Association for Public Policy Analysis & Management

This paper examines the relationship between Medicaid policy change and probation outcomes through a mixed method approach. In an era of mass incarceration, the administration of probation and other forms of community corrections has expanded in hopes of reducing government expenditures on traditional incarceration and overcrowding. Outcomes for probation and other community corrections programs are dependent on a variety of factors. Our focus is on the various treatment needs of probationers (particularly substance abuse and mental health), and whether those needs can be managed and financed in a manner that supports satisfactory program completion (Regenstein & Nolan, 2014; Ryan et al, 2016; ACLU, 2018). The incidence of serious mental illness or substance abuse disorders in the probation services population is twice as high as among the general population. At the same time, probationers are predominantly low-income and uninsured with limited access to needed treatment. When probation management is not supported by appropriate treatment, program performance may be depressed because of behaviors that impede satisfactory completion of probation sentences.

Recent policy action on Medicaid Expansion through the Patient Protection and Affordable Care Act (ACA) offers an opportunity to examine the impact of enhanced access to Medicaid treatment on the performance of probation services, as measured by successful completion and incarceration rates for probationers. The ACA’s Medicaid Expansion extends health care coverage to single individuals and has been adopted by 36 states and the District of Columbia. States that have expanded Medicaid are required to provide mental health and substance abuse treatment to eligible low-income individuals. Thus, expansion states offer substantially improved access to critical treatment programs for many of the people involved in probation services.

We exploit these state policy differences on Medicaid Expansion in order to assess their relationship to the management and performance of state probation programs. Using data from the Annual Probation Survey on Adult Probationers published by the Bureau of Justice Statistics, supplemented with publicly available political, managerial, and economic variables, we examine associations between Medicaid Expansion policies and outcomes for programs charged with preventing incarceration. The analysis includes the effects of governance arrangements and state choices about public or private management of probation supervision, and how those choices relate to performance. We also incorporate data from semi-structured interviews with officials in state and local probation agencies, related interest groups, and other actors. This research contributes to literatures on the interactions among public management, public policies, and program performance.

- ACLU. 2018. “Set up to Fail: Montana’s Probation and Parole System.” Retrieved from https://www.aclumontana.org/sites/default/files/field_documents/setuptofailmontanasprobationparolesystem.pdf.

- Regenstein, M., & Nolan, L. 2014. “Implications of the Affordable Care Act’s Medicaid Expansion on Low-Income Individuals on Probation”. The Robert Wood Johnson Foundation. Web.

- Ryan, J., Pagel, L., Smali, K., Artiga, S., Rudowitz, R., & Gates, A. 2016. “Connecting the Justice Involved Population to Medicaid Coverage and Care: Findings from Three States”. The Kaiser Commission on Medicaid and the Uninsured. Web.