Association for Public Policy Analysis & Management

The prevalence of mental health and substance abuse disorders is high among incarcerated individuals. Many ex-offenders reenter the community without receiving any specialized treatment and return to prison with existing behavioral health problems. We consider a Beckerian law enforcement theory to identify different sources through which access to health care may impact ex-offenders’ propensities to recidivate, and empirically estimate the effect of access to public health insurance on criminal recidivism. We exploit the plausibly exogenous variation in state decisions to expand Medicaid under the Affordable Care Act. Using administrative data on prison admission and release records from 2010 to 2016, we find that the expansions decrease recidivism for both violent and public order crimes. In addition, we find that the public coverage expansions substantially increase access to substance use disorder treatment. The effect is salient for individuals who are covered by Medicaid and referred to treatment by the criminal justice system. These findings are most consistent with the theory that increased access to health care reduces ex-offenders’ perceived non-monetary benefits from committing crimes.