Evaluating Medicaid Access for Halfway House Residents: A Research Partnership with the Connecticut Department of Corrections

STATEMENT OF THE PROBLEM
Many halfway house residents in Connecticut have had to return to prison and jail for health care because their legal status as 'inmates' rather than 'parolees' prevented them from being insured. A new, state-financed Medicaid program will provide 'inmates' with comparable coverage and access to community-based health services. Does this policy change reduce barriers to seeking care, improve health care utilization, and decrease the costs of providing health care? Further, are there impacts on post-release employment and recidivism?

SUBJECTS
Data collection will include all 3,600 individuals statewide who enter halfway houses during the study's pre- and post-insurance time periods. Analyses focus on 2,040 individuals in the target population -'inmates' previously ineligible for Medicaid because they were administratively released from DOC prisons.

PARTNERSHIPS
The Connecticut Department of Correction (DOC) and Department of Social Services (DSS) will serve as practitioner partners. Both have provided letters of commitment.

RESEARCH DESIGN AND METHODS
We propose a pre/post design with qualitative and quantitative data collection methods to measure changes before and after the new Medicaid program's July 1, 2015 statewide implementation.
A qualitative implementation study will include stakeholder interviews with DOC, halfway house, and Medicaid personnel to document program implementation, costs, and challenges. Focus groups with halfway house residents will provide their perspectives on care continuity and any persistent barriers to care.
A quantitative impact study will measure outcomes using administrative data, including Medicaid enrollment, health care use, care continuity from prison to the halfway house, and six-month employment and recidivism outcomes.
A cost analysis will examine whether changes in health care use patterns, halfway house staff activities, and Medicaid agency workloads affected the cost of caring for this population.
Note that random assignment is not feasible because of statewide program implementation and ethical concerns about differential access to health care.

ANALYSIS
Qualitative data will be coded and synthesized to assess implementation, challenges, and stakeholder perspectives. Quantitative pre/post outcome analyses will include t-tests, analysis of variance, and logistic regression. If appropriate, we will develop multilevel models to account for variation across parole regions or halfway house program types.

PRODUCTS, REPORTS, AND DATA ARCHIVING
Results will be synthesized into a summary report to NIJ, two journal articles, a practitioner-oriented article, three or four
conference presentations, and a final site briefing. De-identified analysis files will be archived at NACJD, including data from stakeholder interviews, focus groups, administrative data sources, and the cost analysis.

ca/ncf