Perspectives of California Legislators on Institutional Barriers and Facilitators to Non-Partisan Research Evidence Use in State Health Policymaking.

BACKGROUND: Bridging the translational gap between research evidence and health policy in state legislatures requires understanding the institutional barriers and facilitators to non-partisan research evidence use. Previous studies have identified individual-level barriers and facilitators to research evidence use, but limited perspectives exist on institutional factors within legislatures that influence non-partisan research evidence use in health policymaking. OBJECTIVE: We describe the perspectives of California state legislators and legislative staff on institutional barriers and facilitators of non-partisan research evidence use in health policymaking and explore potential solutions for enhancing use. DESIGN: Case study design involving qualitative interviews. PARTICIPANTS: We interviewed 24 California state legislators, legislative office staff, and legislative research staff. APPROACH: Semi-structured recorded interviews were conducted in person or by phone to identify opportunities for enhancing non-partisan research evidence use within state legislatures. We conducted thematic analyses of interview transcripts to identify (1) when research evidence is used during the policymaking process, (2) barriers and facilitators operating at the institutional level, and (3) potential solutions for enhancing evidence use. RESULTS: Institutional barriers to non-partisan research evidence use in health policymaking were grouped into three themes: institutional policies, practices, and priorities. Interviews also revealed institutional-level facilitators of research evidence use, including (1) access and capacity to engage with research evidence, and (2) perceived credibility of research evidence. The most widely supported institutional-level solution for enhancing evidence-based health policymaking in state legislatures involved establishing independent, impartial research entities to provide legislators with trusted evidence to inform decision-making. CONCLUSIONS: Potential institutional-level changes within state legislatures may enhance evidence use in health policymaking, leading to improved health outcomes and lower healthcare costs for states.

Policy Solutions to End Gaps in Medicaid Coverage during Reentry after Incarceration in the United States: Experts' Recommendations.

Aims: We sought to gather experts' perspectives on Medicaid coverage gaps during reentry to identify high-yield policy solutions to improve the health of justice-involved individuals in the United States. Subject and Methods: We interviewed 28 experts at the intersection of Medicaid and criminal justice via telephone between November 2018 and April 2019. Interviewees included Medicaid administrators, health and justice officials, policy makers, and health policy researchers. We performed thematic analysis of semi-structured interview transcripts to identify emergent themes and distill policy recommendations. Results: Three themes emerged: 1) Medicaid coverage gaps during reentry contribute to poor health outcomes and recidivism, 2) Excessive burden on justice-involved people to re-activate Medicaid leads to coverage gaps, and 3) Scalable policy solutions exist to eliminate Medicaid coverage gaps during reentry. Policy recommendations centered on ending the federal "inmate exclusion," delaying Medicaid de-activation at intake, and promoting re-activation by reentry. Experts viewed coverage gaps as problematic, viewed current approaches as inefficient and burdensome to families and systems, and recommended several policy solutions. Conclusion: By pursuing strategies to eliminate Medicaid gaps during reentry, policymakers can improve health outcomes and efficiency of government spending on healthcare, and may reduce cycles of incarceration.

Reducing Medicaid Coverage Gaps for Youth During Reentry.

Although many justice-involved youth (JIY) rely on Medicaid, due to the federal "inmate exclusion" Medicaid is often suspended or terminated upon youth's intake to detention, which can lead to coverage gaps at release. We interviewed 28 experts on Medicaid and the justice system and conducted thematic analysis to identify solutions for reducing Medicaid coverage gaps during reentry. Participants viewed coverage gaps during reentry as a significant public health problem to which JIY are especially vulnerable. Recommended solutions for reducing coverage gaps for JIY included (a) leave Medicaid activated, (b) reactivate Medicaid before or during reentry, (c) enhance interagency collaboration, and (d) address societal context to ensure health care access for Medicaid-eligible JIY. Doing so may improve health outcomes and reduce cycles of youth incarceration.

Eliminating Gaps in Medicaid Coverage During Reentry After Incarceration.

This commentary explores the health and social challenges associated with gaps in Medicaid health insurance coverage for adults and youths exiting the US criminal justice system, and highlights some potential solutions.Because a high proportion of recently incarcerated people come from low-income backgrounds and experience a high burden of disease, the Medicaid program plays an important role in ensuring access to care for this population. However, the Medicaid Inmate Exclusion Policy, or "inmate exclusion," leads to Medicaid being terminated or suspended upon incarceration, often resulting in gaps in Medicaid coverage at release. These coverage gaps interact with individual-level and population-level factors to influence key health and social outcomes associated with recidivism.Ensuring Medicaid coverage upon release is an important, feasible component of structural change to alleviate health inequities and reduce recidivism. High-yield opportunities to ensure continuous coverage exist at the time of Medicaid suspension or termination and during incarceration prior to release.