Medicaid Expansion’s Spillover to the Criminal Justice System: Evidence from Six Urban Counties

Abstract

Spillovers from the Affordable Care Act Medicaid expansion to other social-sector outcomes have received little attention. One that may be especially salient for public policy is the impact of expanded eligibility on jail-related outcomes. This study compares recidivism outcomes in three non-expansion counties to nearby expansion counties before and after Medicaid expansion. Using forty-eight months of arrest data from six urban county jails, we conduct comparative interrupted time series analyses to describe changes in the probability of rearrest and the number of arrests before and after Medicaid expansion. Consistent with previous literature, we find mixed results. In two case studies, Medicaid expansion is associated with decreased rates of recidivism. In the other, we find differential increases in jail-based recidivism after Medicaid expansion. We use contextual information from site visits and stakeholder interviews to understand the factors that may mediate and moderate the relationship between Medicaid expansion and return to jail.

Keywords

• medicaid
• expansion
• recidivism
• mental health
• substance use disorder