Medicaid Eligibility and Time to Re-incarceration Among Previously Incarcerated Subjects With Schizophrenia.

Chris Kozma,Jacqueline Pesa,Michael Dickson,Carmela J Benson

doi:10.36469/9845

Abstract

Background: Many persons with severe mental illness qualify for Medicaid coverage. However, under federal law, states must either suspend or terminate eligibility once they are incarcerated. We hypothesize that prompt re-acquisition of Medicaid eligibility following release from incarceration lowers the risk of re-incarceration. Objective: To assess the relationship between Medicaid eligibility and risk of re-incarceration among previously incarcerated schizophrenia diagnosed subjects. Methods: Study subjects were selected between January 1, 2006 and September 30, 2011 from a single state Medicaid database that was combined with department of corrections data. Subjects were included if they had a schizophrenia diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification [ICD- 9-CM] code 295.xx), were between the ages of 18 and 62, and had been released from incarceration. Covariates included age, race, gender, marital status, and reason for incarceration. Time to Medicaid eligibility after release from incarceration, cumulative days of eligibility, and whether they were eligible on the re-incarceration date were evaluated in independent models. One and three-year Cox Regression models analyses (p<0.05) were used to evaluate the hazard for re-incarceration. Results: The 932 subjects were 26.5% white, 73.7% male and were, on average, 37.6 years old on their index date (i.e., incarceration release date). They were 73.5% single or divorced and 12.7% were incarcerated for a substance abuse violation. In the 1-year follow-up period, 110 subjects (11.8%) were re-incarcerated. In the 3-year follow-up period 209 (22.4%) were re-incarcerated. Age (in years) was the only significant predictor of re-incarceration for the 1-year models (hazard ratio [HR]=0.976; confidence interval [CI]=0.957, 0.994). Eligibility was a significant predictor in the 3-year follow-up models. A longer 'time to first eligibility' (HR=1.046; CI=1.017, 1.075 was associated with a greater hazard for re-incarceration. Being eligible at the time of re-incarceration (HR=0.659; CI=0.498, 0.870) was associated with a lower hazard, and the cumulative number of months of eligibility (HR=0.978; CI=0.958, 0.997) and age were associated with a lower hazard for re-incarceration (HR=0.986; CI=0.973, 0.999). Conclusions: Access to Medicaid health services post-release may reduce the risk of re-incarceration.

Highlights

Many persons with severe mental illness qualify for Medicaid coverage
Mental illness is astoundingly prevalent among the incarcerated population, with one study estimating that 64% of the jailed population in the United States has some form of mental illness[2], while another reported serious mental illness (SMI) in nearly 15% of incarcerated males and 31% of females[3]; a rate 3-6 times that of the general population.[4]
Given that this population relies heavily on public programs such as Medicaid, the intent of the current study is to investigate the effect of time to acquire Medicaid eligibility on the risk for re-incarceration among individuals diagnosed with schizophrenia

Summary

Introduction

Many persons with severe mental illness qualify for Medicaid coverage. under federal law, states must either suspend or terminate eligibility once they are incarcerated. The National Comorbidity Survey Replication suggested additional risk factors including male gender, past receipt of welfare payments, one or more weeks of homelessness, and history of substance abuse or a dependence diagnosis.[8] Similar risk factors have been identified for reincarceration in this population, with homelessness, substance abuse, lack of health insurance, and lack of timely receipt of outpatient or case management services post-release described as modifiable.[9] Additional evidence comes from a study of New York Medicaid beneficiaries which found that schizophrenia patients in hospitals, homeless shelters, and prisons have an estimated 60% re-admission rate, a higher risk of arrests and incarcerations, and are less likely to have health insurance coverage compared with the general population.[10]

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