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Expedited Medicaid Access Increases Use of Mental Health Services, But Does Not Reduce Recidivism for People Recently Released from Prison

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Psychiatric Services in Advance.

People with serious mental illness depend on public-sector mental health services and are covered primarily by Medicaid. Most states suspend or terminate Medicaid for prison inmates. At any given point, an estimated 250,000 people with severe mental illness are in prisons and more than a million on probation or parole in the U.S. Many have difficulty accessing mental health services and other services when they leave these institutions. Lack of health insurance can be a particular barrier to access.

The study used data from Washington state to look at whether enrolling people with severe mental illness in Medicaid before their release from prison increased their use of community mental health services and reduced rearrest and reincarceration rates. State and local programs that expedite Medicaid enrollment for people being released from jails and prisons have become more common in recent years as part of efforts to reduce soaring criminal justice costs.

Researchers looked at data from 2006 when expedited Medicaid enrollment for people with severe mental illness was first authorized. They found increases in use of general medical services and community mental health services—69 percent of the group with expedited access used outpatient mental health services in the year after release compared to 37 percent of the control group. Researchers found no reduction in criminal recidivism—more than half of the participants in each group had at least one arrest in the year after release.

The authors of this study, led by Joseph Morrissey, Ph.D., with the University of North Carolina at Chapel Hill, concluded that “rather than relying on indirect spillover effects from Medicaid to reduce criminal recidivism, advocates and policy makers would better address the needs of offenders with severe mental illness through direct interventions targeted at underlying causes of recidivism.”

The American Psychiatric Association is a national medical specialty society whose more than 36,000 physician members specialize in the diagnosis, treatment, prevention, and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.

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