Health profiles and racial disparities among individuals on probation in Hennepin County, Minnesota, 2016: a cross-sectional study.

OBJECTIVES: To estimate the health characteristics and racial/ethnic health disparities among a probation cohort in Hennepin County. We hypothesised the probation population would have higher health needs compared with the general population as well as significant racial/ethnic health disparities. DESIGN: Cross-sectional study using linked administrative records. PARTICIPANTS: Of 7992 eligible individuals, 5873 met inclusion criteria of 6 or more months of eligibility for a full-benefit Minnesota healthcare plan. SETTING: Probation system in Hennepin County in 2016. OUTCOMES: We compared health condition prevalence among our probation cohort with survey data from the general population and analysed by race/ethnicity. We also measured sociodemographic characteristics, including the use of safety-net services. RESULTS: Individuals were predominantly male (80.5%), young (mean age: 35.5 years), and disproportionately black or African American (52.9%). A majority of individuals enrolled in Medicaid were eligible via Medicaid expansion (65.9%). Compared with the general population, individuals on probation had higher rates of substance use disorders (66.5% vs 8.1%), mental illness (55.3% vs 14.4%) and many physical conditions (eg, asthma: 17.0% vs 12.5%, chronic kidney disease: 5.8% vs 0.2%). White individuals on probation were significantly more likely than black or African American individuals to have a diagnosed substance use disorder (71.6% vs 62.0%) or mental health disorder (64.9% vs 48.5%), but fewer chronic physical health conditions (average: 0.52 vs 0.73 chronic physical conditions). CONCLUSIONS: Individuals on probation have high health needs, which vary substantially by race/ethnicity. Without attention to this variation, interventions to address health conditions in this population could worsen racial/ethnic disparities.

Identification of Cross-sector Service Utilization Patterns Among Urban Medicaid Expansion Enrollees.

BACKGROUND: The expansion of Medicaid as part of the Affordable Care Act opened new opportunities to provide health coverage to low-income adults who may be involved in other public sectors. OBJECTIVE: The main objective of this study was to describe cross-sector utilization patterns among urban Medicaid expansion enrollees. RESEARCH DESIGN: We merged data from 4 public sectors (health care, human services, housing, and criminal justice) for 98,282 Medicaid expansion enrollees in Hennepin County, MN. We fit a latent class model to indicators of cross-sector involvement. MEASURES: Indicator variables described involvement levels within each sector from March 2011 through December 2014. Demographic and chronic condition indicators were included post hoc to characterize classes. RESULTS: We found 6 archetypes of cross-sector involvement: The "Low Contact" class (33.9%) had little involvement in any public sector; "Primary Care" (26.3%) had moderate, stable health care utilization; "Health and Human Services" (15.3%) had high rates of health care and cash assistance utilization; "Minimal Criminal History" (11.0%) had less serious criminal justice involvement; "Cross-sector" (7.8%) had elevated emergency department use, involvement in all 4 sectors, and the highest prevalence of behavioral health conditions; "Extensive Criminal History" (5.7%) had serious criminal justice involvement. The 3 most expensive classes (Health and Human Services, Cross-sector, and Extensive Criminal History) had the highest rates of behavioral health conditions. Together, they comprised 29% of enrollees and 70% of total public costs. CONCLUSIONS: Medicaid expansion enrollees with behavioral health conditions deserve focus due to the high cost-reduction potential across public sectors. Cross-sector collaboration is a plausible path to reduce costs and improve outcomes.

Cross-Sector Service Use Among High Health Care Utilizers In Minnesota After Medicaid Expansion.

Childless adults in the Medicaid expansion population have complex social and behavioral needs. This study compared the cross-sector involvement of Medicaid expansion enrollees who were high health care utilizers to that of other expansion enrollees in Hennepin County, Minnesota. We examined forty-six months of annualized utilization and cost data for expansion-eligible residents with at least twelve months of enrollment (N = 70,134) across health care, housing, criminal justice, and human service sectors. High health care utilizers, approximately 7 percent of our sample, were disproportionately American Indian, younger, and significantly more likely than other expansion enrollees to have mental health (88.1 percent versus 48.0 percent) or substance use diagnoses (79.2 percent versus 29.6 percent). Total cross-sector public spending was nearly four times higher for high health care users ($25,337 versus $6,786), and their non-health care expenses were 2.4 times higher ($7,476 versus $3,108). High levels of cross-sector service use suggest that there are opportunities for collaboration that may result in cost savings across sectors.