Expediting Medicaid Enrollment for Released Offenders Improves Health Access, But Not Recidivism

Treating Mental Illness Behind Bars
Treating Mental Illness Behind Bars
Released offenders with mental illness who received expedited enrollment in Medicaid were more likely to return to prison that those who weren't.

Expediting Medicaid enrollment for Washington state prisoners with severe mental illness increased enrollment and health care utilization but did not influence recidivism, according to research recently published in Psychiatric Services in Advance.

Joseph P Morrissey, PhD, and his colleagues at the University of North Carolina, Chapel Hill, compared 895 prisoners who were referred for expedited Medicaid enrollment to 2191 prisoners who were not. All the prisoners had diagnosed schizophrenia or bipolar disorder and were released between January 2006 and December 2007, the first two years after Washington began expediting Medicaid enrollment for offenders released from state prisons with severe mental illness.

The researchers tracked their Medicaid enrollment status, use of health services and recidivism, based on arrests for felonies or gross misdemeanors, any jail days or any prison incarcerations, for 12 months.

Among those referred for expedited enrollment, 60% enrolled in Medicaid the day they were released, a rate 35 percentage points higher than the control group after accounting for baseline differences. A year after release, 81% of referred offenders and 43% non-referred offenders were enrolled in Medicaid, an adjusted difference of 30 percentage points. Further, 69% of the referred group and 37% of the control group used mental health services within a year after release.

While 46% of the referred group filled prescriptions for antipsychotics within 12 months after release, only 19% of the control group did. Similarly higher rates for referred offenders existed for antidepressant, sedative, anxiolytic and narcotic prescriptions.

Both Medicaid enrollment and utilization of community mental health and general medical services therefore increased among prisoners with severe mental illness referred for expedited enrollment, but recidivism rates were similar between groups.

While 59% of the referred offenders were arrested during follow-up, 54% of the control group was. Similarly, 43% of referred prisoners and 34% of non-referred prisoners spent any days in jail, and 56% of referred offenders and 46% of non-referred offenders spent any days in state prison.   

“Even though health insurance such as Medicaid may be necessary for offenders with severe mental illness to obtain needed services, it alone was not sufficient to reduce their criminal justice involvement,” the authors reported. “Our study findings strongly suggest that rather than placing unrealistic hopes on indirect spillovers from health insurance, advocates and policy makers would better address the needs of offenders with severe mental illness through direct interventions targeted at underlying causes of recidivism.”


Morrissey JP, et al. Expedited Medicaid Enrollment, Mental Health Service Use, and Criminal Use Recidivism Among Released Prisoners With Severe Mental Illness. Psychiatric Serv in Adv. 2016; doi: 10.1176/appi.ps.201500305.