Enrollment and Service Use Patterns Among Persons With Severe Mental Illness Receiving Expedited Medicaid on Release From State Prisons, County Jails, and Psychiatric Hospitals

Abstract

Expediting Medicaid benefits for persons with severe mental illness was associated with increased enrollment and outpatient mental health service use in the 90 days after release from state prisons, county jails, and psychiatric hospitals in Washington State.

Do timely mental health services reduce re‐incarceration among prison releasees with severe mental illness?

“…Control subjects were retained if they enrolled in Medicaid through some mechanism other than the expedited program; 82 people who received an expedited Medicaid referral more than 31 days after release were recoded as controls rather than treated individuals. These may be individuals who deferred finalizing their Medicaid enrollment or who were referred to the expedited program during a subsequent hospitalization or stay in the criminal justice setting . These 82 individuals had substantially higher rates of subsequent contact with the Department of Corrections ( P < 0.001) or jail ( P < 0.002) and a greater number of arrests ( P < 0.001) in the 12 months post–index release than did other study subjects, making a referral after a subsequent re‐incarceration a likely explanation.…”

“…In this analysis, we find that it is also highly associated with the receipt of timely mental health services or that it serves as a strong instrument, with linear F ‐statistics well over 100 in all models on the full sample and over 20 in all subsample models, controlling for 59 additional exogenous variables. The primary reason for lack of referral was due to capacity constraints in identifying and recommending individuals to the program, which was just started in 2006 . We believe that referral to expedited Medicaid is not otherwise associated with criminal justice use except through the receipt of mental health treatment, once we control for a large number of baseline criminal justice and history of mental health services variables that occurred prior to the index incarceration.…”

Expedited Medicaid Enrollment, Mental Health Service Use, and Criminal Recidivism Among Released Prisoners With Severe Mental Illness

“…In state prisons, corrections mental health staff first identified offenders with mental illness, assisted them with Medicaid applications, and referred them to Community Service Offices where offenders had to appear following release for approval determinations. Further details about the policy context are available elsewhere (30). …”

“…A pilot study in three Oklahoma prisons found that a discharge planning program for inmates with serious mental illness increased both Medicaid enrollment and mental health service use by 16% within 90-days of release (29). Our prior research on prisons in Washington State also showed that expediting Medicaid for offenders with severe mental illness was associated with increased Medicaid enrollment by 15% and increased outpatient mental health service use by 13% in the 90 days following release from state prison (30). However, no prior research on state prisoners has addressed the question of whether expediting Medicaid benefits actually leads to reduced criminal recidivism for offenders with severe mental illness.…”

“…We employ a quasi-experimental design using administrative data with a propensity-weighted control group that adjusts for selection artifacts, thereby allowing for causal inferences about the effects of expediting Medicaid. Further, we narrow the focus to offenders with schizophrenia or bipolar disorder (those most likely to be referred for expedited Medicaid in our prior research [30]), expand the sample from one to two years, lengthen the follow-up period from three to 12 months, and include measures of criminal recidivism during the 12-month follow-up period. The hypothesis that guided our research is: Offenders with severe mental illness who were referred for expedited Medicaid prior to release from prison will have greater Medicaid access, more use of community mental health services, and lower criminal recidivism rates in the 12-months following release than offenders with severe mental illness who were not referred for expedited Medicaid.…”