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Journal of Urban Health

, Volume 95, Issue 2, pp 149–158 | Cite as

Implementing a Prison Medicaid Enrollment Program for Inmates with a Community Inpatient Hospitalization

  • David L. RosenEmail author
  • Catherine A. Grodensky
  • Anna R. Miller
  • Carol E. Golin
  • Marisa E. Domino
  • Wizdom Powell
  • David A. Wohl
Article

Abstract

In 2011, North Carolina (NC) created a program to facilitate Medicaid enrollment for state prisoners experiencing community inpatient hospitalization during their incarceration. The program, which has been described as a model for prison systems nationwide, has saved the NC prison system approximately $10 million annually in hospitalization costs and has potential to increase prisoners’ access to Medicaid benefits as they return to their communities. This study aims to describe the history of NC’s Prison-Based Medicaid Enrollment Assistance Program (PBMEAP), its structure and processes, and program personnel’s perspectives on the challenges and facilitators of program implementation. We conducted semi-structured interviews and a focus group with PBMEAP personnel including two administrative leaders, two “Medicaid Facilitators,” and ten social workers. Seven major findings emerged: 1) state legislation was required to bring the program into existence; 2) the legislation was prompted by projected cost savings; 3) program development required close collaboration between the prison system and state Medicaid office; 4) technology and data sharing played key roles in identifying inmates who previously qualified for Medicaid and would likely qualify if hospitalized; 5) a small number of new staff were sufficient to make the program scalable; 6) inmates generally cooperated in filling out Medicaid applications, and their cooperation was encouraged when social workers explained possible benefits of receiving Medicaid after release; and 7) the most prominent program challenges centered around interaction with county Departments of Social Services, which were responsible for processing applications. Our findings could be instructive to both Medicaid non-expansion and expansion states that have either implemented similar programs or are considering implementing prison Medicaid enrollment programs in the future.

Keywords

Prison Prisoners Medicaid Healthcare Access Program evaluation Social workers 

Notes

Acknowledgments

We thank the NC prison system administrators and Social Work program staff who made this project possible. This project was funded by the National Institutes of Health (R01 MD008979 and R21 MH099162) and supported by the University of North Carolina at Chapel Hill Center for AIDS Research (CFAR, NIH Funded program P30 AI50410) and the UNC Criminal Justice Working Group.

Compliance with Ethical Standards

Funding

This project was funded by the National Institutes of Health (R01 MD008979 and R21 MH099162) and supported by the University of North Carolina at Chapel Hill Center for AIDS Research (CFAR, NIH Funded program P30 AI50410) and the UNC Criminal Justice Working Group.

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Copyright information

© The New York Academy of Medicine 2017

Authors and Affiliations

  • David L. Rosen
    • 1
    Email author
  • Catherine A. Grodensky
    • 1
  • Anna R. Miller
    • 1
  • Carol E. Golin
    • 2
    • 4
  • Marisa E. Domino
    • 3
  • Wizdom Powell
    • 2
  • David A. Wohl
    • 1
  1. 1.Institute for Global Health and Infectious Diseases, Division of Infectious Diseases, Department of Medicine, School of MedicineUniversity of North CarolinaChapel HillUSA
  2. 2.Department of Health Behavior, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  3. 3.Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  4. 4.Department of Medicine, School of MedicineUniversity of North CarolinaChapel HillUSA

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