Incarcerated persons bear a heavy burden of chronic and severe health conditions: the prevalence of HIV among prisoners is five times that of the general population, and 25%-50% of prisoners have a mental health condition. Before incarceration, some of the most disabled and impoverished prisoners, including those with severe mental illness, are able to access healthcare through enrollment in Medicaid. Little is known about the exact healthcare needs of these individuals, but their eligibility for Medicaid and involvement with the criminal justice system suggest a maelstrom of social, economic, and health-related problems. The continued access to healthcare as these individuals transition to their community is particularly important to protect their own health and the health of the communities to which they return. Yet current policies in much of the US impede resumption of Medicaid at prison release. In most states, Medicaid enrollment is terminated upon admission to prison;prisoners may re-apply for Medicaid following their release from prison, but approval often takes months. Until they resume Medicaid coverage, recently released chronically ill prisoners must navigate the difficult transition back to community life typically with no means to pay for health services. The effects of these lapses in Medicaid are not well understood, but existing evidence suggests that for released prisoners with chronic and severe disorders, gaps in care lead to worsened health, disease transmission, re-incarceration, and higher healthcare costs. To diminish gaps in care, New York in 2008 began suspending, rather than terminating, Medicaid benefits upon imprisonment, allowing released prisoners to immediately resume Medicaid coverage. Although it is assumed that Medicaid suspension-compared to termination-improves continuity of care, the actual effect of this policy is unknown. To assess the effect of Medicaid policy on former prisoners'use of healthcare, we will construct and analyze a novel database linking state prison records with Medicaid records. We will link records for the years 2007-2009 for New York (NY) and North Carolina (NC). Comparing data from before and after the policy change in NY, we will examine whether Medicaid policy (termination vs. suspension) had an effect on how quickly released prisoners who were enrolled in Medicaid prior to their incarceration resumed Medicaid-funded services after their release. Using data from NY and NC, we will also examine whether gaps in resuming Medicaid-funded care affects the amount of Medicaid-funded care used (e.g. hospitalization days), the costs of that care, and re-incarcerations. In addition to the proposed analyses, the database constructed in this pilot project will lead to several future lines of policy-significant research to improve the health and mental health of released prisoners.

Public Health Relevance

Findings from this study will provide states with evidenced-based research as they consider the effect of Medicaid termination policies on access to, use of, and costs of Medicaid-funded health services following release from prison. Our results will also inform correctional personnel and public health practitioners interested in better understanding prisoners'health needs and improving mechanisms to bridge healthcare from prison to the community.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (SERV)
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Juliano-Bult, Denise M
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University of North Carolina Chapel Hill
Internal Medicine/Medicine
Schools of Medicine
Chapel Hill
United States
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Rosen, David L; Grodensky, Catherine A; Miller, Anna R et al. (2018) Implementing a Prison Medicaid Enrollment Program for Inmates with a Community Inpatient Hospitalization. J Urban Health 95:149-158
Rosen, David L; Grodensky, Catherine A; Holley, Tara K (2016) Federally-Assisted Healthcare Coverage among Male State Prisoners with Chronic Health Problems. PLoS One 11:e0160085
Haley, Danielle F; Golin, Carol E; Farel, Claire E et al. (2014) Multilevel challenges to engagement in HIV care after prison release: a theory-informed qualitative study comparing prisoners' perspectives before and after community reentry. BMC Public Health 14:1253