(March 12, 2019) Programs that assist incarcerated individuals with serious mental illness in expediting their Medicaid enrollment are a promising new method of improving treatment access among released inmates, according to a new study of Washington State prisons from 2002 to 2010.
When individuals are incarcerated, Medicaid coverage is typically terminated or suspended by the state. Individuals who are released from incarceration are thus required to re-enroll or reactivate their Medicaid enrollment—a tedious and burdensome process that becomes a barrier for many who would not be insured if it were not for Medicaid. This issue is of particular concern for individuals with co-occurring mental illness and substance use disorders, as they frequently finance their treatments through Medicaid.
The study, led by Dr. Alex Gertner and other researchers from the University of North Carolina at Chapel Hill, examined a program that allowed correctional staff in Washington to refer individuals with serious mental illness to expedited Medicaid enrollment services. The authors found that this program was effective in increasing overall Medicaid enrollment as well as mental health and substance use disorder treatment utilization for individuals post-release.
Six months after being released, the likelihood of receiving any substance use disorder treatment increased 7 points compared to those who were not referred. At the 12-month follow-up, the differential decreased to 4.8 points; however, the impacts remain positive.Three months after being released, the percentage of inmates with serious mental illness who received expedited Medicaid enrollment referrals likely to receive any type of substance use disorder treatment increased by 6.7 points compared to those who were not referred, according to the study.
Women who were referred to expedited Medicaid enrollment were more likely to enroll in Medicaid and utilize substance use disorder treatment than men who were also referred. The authors suggest that this is possibly due to women facing greater barriers to insurance coverage than men to begin with, and recommend further study on this finding.
The authors point to a similar study from 2016 that found that referrals to expedited Medicaid enrollment increased the probability of using any mental health services 12 months after release by 26 percentage points—a much larger effect than the authors found for utilizing any substance use disorder treatment 12 months after release. The authors acknowledge that different barriers for individuals with serious mental illness to access substance use disorder treatment and mental health treatment may account for this difference.
In addition, during the time of the study, the authors note that Washington State ran a block grant program providing substance use disorder treatment to low-income individuals who were not enrolled in Medicaid—and ultimately provided treatment to individuals regardless of whether they enrolled in the state program or not. These programs may explain why the people from the 2016 study were more likely to utilize treatment for mental health concerns than the people in the present study utilized treatment for substance use disorders. Ultimately, this draws attention to the importance of coordinating expedited Medicaid referral and treatment programs to ensure the most beneficial outcomes for individuals with severe mental illness.
· Gertner, Alex et al. (2019). The effect of referral to expedited Medicaid on substance use treatment utilization among people with serious mental illness released from prison. Journal of Substance Abuse Treatment.
Grace Lim
Research Intern
Treatment Advocacy Center