Medicaid Enrollment Assistance, Utilization Rates Among Formerly Incarcerated People With SUD

The addition of Medicaid enrollment assistance to correctional facilities’ discharge plans was linked to a higher likelihood of individuals with substance use disorders using health care resources, new findings indicate.

“The transition from prison to community is characterized by elevated morbidity and mortality, particularly owing to drug overdose,” authors noted. “However, most formerly incarcerated adults with substance use disorders do not use any health care, including treatment for substance use disorders, during the initial months after incarceration.”

The retrospective cohort study was conducted with a sample of 16,307 adults with 18,265 eligible releases who had a history of substance use and were released from Wisconsin state prisons beginning April 2014 through December 2016. Prerelease Medicaid enrollment assistance was added to prison discharge plans in January 2015.

The sample included people between 19 and 64 years of age (mean 35.5) who were predominantly male (16,320 of 18,265 total eligible releases). About one-third of individuals were Black (6213 of 18,265 eligible releases).

Authors reviewed Medicaid-reimbursed health care utilization within 30 days of individuals being released from prison. They included both outpatient and inpatient care, as well as emergency department use.

After Medicaid enrollment assistance was implemented, in the month following release, individuals were 7.7% more likely to use outpatient care for substance use (95% CI, 6.4-8.9%; P<.001). This outpatient increase included a .7% higher likelihood for an opioid use disorder visit (95% CI, .4-1%; P<.001), a 1% higher likelihood for any substance use disorder visit (95% CI, .5-1.6%; P<.001), and a .4% higher likelihood for receiving medication to treat opioid use disorder, such as methadone, buprenorphine, or others (95% CI, .2-.6%; P<.001).

Authors also reported a .4% increase in the probability of inpatient stays (95% CI, .03-.7%; P=.03), but no significant change in emergency department utilization (.7% [95% CI, -.15-1.4%].

“Treatment of [substance use disorders] during this transition is associated with a reduced risk of relapse and overdose,” researchers noted.

“Currently, adults leaving correctional facilities face different Medicaid enrollment opportunities depending on the Medicaid expansion status of their state and the availability and type of enrollment assistance,” authors added. “The results of this cohort study suggest that prerelease Medicaid enrollment assistance was associated with increased use of outpatient health care after incarceration and highlights the value of making this assistance universally available within correctional settings.”

Reference:
Burns ME, Cook S, Brown LM, et al. Association between assistance with Medicaid enrollment and use of health care after incarceration among adults with a history of substance use. JAMA Netw Open. 2022;5(1):e2142688. doi:10.1001/jamanetworkopen.2021.42688