Medicaid Expansion Boosted Coverage for Adults with Legal Involvement

April 18, 2022 - Medicaid expansion was associated with a significant increase in health insurance coverage for low-income individuals with recent criminal legal involvement, according to a study published in JAMA Health Forum.

More than 80 percent of Americans with criminal legal involvement were uninsured before the Affordable Care Act (ACA) was passed. Following its implementation, health insurance coverage increased among this population.

Medicaid expansion has helped increase access to coverage for low-income individuals as the policy expands Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level (FPL).

To understand the impact that Medicaid expansion had on health insurance coverage for adults with criminal legal involvement, researchers gathered data from 2010 to 2017 from the National Survey on Drug Use and Health.

The study included data on nearly 10,000 adults between 18 and 64 years of age who reported having a household income of 138 percent of FPL or less and had experienced a criminal legal involvement in the past year, such as being arrested and booked, paroled, or on probation.

Researchers considered individuals insured if they were enrolled in a private health plan, Medicaid, or other health insurance, such as Medicare, Tricare, or the Veterans Health Administration.

The number of insured low-income adults with criminal legal involvement increased after ACA implementation in states that expanded Medicaid and nonexpansion states. However, Medicaid expansion was associated with a 14.9 percentage point increase in coverage among this population.

Following ACA implementation, 82.5 percent of low-income individuals with criminal legal involvement had health insurance coverage in states that had expanded Medicaid. In contrast, only 54.2 percent of adults in nonexpansion states were insured.

The boost in insured adults in Medicaid expansion states was attributed to an increase in Medicaid coverage, the study noted. Before the ACA, 37 percent of adults with recent criminal legal involvement were enrolled in Medicaid in expansion states. After ACA implementation, this figure rose to 61.4 percent.

In nonexpansion states, 24.7 percent of adults received Medicaid coverage before ACA implementation compared to 29.6 percent following the ACA.

There was no significant difference when comparing private insurance enrollment in expansion and nonexpansion states.

Twelve states have yet to expand Medicaid eligibility under the ACA. These states are home to more than 100 million individuals and have higher incarceration rates compared to expansion states, according to the study.

“Our results suggest that Medicaid expansion in these states could disproportionately benefit people with criminal legal involvement through expanded access to treatment for chronic conditions (e.g., behavioral health conditions) and outcomes beyond population health (e.g., increased employment and reduced crime),” the researchers wrote.

A separate study highlighted how prerelease Medicaid enrollment assistance helped increase outpatient utilization among incarcerated individuals with substance use disorder.

Past data has shown Medicaid expansion yielding additional benefits for several populations.

For example, a report from the Menges Group found that Medicaid expansion states saw greater access to health insurance coverage. In addition, the states had lower Medicaid spending, despite providing coverage for more beneficiaries.

In particular, Medicaid expansion helped increase coverage access for young adults between 19 and 25 years, an Urban Institute report found.

Data from the Kaiser Family Foundation (KFF) also revealed that Medicaid expansion under the Build Back Better Act could help increase access to affordable healthcare for individuals with HIV.