Increasing Medicaid enrollment among formerly incarcerated adults

Abstract

Objective: To estimate the incremental associations between the implementation of expanded Medicaid eligibility and prerelease Medicaid enrollment assistance on Medicaid enrollment for recently incarcerated adults.

Data sources/study setting: Data include person-level merged, longitudinal data from the Wisconsin Department of Corrections and the Wisconsin Medicaid program from 2013 to 2015.

Study design: We use an interrupted time series design to estimate the association between each of two natural experiments and Medicaid enrollment for recently incarcerated adults. First, in April 2014 the Wisconsin Medicaid program expanded eligibility to include all adults with income at or below 100% of the federal poverty level. Second, in January 2015, the Wisconsin Department of Corrections implemented prerelease Medicaid enrollment assistance at all state correctional facilities.

Data collection/extraction methods: We collected Medicaid enrollment, and state prison administrative and risk assessment data for all nonelderly adults incarcerated by the state who were released between January 2013 and December 2015. The full sample includes 24 235 individuals. Adults with a history of substance use comprise our secondary sample. This sample includes 12 877 individuals. The primary study outcome is Medicaid enrollment within the month of release.

Principal findings: Medicaid enrollment in the month of release from state prison grew from 8 percent of adults at baseline to 36 percent after the eligibility expansion (P-value < .01) and to 61 percent (P-value < .01) after the introduction of enrollment assistance. Results were similar for adults with a history of substance use. Black adults were 3.5 percentage points more likely to be enrolled in Medicaid in the month of release than White adults (P-value < .01).

Conclusions: Medicaid eligibility and prerelease enrollment assistance are associated with increased Medicaid enrollment upon release from prison. States should consider these two policies as potential tools for improving access to timely health care as individuals transition from prison to community.

Keywords: Medicaid; adult; health policy; prisoners; substance use disorders.

FIGURE 1

Percentage of adults released from a state correctional facility who are enrolled in Medicaid in the month of release. Source: Authors' analysis of Wisconsin Department of Corrections administrative and case management data and Wisconsin Medicaid enrollment data. Notes: The figure plots the unadjusted percentage of adults released in the month who are enrolled in Medicaid in that same month. The denominator is the number of adults released in each month, and the numerator is the number of individuals enrolled in Medicaid in that month

FIGURE 2

Percentage of adults released from a state correctional facility who are enrolled in Medicaid in the month of release and had a Medicaid application within 60 d before the release date. Source: Authors' analysis of Wisconsin Department of Corrections administrative and case management data and Wisconsin Medicaid enrollment data. Notes: The figure plots the unadjusted percentage of adults released who were enrolled in Medicaid in the month of release and had a Medicaid application dated within 60 d before the release date