Healthcare Utilization Among Justice‐Involved Individuals Enrolled in Medicaid: Lessons from a Midwestern State

Abstract

Research ObjectiveJustice‐involved individuals have historically faced numerous barriers to accessing timely healthcare, especially after release from incarceration. This population disproportionately needs behavioral health services, for which continuity of care is crucial to prevent poor outcomes. To address this need, several states including Indiana have implemented policies to facilitate Medicaid enrollment for justice‐involved adults. Specifically, Indiana implemented policies and procedures, including Medicaid eligibility expansion through an 1115 waiver, the ability of the Indiana Department of Corrections (IDOC) to submit applications for coverage on behalf of the individuals prior to release, and allowing for coverage to be suspended rather than terminated during incarceration. Increased Medicaid coverage after release followed, but healthcare utilization patterns after release are not yet well understood. The purpose of this study is to describe healthcare utilization for individuals released from state prisons and enrolled in the Healthy Indiana Plan, Indiana's Medicaid coverage for adults.Study DesignIn this retrospective, observational study, we linked IDOC release data to Medicaid enrollment, claims data, and other state program data. We described trends in healthcare utilization in the four months following Medicaid coverage and further explore trends by time between release and Medicaid coverage.Population StudiedJustice‐involved adults released from IDOC state correctional facilities and subsequently enrolled in Medicaid between 2013‐2018 (n=19,636).Principal FindingsApproximately 80% of individuals received some sort of healthcare within the first 4 months of becoming enrolled in Medicaid, with the highest utilization occurring in the emergency department (ED, 44.1%) and office visits (41.2%). The average time to first service was approximately 55 days (SD: 37.4). The ED was the most common first setting for care (30.8%) and 20.3% of first encounters were for mental health and substance use‐related services. Those who were enrolled in Medicaid shortly after their release (within 7 days) were more likely to utilize any care compared to those who were enrolled later (89.5% vs 77.0%, p <0.0001) and received care an average of 27 days quicker (p<0.0001). In addition, those who were enrolled quickly were more likely to receive any care in almost all settings, receive substance use and mental health services, and seek care faster than those who were enrolled later.ConclusionsWe identify high healthcare utilization in this population after release from prison, largely higher than among the general population. In addition, we find that individuals who receive Medicaid coverage shortly after release are more likely to seek care in most settings and faster. While this may be indicative of better access to care, this may also be driven by selection or individuals becoming enrolled presumptively at the time of an acute encounter.Implications for Policy or PracticeThe transition that occurs when individuals are released from prison represents an important opportunity to fill gaps in coverage and facilitate continuous access to needed services. Findings from this study provide a better understanding of the patterns of healthcare utilized after release from prison, including the settings and types of care received. Further research is needed to understand of the extent to which Medicaid coverage improves behavioral health outcomes and chronic disease management.Primary Funding SourceState of Indiana