Every year, roughly 10 million Americans cycle through the criminal justice system, including 725,000 individuals released from prisons. Compared to the general population, these individuals are up to seven times more likely to have chronic health conditions requiring ongoing care, most notably substance use disorders and mental health needs. For example, a July 2005 Bureau of Justice Statistics Special Report found that 68 percent of jail inmates met the diagnostic criteria for substance abuse or dependence.
Incarcerated individuals typically receive only limited treatment for substance use disorders and an estimated 70 to 90 percent of adults released from criminal justice settings are uninsured. As such, these individuals lack access to necessary health services, leading to higher reincarceration rates and significantly worse health outcomes. One study in Washington State found that released inmates were 12.7 times more likely than the general population to die within two weeks after their release, with drug overdose and cardiovascular disease among the leading causes.
Medicaid, the insurance program for low-income people, traditionally provided coverage only to individuals meeting certain “categorical” requirements, such as pregnant women, children, and blind or disabled persons. This left many previously incarcerated adults with few, if any, affordable options for health coverage. This changed in 2014, when the Affordable Care Act (ACA) extended Medicaid eligibility to all individuals with annual incomes at or below 138 percent of the Federal Poverty Line - $16,242.60 for an individual or $33,465 for a family of four in 2015.
The U.S. Department of Justice estimated that 35 percent of individuals gaining Medicaid eligibility under the ACA have previous involvement with the criminal justice system. In the 30 states (including the District of Columbia) that implemented Medicaid expansion, many recently released individuals and other justice-involved populations now have an opportunity to access vital health services, including guaranteed coverage of services for mental health and substance use disorders.
Unfortunately, too often these individuals do not know that they are eligible for or how to enroll in Medicaid and are thus unable to take advantage of available services. To address this issue, state and local governments have implemented programs designed to enroll individuals during their direct involvement in the criminal justice system, thereby ensuring immediate coverage following their release. As of January 2015, at least 64 such programs exist across the country, from New York and California to Texas and North Carolina. These programs complement existing community-based organizations that work with justice-involved populations only after the individuals return home.
Thus far, these programs have produced promising results. Multiple studies have demonstrated that previously incarcerated individuals enrolled in Medicaid upon release were more likely to use substance abuse and mental health services and less likely to be arrested or face reincarceration. Moreover, government agencies, including law enforcement and courts, save thousands of dollars for each individual who avoids arrest or reincarceration after receiving treatment. If governments and advocates double-down on these efforts, establishing programs where none exist and improving those that do, they will not only save money – they save lives.
This guest post was developed by Derek Carr, J.D., Legal Fellow at the Network for Public Health Law — Southeastern Region.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.