Connecting the Justice-Involved Population to Medicaid Coverage and Care: Findings from Three States

This brief provides an overview of initiatives to connect the justice-involved population to Medicaid coverage and care in three states—Arizona, Connecticut, and Massachusetts. These states are leading efforts in these areas and provide key lessons about how to coordinate across health care and corrections and the potential of such initiatives to better link individuals to physical and behavioral health services. While their experiences to date point to important benefits stemming from these efforts, more time and data are needed to examine the effects on health and criminal justice outcomes. In sum, this brief finds:

Each of the case study states is connecting individuals to Medicaid coverage at multiple points within the justice system. The states have processes to suspend Medicaid eligibility for incarcerated individuals and to enroll incarcerated individuals who receive inpatient care. They also have initiatives to enroll inmates prior to release from incarceration and individuals on probation and parole. In Connecticut, about 60% of the incarcerated population is enrolled in Medicaid upon release, and, in Massachusetts, the majority of individuals released from prison each year are enrolled. Arizona reaches a smaller share of the incarcerated population since it targets efforts to those with serious mental illness and complex health conditions, but plans to broaden its scope in the future. Even with these efforts, there remain enrollment barriers, including difficulty reaching individuals who move into and out of custody quickly and system limitations.

The study states also connect individuals to health care in the community as they are released from jail or prison. To date, the initiatives primarily target individuals with significant health needs. They help individuals establish connections with community providers, schedule appointments, and obtain referrals for care or other services. The study states also have processes to provide individuals access to prescription drugs upon release. Newly released individuals face a range of access barriers even with this support. Providing assistance through individuals with a shared incarceration history, helping individuals address their priority needs, and identifying culturally competent providers can help overcome these challenges.

These approaches have increased coverage, facilitated access to care, and contributed to administrative efficiencies and state savings, but effects on criminal justice outcomes have not been measured. Savings include avoided capitation payments, increased federal funds for inpatient care for incarcerated individuals, and reduced costs in other programs. More research is needed on the effects on health and criminal justice outcomes, including recidivism rates. Strong leadership and close collaboration across stakeholders are key to success given that these are complex initiatives that involve multiple agencies.