The role of Medicaid enrollment and outpatient service use in jail recidivism among persons with severe mental illness.
OBJECTIVE
This study sought to determine whether having Medicaid benefits and receiving behavioral health services are associated with a reduction in recidivism for jail detainees with severe mental illness.


METHODS
A quasi-experimental design with linked administrative data was used. All persons released over a two-year period from jails in King County, Washington (N=5,189), and Pinellas County, Florida (N=2,419), who had severe mental illness were followed for 12 months after jail release. Those who were receiving Medicaid benefits at release and those who were not were compared on three indicators: how many subsequent arrests occurred, how soon the arrest occurred, and how serious the associated offense was. The data were analyzed with negative binomial, Cox proportional hazards models and logistic regression with adjustments for dependent observations.


RESULTS
In both counties, having Medicaid at release was associated with a 16% reduction in the average number of subsequent detentions (p<.001 and p<.01, respectively). After the analysis controlled for demographic and clinical variables, more days on Medicaid were associated with a reduced number of subsequent detentions in King County (p<.001) and more days in the community before subsequent arrest in both counties (p<.01 and p<.05, respectively). No association was found between Medicaid status and the seriousness of the subsequent offense in either county.


CONCLUSIONS
Although Medicaid benefits and behavioral health services were associated with fewer rearrests and more time in the community, the observed differences were relatively small. Further research is needed to determine how greater reductions in jail recidivism can be achieved for this target population.
Morrissey
Joseph P
JP
Department of Health Policy and Administration, School of Public Health and the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599-7590, USA. joemorrissey@unc.edu
Cuddeback
Gary S
GS
Cuellar
Alison Evans
AE
Steadman
Henry J
HJ
D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001521:Behavior Therapy; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003415:Crime / Q000517:prevention & control / Q000706:statistics & numerical data*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D005431:Florida; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D028642:Persons with Psychiatric Disorders / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011618:Psychotic Disorders / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D012008:Recurrence; D012044:Regression Analysis; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D014600:Utilization Review / Q000706:statistics & numerical data