatment System. NAM Perspect 2020; 2020:202004b. [PMID: 35291732 PMCID: PMC8916813 DOI: 10.31478/202004b] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Even though evidence-based treatment for opioid use disorders (OUD) is effective, almost four in five Americans with OUD do not receive any form of treatment. The gap in access to evidence-based care, including treatment with medications for OUD, stems in part from barriers to change within the health care system. This paper includes nine key barriers that prevent access to evidence-based care, including stigma; inadequate clinical training; a dearth of addiction specialists; lack of integration of MOUD provision in practice; regulatory, statutory, and data sharing restrictions; and financial barriers. Action from a number of actors is urgently needed to address this crisis.
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Affiliation(s)
| | - N Jia Ahmad
- Johns Hopkins Bloomberg School of Public Health
| | - Jenny Wen
- Johns Hopkins University School of Medicine
| | - Joshua Sharfstein Sharfstein
- Johns Hopkins Bloomberg School of Public Health; and the Prevention, Treatment, and Recovery Working Group of the Action Collaborative on Countering the U.S. Opioid Epidemic
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Wang EA, Macmadu A, Rich JD. Examining the Impact of Criminal Justice Involvement on Health Through Federally Funded, National Population-Based Surveys in the United States. Public Health Rep 2019; 134:22S-33S. [PMID: 31059413 DOI: 10.1177/0033354918824324] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Emily A Wang
- 1 Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Alexandria Macmadu
- 2 Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA.,3 Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Josiah D Rich
- 2 Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA.,3 Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,4 Department of Medicine, Brown University, Providence, RI, USA
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8
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Howell BA, Wang EA, Winkelman TNA. Mental Health Treatment Among Individuals Involved in the Criminal Justice System After Implementation of the Affordable Care Act. Psychiatr Serv 2019; 70:765-771. [PMID: 31138056 DOI: 10.1176/appi.ps.201800559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this study was to assess changes in health insurance coverage and mental health treatment among individuals with and without involvement in the criminal justice system after implementation of key provisions of the Affordable Care Act (ACA). METHODS Data from the National Survey on Drug Use and Health were used to assess changes in coverage, mental health treatment, and payer between 2011-2013 and 2014-2017 for nonelderly adults (ages 19 to 64) with and without criminal justice involvement in the past year who reported serious psychological distress. Multivariable logistic regression was used to obtain adjusted estimates. RESULTS The weighted sample represented, on average, 2.0 million individuals with criminal justice involvement (total unweighted N=3,688) and 20.9 million without criminal justice involvement (total unweighted N=33,872) in each study year. Following implementation of the ACA's key provisions, health insurance coverage increased by 13.4 percentage points (95% CI=8.5-18.3) among individuals with past year criminal justice involvement and by 8.1 percentage points (95% CI=6.9-9.4) among those without. Receipt of any mental health treatment did not change significantly among individuals with criminal justice involvement (-3.4 percentage points [95% CI=-8.0 to 1.1]), whereas it increased significantly in the general population (2.2 percentage points [95% CI=0.4-3.9]). CONCLUSIONS Despite an increase in health insurance coverage for people with criminal justice involvement, there was no increase in mental health treatment following implementation of the ACA's key provisions. Health insurance coverage is necessary, but not sufficient, to expand access to mental health treatment for individuals involved in the criminal justice system.
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Affiliation(s)
- Benjamin A Howell
- National Clinician Scholars Program, Yale School of Medicine, and U.S. Department of Veterans Affairs Connecticut Health Care System, New Haven, Connecticut (Howell); Division of General Internal Medicine, Yale School of Medicine, New Haven (Wang); Division of General Internal Medicine, Hennepin Healthcare, and Hennepin Healthcare Research Institute, Minneapolis (Winkelman)
| | - Emily A Wang
- National Clinician Scholars Program, Yale School of Medicine, and U.S. Department of Veterans Affairs Connecticut Health Care System, New Haven, Connecticut (Howell); Division of General Internal Medicine, Yale School of Medicine, New Haven (Wang); Division of General Internal Medicine, Hennepin Healthcare, and Hennepin Healthcare Research Institute, Minneapolis (Winkelman)
| | - Tyler N A Winkelman
- National Clinician Scholars Program, Yale School of Medicine, and U.S. Department of Veterans Affairs Connecticut Health Care System, New Haven, Connecticut (Howell); Division of General Internal Medicine, Yale School of Medicine, New Haven (Wang); Division of General Internal Medicine, Hennepin Healthcare, and Hennepin Healthcare Research Institute, Minneapolis (Winkelman)
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9
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Nowotny KM, Frankeberger J, Rodriguez VE, Valdez A, Cepeda A. Behavioral, Psychological, Gender, and Health Service Correlates to Herpes Simplex Virus Type 2 Infection among Young Adult Mexican-American Women Living in a Disadvantaged Community. Behav Med 2019; 45:52-61. [PMID: 29558260 PMCID: PMC6148393 DOI: 10.1080/08964289.2018.1447906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Herpes simplex virus type 2 (HSV-2) is among the most prevalent sexually transmitted infections in the United States. Despite this, there has been limited research on the correlates to HSV-2 among disadvantaged and marginalized women, particularly among Latinas. Data for the present analysis include 125 young adult Mexican-American women enrolled in a longitudinal study in a disadvantaged urban community in San Antonio, Texas. The current rate of tested HSV-2 infection is 56.8%. Our findings suggest strong comorbidity of genital herpes with injecting heroin use, Hepatitis C, sexual violence, incarceration, and mental illness. Contributing to this population's nexus of risk are the low rates of health service utilization among those infected with HSV-2. Integration between behavioral health and primary care, including access to preventative services, are essential for improving the health of Latinas living in disadvantaged neighborhoods.
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Affiliation(s)
- Kathryn M Nowotny
- a Department of Sociology , University of Miami , Coral Gables , FL , USA
| | - Jessica Frankeberger
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Victoria E Rodriguez
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Avelardo Valdez
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Alice Cepeda
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
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10
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Anderson VR, Ouyang F, Tu W, Rosenman MB, Wiehe SE, Aalsma MC. Medicaid Coverage and Continuity for Juvenile Justice–Involved Youth. JOURNAL OF CORRECTIONAL HEALTH CARE 2019; 25:45-54. [DOI: 10.1177/1078345818820043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Fangqian Ouyang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marc B. Rosenman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sarah E. Wiehe
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew C. Aalsma
- Division of Adolescent Medicine, Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Psick Z, Simon J, Brown R, Ahalt C. Older and incarcerated: policy implications of aging prison populations. Int J Prison Health 2017; 13:57-63. [PMID: 28299972 PMCID: PMC5812446 DOI: 10.1108/ijph-09-2016-0053] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to explore the policy Implications of aging prison populations. Design/methodology/approach An examination of the worldwide aging trend in prison and its implications for correctional policy, including an examination of population aging in California prisons as a case example of needed reform. Findings Prison populations worldwide are aging at an unprecedented rate, and age-related medical costs have had serious consequences for jurisdictions struggling to respond to the changes. These trends are accompanied by a growing body of evidence that old age is strongly correlated with desistance from criminal behavior, suggesting an opportunity to at least partially address the challenges of an aging prison population through early release from prison for appropriate persons. Originality/value Some policies do exist that aim to reduce the number of older, chronically ill or disabled and dying people in prison, but they have not achieved that goal on a sufficient scale. An examination of the situation in California shows that recognizing how the healthcare needs of incarcerated people change as they age - and how aging and aging-related health changes often decrease an older person's likelihood of repeat offense - is critical to achieving effective and efficient policies and practices aimed at adequately caring for this population and reducing their numbers in prisons when appropriate.
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Affiliation(s)
- Zachary Psick
- Department of Sociology, University of California , Davis, Davis, California, USA
| | - Jonathan Simon
- University of California, Berkeley , Berkeley, California, USA
| | - Rebecca Brown
- Division of Medicine, Department of Geriatrics, University of California, San Francisco , San Francisco, USA
| | - Cyrus Ahalt
- University of California, San Francisco , San Francisco, California, USA
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12
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Bandara SN, Huskamp HA, Riedel LE, McGinty EE, Webster D, Toone RE, Barry CL. Leveraging The Affordable Care Act To Enroll Justice-Involved Populations In Medicaid: State And Local Efforts. Health Aff (Millwood) 2017; 34:2044-51. [PMID: 26643624 DOI: 10.1377/hlthaff.2015.0668] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act provides an unprecedented opportunity to enroll criminal justice-involved populations in health insurance, particularly Medicaid. As a result, many state and county corrections departments have launched programs that incorporate Medicaid enrollment in discharge planning. Our study characterizes the national landscape of programs enrolling criminal justice-involved populations in Medicaid as of January 2015. We provide an overview of sixty-four programs operating in jails, prisons, or community probation and parole systems that enroll individuals during detention, incarceration, and the release process. We describe the variation among the programs in terms of settings, personnel, timing of eligibility screening, and target populations. Seventy-seven percent of the programs are located in jails, and 56 percent use personnel from public health or social service agencies. We describe four practices that have facilitated the Medicaid enrollment process: suspending instead of terminating Medicaid benefits upon incarceration, presuming that an individual is eligible for Medicaid before the process is completed, allowing enrollment during incarceration, and accepting alternative forms of identification for enrollment. The criminal justice system is a complex one that requires a variety of approaches to enroll individuals in Medicaid. Future research should examine how these approaches influence health and criminal justice outcomes.
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Affiliation(s)
- Sachini N Bandara
- Sachini N. Bandara is a doctoral student in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Haiden A Huskamp
- Haiden A. Huskamp is a professor of health care policy at Harvard Medical School, in Boston, Massachusetts
| | - Lauren E Riedel
- Lauren E. Riedel is a research assistant at Harvard Medical School
| | - Emma E McGinty
- Emma E. McGinty is an assistant professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Daniel Webster
- Daniel Webster is a professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Robert E Toone
- Robert E. Toone is an attorney in West Newton, Massachusetts
| | - Colleen L Barry
- Colleen L. Barry is an associate professor and associate chair for research and practice in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
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13
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Health Insurance Trends and Access to Behavioral Healthcare Among Justice-Involved Individuals-United States, 2008-2014. J Gen Intern Med 2016; 31:1523-1529. [PMID: 27638837 PMCID: PMC5130958 DOI: 10.1007/s11606-016-3845-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A large proportion of justice-involved individuals have mental health issues and substance use disorders (SUD) that are often untreated due to high rates of uninsurance. However, roughly half of justice-involved individuals were estimated to be newly eligible for health insurance through the Affordable Care Act (ACA). OBJECTIVE We aimed to assess health insurance trends among justice-involved individuals before and after implementation of the ACA's key provisions, the dependent coverage mandate and Medicaid expansion, and to examine the relationship between health insurance and treatment for behavioral health conditions. DESIGN Repeated and pooled cross-sectional analyses of data from the National Survey on Drug Use and Health (NSDUH). PARTICIPANTS Nationally representative sample of 15,899 adults age 19-64 years between 2008 and 2014 with a history of justice involvement during the prior 12 months. MAIN MEASURES Uninsurance rates between 2008 and 2014 are reported. Additional outcomes include adjusted treatment rates for depression, serious mental illness, and SUD by insurance status. KEY RESULTS The dependent coverage mandate was associated with a 13.0 percentage point decline in uninsurance among justice-involved individuals age 19-25 years (p < 0.001). Following Medicaid expansion, uninsurance declined among justice involved individuals of all ages by 9.7 percentage points (p < 0.001), but remained 16.3 percentage points higher than uninsurance rates for individuals without justice involvement (p < 0.001). In pooled analyses, Medicaid, relative to uninsurance and private insurance, was associated with significantly higher treatment rates for illicit drug abuse/dependence and depression. CONCLUSION Given the high prevalence of mental illness and substance use disorders among justice-involved populations, persistently elevated rates of uninsurance and other barriers to care remain a significant public health concern. Sustained outreach is required to reduce health insurance disparities between individuals with and without justice involvement. Public insurance appears to be associated with higher treatment rates, relative to uninsurance and private insurance, among justice-involved individuals.
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14
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Chen MS, Huang SK. Mainstream Health Care in Taiwan’s Prisons: A Model for Expanding Medicaid Coverage to Incarcerated Americans. Am J Public Health 2016; 106:794-5. [DOI: 10.2105/ajph.2016.303135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Michael S. Chen
- Michael S. Chen is with the Department of Social Welfare, National Chung University, Taiwan. San-Kuei Huang is with the National Health Insurance Administration, Ministry of Health and Welfare, Taiwan
| | - San-Kuei Huang
- Michael S. Chen is with the Department of Social Welfare, National Chung University, Taiwan. San-Kuei Huang is with the National Health Insurance Administration, Ministry of Health and Welfare, Taiwan
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15
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Nowotny KM, Cepeda A, James-Hawkins L, Boardman JD. Growing Old Behind Bars: Health Profiles of the Older Male Inmate Population in the United States. J Aging Health 2015; 28:935-56. [PMID: 26553724 DOI: 10.1177/0898264315614007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study examines patterns of multimorbidity among elderly male inmates across four domains of health (chronic medical conditions, drug- and alcohol-related diseases, impairments, and mental and behavioral health) to understand the complex health care needs of this growing population. METHOD We use the 2004 Survey of Inmates in State Correctional Facilities and Latent Class Regression Analysis to examine 22 health problems among 1,026 men aged 50 and older. RESULTS There are four groups of elderly male inmates: (a) relatively healthy (45.1%), (b) substance users with behavioral health issues (23.4%), (c) chronic unhealthy with impairments and violence/injury (23.6%), and (d) very unhealthy across all domains (7.9%). These groups have unique sociodemographic background and incarceration history characteristics. CONCLUSION This study demonstrates the complexity of health for elderly inmates. Prison health should continue to be monitored to aid correctional and community health programs in understanding clinical risks, exposures, and health care needs for this population.
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Affiliation(s)
| | - Alice Cepeda
- University of Southern California, Los Angeles, USA
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16
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Mundt MP, Zakletskaia LI, Shoham DA, Tuan WJ, Carayon P. Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs. Alcohol Clin Exp Res 2015; 39:2003-15. [PMID: 26350957 DOI: 10.1111/acer.12831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 06/29/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. METHODS Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. RESULTS Teams (n = 31) whose registered nurses displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (rate ratio [RR] = 0.90; 95% confidence interval [CI]: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1,030 (95% CI: -$1,819, -$241) lower alcohol-related patient healthcare costs per 1,000 team patients in the past 12 months. Conversely, teams whose primary care practitioner (PCP) had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR = 1.12; 95% CI: 1.03, 1.23) and $1,428 (95% CI: $378, $2,478) higher alcohol-related healthcare costs per 1,000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and comorbidity diagnoses. CONCLUSIONS Excessive alcohol-using patients may fair better if cared for by teams whose face-to-face and electronic communication networks include more team members and whose communication to the PCP has been streamlined to fewer team members.
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Affiliation(s)
- Marlon P Mundt
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Larissa I Zakletskaia
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David A Shoham
- Stritch School of Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois
| | - Wen-Jan Tuan
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Pascale Carayon
- College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin
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17
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Birnbaum N, Lavoie M, Redmond N, Wildeman C, Wang EA. Termination of medicaid policies and implications for the Affordable Care Act. Am J Public Health 2014; 104:e3-4. [PMID: 24922155 DOI: 10.2105/ajph.2014.302017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nathan Birnbaum
- Nathan Birnbaum and Emily A. Wang are with the Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT. Melissa Lavoie is with the Goucher Post-Baccalaureate Premedical Program, Towson, MD. Nicole Redmond is with the Division of Preventive Medicine (NR), University of Alabama at Birmingham. Christopher Wildeman is with the Department of Sociology, Yale University
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