How Medicaid Enrollment Assistance Supports Incarcerated Persons

Prerelease Medicaid enrollment assistance for incarcerated individuals who have substance use disorders can help improve outpatient utilization after release, a study published in JAMA Open Network found.

The researchers studied over 16,300 adults who had been in the state justice system for at least 31 days and who had a history of substance use. Based on those parameters, the Wisconsin Department of Corrections yielded data on more than 18,200 eligible releases from April 2014 through the end of December 2016.

The study tracked the outcomes of a prerelease enrollment assistance program. The goal was to assess the connection between Medicaid enrollment assistance and healthcare utilization after release.

The enrollment assistance program gave eligible adults access to discharge staff, case workers, and paralegal benefits specialists who could weigh in on individuals’ Medicaid coverage options and support healthcare system navigation.

The researchers then assessed four healthcare utilization metrics to see whether the enrollment assistance program had any impact on individuals’ utilization of care after release. In the 30 days following release, researchers tracked outpatient visits, visits related to substance use disorders as well as those related to opioid use disorders, and prescriptions for opioid use disorders.

Nine out of ten of the individuals in the study were men. Additionally, slightly more than 60 percent of the individuals studied were White individuals and 34 percent of the study participants were Black individuals.

Consumer assistance is essential for Medicaid enrollment, regardless of consumers’ involvement with the justice system. But support can be particularly critical for individuals who have just been released from the justice system and who have a substance use disorder.

The healthcare utilization data post-release indicated that there may be a connection between enrollment assistance and healthcare utilization. This was evident across all of the subgroups studied, except for married individuals. The subgroup that saw the greatest impact consisted of women, who saw a 12.8 percentage point increase in the likelihood of a post-release outpatient visit.

Overall, outpatient visits increased by 7.7 percentage points, with almost a quarter of individuals receiving outpatient treatment within 30 days of release. Utilization of outpatient services that were specifically tied to an opioid use disorder rose by 100 percent. 

Additionally, 3.8 percent of released individuals had an outpatient visit tied to a substance use disorder in the month after release, an increase of 40 percent.

More individuals received a prescription for opioid use disorder after receiving enrollment assistance. Prescription receipts rose 133 percent post-release.

While outpatient services improved due to Medicaid enrollment assistance, hospital care utilization did not show any signs of change as a result of the program’s implementation. Inpatient stays for drug overdose rose by 0.1 percentage points while emergency department utilization held steady.

“Individuals who are at highest risk of a drug overdose may be relatively less likely to obtain outpatient care without support or intervention that goes beyond health insurance,” the researchers suggested.

“Alternatively, the type or timing of outpatient health care received may have been insufficient to mitigate acute events. Future research that characterizes the health and social characteristics of individuals who do or do not seek postrelease care and the nature of the care received will be important to crafting care transition interventions that reduce the risk of drug overdose.”

Separate work has demonstrated that Medicaid can be a useful tool for supporting individuals who have been recently released from the justice system. 

In particular, Medicaid expansion could help individuals transition into their new life post-release, studies have suggested. In Indiana, Medicaid enrollment among individuals in the justice system increased from eight percent to 25 percent following the state’s Medicaid expansion.

While Medicaid expansion can help individuals who have been incarcerated in the justice system, the results of the study that was published in JAMA Open Network may more closely align with the findings of the National Quality Forum’s (NQF) Opioids and Behavioral Health committee.

NQF’s report on opioids and behavioral health supported prerelease Medicaid enrollment assistance as an intervention.

“While Medicaid expansion has been associated with improving rates of MOUD post-incarceration, enrollment assistance programs are likely necessary to increase rates of effective insurance coverage at release,” the NQF report emphasized.