Justice-Involved Adults With Substance Use Disorders: Coverage Increased But Rates Of Treatment Did Not In 2014.
More than one-third of US adults in the criminal justice system have substance use disorders, which contribute to health problems and recidivism. Health insurance and criminal justice reforms initiated in the last decade offer opportunities for increasing treatment access among justice-involved individuals. Using national survey data, we examined trends in treatment of substance use disorders from 2004 to 2014 among adults who reported past-year criminal justice contact and met screening criteria for substance use disorders. We found that the uninsurance rate was relatively unchanged in that population from 2004 to 2013. In 2014, the first year of the Affordable Care Act Medicaid expansion, the uninsurance rate among justice-involved individuals with substance use disorders declined from 38 percent to 28 percent. Although overall treatment rates did not increase in 2014, individuals receiving treatment were more likely to have their care paid for by Medicaid than in the prior decade. Medicaid reimbursement can be a critical lever for improving the quality and continuity of substance use disorder treatment for justice-involved populations.
Brendan Saloner (bsaloner@jhu.edu) is an assistant professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.
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Sachini N. Bandara is a doctoral student in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health.
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Emma E. McGinty is an assistant professor in the Department of Health Policy and Management, with a joint appointment in the Department of Mental Health, at the Johns Hopkins Bloomberg School of Public Health, and is co-deputy director of the Johns Hopkins Center for Mental Health and Addiction Policy Research.
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Colleen L. Barry is a professor in the Department of Health Policy and Management, with a joint appointment in the Department of Mental Health, at the Johns Hopkins Bloomberg School of Public Health, and is codirector of the Johns Hopkins Center for Mental Health and Addiction Policy Research.
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D000328:Adult; D003416:Criminal Law / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000628:therapy*; D011795:Surveys and Questionnaires; D014481:United States
Access To Care; Health Reform; Mental Health/Substance Abuse; criminal justice