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

Abstract

Objective To investigate whether Washington State’s 2006 policy of expediting Medicaid enrollment for offenders with severe mental illness released from state prisons increased Medicaid access and use of community mental health services while decreasing criminal recidivism. Methods A quasi-experimental design with linked administrative data was used to select all prisoners with a severe mental illness (schizophrenia or bipolar disorder) released during the policy’s first two years (January 1, 2006 through December 31, 2007), separating those referred for expedited Medicaid (n= 895) from a propensity-weighted control group of those not referred (n= 2191). Measures included binary indicators of Medicaid enrollment; other public insurance enrollment; post-release use of inpatient and outpatient health services; and any post-release criminal justice contacts. All data were collapsed to person-level observations during the 12 months following index release and outcomes were estimated via propensity-weighted logit models. Results Referral for expedited Medicaid upon release from prison greatly increased Medicaid enrollment (p< .01) and use of community mental health and medical services (p< .01) for persons with severe mental illness. No evidence was found that expediting Medicaid reduced criminal recidivism. Conclusions Expediting Medicaid was associated with increased Medicaid enrollment and mental health service use but study findings strongly suggest that, rather than relying on indirect spill-over effects from Medicaid to reduce criminal recidivism, advocates and policymakers would better address the needs of offenders with severe mental illness through direct interventions targeted at underlying causes of recidivism.

Interventions at the Transition from Prison to the Community for Prisoners with Mental Illness: A Systematic Review

“…In Wenzlow et al (2011), the study’s secondary outcomes were significant with more of the intervention group having contact with mental health services ( p  = .009) and being prescribed medication ( p  = .041) in the 90 days following release. Morrissey et al (2016) also found participants in the intervention group also had higher rates of mental health and other health service use as well as prescribed medication and although this information was recorded from insurance based payment systems the differences appear robust.…”

“…The majority of the included studies were conducted in the United States of America (US; n = 10; Brown et al 2013; Buck et al 2011; Burke and Keaton 2004; Hartwell and Orr 1999; Kesten et al 2012; Morrissey et al 2016; Roskes and Feldman 1999; Solomon and Draine 1995; Theurer and Lovell 2008; Trupin et al 2011; Wenzlow et al 2011) with two studies conducted in England (Jarrett et al 2012; Shaw et al 2017) and one in Australia (Green et al 2016). Nine used a wide geographical area which included urban and rural settings, whereas four related to a single urban area (Brown et al 2013; Buck et al 2011; Roskes and Feldman 1999; Solomon and Draine 1995; Theurer and Lovell 2008).…”

“…Six studies were based on cohort comparisons (Green et al 2016; Kesten et al 2012; Morrissey et al 2016; Theurer and Lovell 2008; Trupin et al 2011; Wenzlow et al 2011), either from facilities that did not offer the intervention, from a time when the intervention was not available, or with a group not referred to an intervention. Four studies were randomised controlled trials (Burke and Keaton 2004; Jarrett et al 2012; Shaw et al 2017; Solomon and Draine 1995).…”

“…Two studies aimed to ensure that prisoners with mental illness were enrolled in Medicaid at re-entry to facilitate access to health services by reducing financial barriers (Morrissey et al 2016; Wenzlow et al 2011). In an Oklahoma state based study (Wenzlow et al 2011), participants in the intervention group had higher rates of Medicaid enrolment on the day of re-entry (25%) compared with those at the facility before the introduction of the intervention (8%) and comparison facilities without the intervention (3%).…”

“…Seven studies were rated weak (Brown et al 2013; Buck et al 2011; Burke and Keaton 2004; Green et al 2016; Hartwell and Orr 1999; Jarrett et al 2012; Roskes and Feldman 1999; Solomon and Draine 1995) according to the Quality Assessment Tool (Effective Public Health Practice Project 2009), four were rated moderate (Shaw et al 2017; Theurer and Lovell 2008; Trupin et al 2011; Wenzlow et al 2011) and two were rated strong (Kesten et al 2012; Morrissey et al 2016). Details of the quality assessment are given in Online Appendix II.…”