Jointly funded with the Robert Wood Johnson Foundation
The incarcerated population—which includes a disproportionate number of young, low-income black and Latino men—exhibits higher rates of infectious disease, mental illness and substance use disorders than the general population. Despite these health challenges, most released offenders lack health insurance and have weak attachments to traditional sources of coverage, such as employment, educational institutions, and social safety net programs. The National Institute of Corrections estimates that the recently incarcerated account for about 35 percent of the uninsured who became eligible for health insurance through Medicaid expansions under the ACA.
In California, the expansion of Medicaid (Medi-Cal), along with a new state law that facilitates the enrollment of jail inmates, has made it easier to enroll this population. Although insurance coverage does not always increase the use of health services, there is some evidence of higher treatment rates among ex-offenders with severe mental illness and substance use disorders when they have Medicaid coverage. In addition, chemical dependence treatment and outpatient mental health services are associated with reductions in rearrest rates and fewer total arrests, suggesting that Medicaid enrollment may facilitate prisoner reentry. Thus, enrollment represents an attractive intervention that might both improve public safety and reduce overall costs.
Mia Bird will use newly available data to estimate the effects of the ACA’s coverage expansion on recidivism outcomes. She will track individuals as they move through the justice system in order to examine the effects of ACA enrollment on recidivism for various groups, including race and ethnicity. Her research will shed insight on the extent to which limited correctional dollars should be directed towards enrollment programs, as well as contribute to a growing literature on the effects of the ACA on underserved and vulnerable populations.