Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan 4;5(1):e2142688.
doi: 10.1001/jamanetworkopen.2021.42688.

Association Between Assistance With Medicaid Enrollment and Use of Health Care After Incarceration Among Adults With a History of Substance Use

Marguerite E Burns  1 , Steven Cook  2 , Lars M Brown  3 , Laura Dague  4 , Steve Tyska  5 , Karla Hernandez Romero  6 , Cici McNamara  6 , Ryan P Westergaard  7
Affiliations

Association Between Assistance With Medicaid Enrollment and Use of Health Care After Incarceration Among Adults With a History of Substance Use

Marguerite E Burns et al. JAMA Netw Open. .

Abstract

Importance: The transition from prison to community is characterized by elevated morbidity and mortality, particularly owing to drug overdose. However, most formerly incarcerated adults with substance use disorders do not use any health care, including treatment for substance use disorders, during the initial months after incarceration.

Objective: To evaluate whether a prerelease Medicaid enrollment assistance program is associated with increased health care use within 30 days after release from prison.

Design, setting, and participants: This retrospective cohort study included 16 307 adults aged 19 to 64 years with a history of substance use who were released from state prison between April 1, 2014, and December 31, 2016. The Wisconsin Department of Corrections implemented prerelease Medicaid enrollment assistance in January 2015. Statistical analysis was performed from January 1 to August 31, 2021.

Exposure: A statewide Medicaid prerelease enrollment assistance program.

Main outcomes and measures: The main outcome was Medicaid-reimbursed health care, associated with substance use disorders and for any cause, within 30 days of prison release, including outpatient, emergency department, and inpatient care. Mean outcomes were compared for those released before and after implementation of prerelease Medicaid enrollment assistance using an intention-to-treat analysis and person-level data from the Wisconsin Department of Corrections and Medicaid.

Results: The sample included 16 307 individuals with 18 265 eligible releases (men accounted for 16 320 of 18 265 total releases, and 6213 of 18 265 releases were among Black individuals; mean [SD] age at release, 35.5 [10.7] years). The likelihood of outpatient care use within 30 days of release increased after implementation of enrollment assistance relative to baseline by 7.7 percentage points for any visit (95% CI, 6.4-8.9 percentage points; P < .001), by 0.7 percentage points for an opioid use disorder visit (95% CI, 0.4-1.0 percentage points; P < .001), by 1.0 percentage point for any substance use disorder visit (95% CI, 0.5-1.6 percentage points; P < .001), and by 0.4 percentage points for receipt of medication for opioid use disorder (95% CI, 0.2-0.6 percentage points; P < .001). There was no significant change in use of the emergency department (0.7 percentage points [95% CI, -0.15 to 1.4 percentage points]). The probability of an inpatient stay increased by 0.4 percentage points (95% CI, 0.03-0.7 percentage points; P = .03).

Conclusions and relevance: The results of this cohort study suggest that prerelease Medicaid enrollment assistance was associated with increased use of outpatient health care after incarceration and highlights the value of making this assistance universally available within correctional settings. More tailored interventions may be needed to increase the receipt of treatment for substance use disorders.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Mr Cook reported receiving grants from the National Institutes of Health and the Wisconsin Partnership Program during the conduct of the study. Dr Dague reported a Contract for Evaluation of Medicaid 1115 Waiver from the state of Wisconsin Department of Health Services outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Association of the Availability of a Medicaid Enrollment Assistance Program With Use of Health Care Within 30 Days of Release From Prison: Results From Regression Analyses
Authors’ calculations from Wisconsin Medicaid and Department of Corrections data. Each row in the table presents the results of a separate regression for the identified outcome, the point estimate, and its 95% CI. The adjacent graph plots the point estimate and its 95% CI relative to the dashed line at 0, which represents the null hypothesis (which is no change in health care use associated with being released after implementation of the enrollment assistance program relative to being released before its implementation). OUD indicates opioid use disorder; SUD, substance use disorder. aP < .001. bP < .05.
Figure 2.
Figure 2.. Association of the Availability of a Medicaid Enrollment Assistance Program With Any Outpatient Visit Within 30 Days of Release From Prison: Results From Regression Analyses by Subgroup
Authors’ calculations from Wisconsin Medicaid and Department of Corrections data. Each row in the table presents the results of a separate regression for the identified subgroup, the point estimate, and its 95% CI. The adjacent graph plots the point estimate and its 95% CI relative to the dashed line at 0, which represents the null hypothesis (which is no change in health care use associated with being released after implementation of the enrollment assistance program relative to being released before its implementation). HCV indicates hepatitis C virus; MSA, metropolitan statistical area; and SUD, substance use disorder. aP < .001. bOther races and ethnicities include American Indian or Alaska Native, Asian or Pacific Islander, and unknown. cP < .05.
See this image and copyright information in PMC

Comment in

References

    1. Chandler RK, Fletcher BW, Volkow ND. Treating drug abuse and addiction in the criminal justice system: improving public health and safety. JAMA. 2009;301(2):183-190. doi:10.1001/jama.2008.976 - DOI - PMC - PubMed
    1. Carson EA. Prisoners in 2019. Bureau of Justice Statistics, US Department of Justice. October 2020. Accessed March 2, 2021. https://bjs.ojp.gov/content/pub/pdf/p19.pdf
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 4th ed. American Psychiatric Association; 1994.
    1. Bronson J, Stroop J, Zimmer S, Berzofsky M. Drug use, dependence, and abuse among state prisoners and jail inmates, 2007-2009. Bureau of Justice Statistics, US Department of Justice. June 2017. Accessed January 27, 2021. https://bjs.ojp.gov/content/pub/pdf/dudaspji0709.pdf
    1. Mallik-Kane K, Visher CA. Health and Prisoner Reentry: How Physical, Mental, and Substance Abuse Conditions Shape the Process of Reintegration. Urban Institute; 2008.