Association for Public Policy Analysis & Management

More than 600,000 people are released from prisons and almost 11 million people cycle through local jails each year. While all prisons and jails are required to provide adequate healthcare, continuity of care upon release is not a constitutional right. Despite having significant health care needs, many individuals leave prison with no health insurance, and Medicaid might be the only opportunity for these individuals to receive health care coverage. However, Medicaid eligibility policies for incarcerated individuals vary across states. These policies affect if and when individuals may enroll for Medicaid after release. Nineteen states terminate Medicaid upon incarceration, while the rest suspend Medicaid for the duration of the incarceration spell or for specific period of time. Convicts incarcerated in states with suspension policy can keep their Medicaid coverage (if they already have one at the time of prison admission) or apply for Medicaid while in prison, and receive needed care more quickly upon release compared to convicts in states with termination policy. We estimate the effect of Medicaid suspension policies on recidivism using data from the National Corrections Reporting Program (NCRP) that reports prison releases from 43 states between 2000 and 2013. We combine the NCRP data with a new comprehensive primary data source we have developed on state Medicaid programs for incarcerated adults. To estimate the effect of Medicaid policies for incarcerated individuals on whether a released prisoner recidivates within a certain time period, we employ a difference-in-differences design. This design exploits the panel nature of our data and the fact that Medicaid suspension policies change in different years and months across many states between 2000 and 2015. We also explore the impact of Medicaid policies on crime-specific and female recidivism rates. We also look at how the Affordable Care Act expansion policy of public healthcare interacts with Medicaid suspension policy for incarcerated individuals, and what the combined effect of both these policies is on criminal reoffending.