The Effect of Medicaid on Recidivism and Employment after Release from Prison

• In Event: Bolstering the Safety Net at a Critical Moment: Policy and Programmatic Approaches to Successful Reentry

Abstract

The period immediately following release from a correctional facility represents a critical juncture for formerly incarcerated individuals, characterized by alarmingly elevated rates of morbidity and mortality, with drug overdose being a leading cause. Despite this profound health crisis, a significant majority of adults with substance use disorders—and other chronic conditions—do not engage with any form of health care, including crucial treatment for substance use, during the initial months of their return to the community. This failure to bridge the gap in care continuity severely hampers successful reentry and exacerbates public health and safety challenges.

This study examines the impact of Medicaid-facilitated prescription medication continuity on recidivism, employment, and earnings among adults released from Wisconsin state prisons. Over 600,000 individuals leave U.S. prisons annually, facing high rates of unemployment, reincarceration, and poor health. Prior research by the research team suggests that prerelease Medicaid enrollment assistance is associated with increased use of outpatient health care after incarceration and highlights the value of making this assistance universally available within correctional settings. Specifically, the cohort study of 16, 307 individuals found that the availability of prerelease Medicaid enrollment assistance was associated with large absolute increases in the likelihood of any outpatient visit and small or no absolute increases for substance use–associated and hospital-based care use. This research expands upon that study to further explore the mechanisms through which Medicaid enrollment affects outcomes. 

Using linked administrative data from the Wisconsin Department of Corrections, Medicaid, and Unemployment Insurance programs, we analyze a cohort of nearly 20,000 adults released between 2015 and 2017. We first estimate the association between pre-release health conditions—measured via prison prescription claims—and post-release outcomes. We then use an instrumental variables approach, leveraging quasi-random variation in distance to the nearest pharmacy and changes to the Medicaid Preferred Drug List, to estimate the causal effect of prescription continuity on reincarceration and labor market outcomes. Results will clarify the mechanisms by which Medicaid enrollment improves post-incarceration outcomes and inform targeted reentry policy.

Author

• Cici McNamara, Georgia Institute of Technology
  Presenting Author