Will the ACA Help Prisoners Stop Offending? Oregon's Experience with Medicaid for Childless Adults

Prisoners returning to the community have unprecedented access to health coverage under the Affordable Care Act (ACA) and Medicaid expansion, but little is known about (1) the extent to which prisoners will apply, and (2) the realization of potential public health and public safety benefits.  This randomized controlled study gives a preview of the ACA’s impacts for this population, drawing from Oregon’s efforts since 2010 to enroll inmates in the state’s Medicaid program for “childless adults.”  BACKGROUND:  While returning prisoners often have chronic physical health, mental health, and substance abuse problems, relatively few have qualified for Medicaid under traditional eligibility criteria.  Increased access to healthcare could improve management of these chronic conditions, potentially contributing to better post-release reintegration and recidivism outcomes.  METHODOLOGY:  Oregon was among the states that provided pre-ACA access to Medicaid for childless adults.  Because funding was limited, Oregon used a random selection “lottery” process to allocate program slots.  This study follows a cohort of 1,512 prisoners who registered for the chance to enroll in Medicaid, and compares the outcomes of those who were and were not randomly selected.  RESULTS:  Given the opportunity, Oregon prisoners were as likely as the general population to apply for Medicaid and less likely to be denied.  We present these prisoners’ Medicaid service utilization after release, and the extent to which this impacted employment and re-offending.  Lessons from Oregon’s enrollment of returning prisoners will be instructive as additional states develop strategies to enroll various subgroups of low-income adults under the ACA.