Medicaid’s impact on inmate health and recidivism rates explored in new research

LAWRENCE — Inmates face numerous difficulties upon reentry into society. Public health care services are not always easily accessible to them while making this transition.

“Recidivism is an expensive and tragic societal problem," said David Slusky, a professor of economics at the University of Kansas. “In addition to designing new policies to help reduce it, policymakers also want to understand what existing policies and programs could help.” 

His new paper titled “Accessing the Safety Net: How Medicaid Affects Health and Recidivism” addresses this by estimating the causal impact of access to means-tested public health insurance coverage on health outcomes and recidivism for those recently released from incarceration. It finds that reducing barriers in access to Medicaid for vulnerable populations increases enrollment and utilization of health care services, but it does not reduce 1-year or 3-year recidivism. This suggests the effectiveness of such policies is context-dependent.

The findings appear as a working paper for the National Bureau of Economic Research.

“The U.S. makes it very difficult for those released from prison to rejoin the formal economy,” said Slusky, who co-wrote the article with Analisa Packham of Vanderbilt University. 

“Many mundane tasks for the general population are extremely difficult, if not impossible, including housing, employment and voting. Many individuals see continued criminal activity as their best economic option.” 

The U.S. boasts an incarcerated percentage of its population that is much higher than other countries, which also leads to a much higher incidence of recidivism. According to the Bureau of Justice Statistics, nearly half of those returning to the community are rearrested within one year, and 77% are rearrested within five years.

As noted in “Accessing the Safety Net,” a large proportion of inmates have high rates of chronic medical conditions such as diabetes and hypertension, as well as severe mental health disorders and substance use issues, which can lead to a higher likelihood of recidivism. But despite the need for timely and continuous access to care, many offenders do not receive necessary medical treatment. 

To study these issues, Slusky focused on South Carolina, a non-Medicaid expansion state that implemented a 2016 policy to more easily re-enroll previously incarcerated individuals in the Medicaid program.

“The South Carolina program we studied was relatively limited in its scale and resources," Slusky said. “Other states. such as Wisconsin,  introduced far more expansive pre-release enrollment assistance. And many other states also changed their laws to allow those beginning incarceration who were on Medicaid to suspend their benefits instead of being terminated so they could much more easily and quickly be reactivated upon release.”

In terms of a strategy to combat this issue, some states are now exploring enrolling inmates on Medicaid while they are incarcerated, in the hopes that it will deliver better and more efficient care then and increase continuity of care before and after release.

However, Slusky found no evidence that people with easier access to Medicaid are less likely to commit future violent or property crimes. 

So what exactly is the benefit for the community if this doesn’t curb crime?

“Medicaid has been shown in many other cases to improve economic and financial outcomes and make individuals less likely to skip necessary medical care due to cost,” he said. “We also do see increased overall healthcare utilization from the policy change, which is evidence individuals are getting more care — which is the outcome most directly affected by increased insurance rates.”

A KU faculty member since 2015, Slusky specializes in health economics and labor economics. He has conducted research on a wide variety of topics, including the Flint water crisis, COVID-19 restrictions, abortion care and physician birth outcomes. He is currently interim chair of KU’s Department of Speech-Language-Hearing. In 2022, he was named executive director of the American Society of Health Economics.

“There are limits to what can be done in non-Medicaid expansion states as enrollment assistance programs can only help those who are eligible,” Slusky said.

“It’s very difficult to scale up a program like the one in South Carolina. Despite all of the effort and expense, we just don’t see that large an increase in the share of released individuals who end up on Medicaid. There is just only so much that non-expansion states can do to help those in need.”