Medicaid Coverage of Behavioral Health Supports for Opioid Use Disorder During Post-Incarceration Reentry - As opioid overdoses continue to occur at alarming rates in the US, formerly incarcerated individuals account for at least 9% of overdose fatalities. This population has high prevalences of opioid use disorder (OUD) and other health conditions and faces many barriers to accessing critical health services, such as medications for OUD treatment. To address these multi-faceted needs, promising models of post-incarceration reentry health services provide care navigation and linkage to social resources, but critical knowledge gaps remain regarding the impacts of reentry navigation services for OUD when implemented at scale. Medicaid is the most apt policy lever for scaling up and sustainably funding reentry services, as 80-90% of people leaving carceral facilities are Medicaid-eligible in most states. In 2022, the Massachusetts Medicaid program launched its statewide Behavioral Health supports for Justice-involved Individuals (BH- JI) program, which contracts with community providers in each county to cover care navigation and reentry supports for recently incarcerated members with behavioral health needs. This Mentored Research Career Development Award uses the statewide implementation of BH-JI as a natural experiment to conduct a mixed methods study with the following scientific aims: (Aim 1) To determine the impact of BH-JI reentry care navigation services on post-release healthcare utilization, costs, and overdose outcomes for individuals with OUD released from incarceration. This quantitative aim uses quasi-experimental study designs and the Massachusetts Public Health Data Warehouse, which links individual-level data from an All Payer Claims Database to more than twenty statewide databases, including healthcare, public health, jails, and prisons. (Aim 2) To identify the perceived facilitators and barriers to statewide policy implementation of the BH-JI reentry care navigation program and the mechanisms that explain any impact on client outcomes. This qualitative aim uses a policy-focused implementation science approach and in- depth interviews with key informants, including state Medicaid officials, healthcare delivery organizations, BH-JI providers, carceral facilities, and BH-JI clients. Lastly, a convergent mixed methods analysis will integrate findings from both aims. With the exceptional mentorship team assembled in this K08 and through an intensive combination of formal courses, training workshops, field experiences, and applied research, the candidate will: (1) deepen existing skills in quantitative methods; (2) cultivate new skills for policy-focused implementation science, including qualitative and mixed methods; (3) enhance their addiction medicine and correctional healthcare expertise; and (4) develop the professional skills of an independent physician- investigator. Acquisition of these skills will propel the candidate to accomplish their long-term career goal: to become a thought leader on policy innovations to improve health care and outcomes for people with substance use disorders and criminal legal involvement.
