Joseph P. Morrissey, Ph.D., Principal Investigator
Gary Cuddeback, PhD, MSW, MPH, Co-Investigator
Over one million bookings into US jails occur each year involving persons with a severe mental illness. The policy of discontinuing Social Security benefits (both monthly income and health insurance) for persons incarcerated in U.S. jails has come under increasing scrutiny. The purported goal of the policy is to prevent fraudulent receipt of benefits during periods of incarceration. However, this policy may work to the disadvantage of detained persons with severe mental illness, as health insurance (Medicaid) increases the likelihood of receiving mental health services following release from jail. And one connection that has not yet been fully explored in this policy review is whether having Medicaid and receiving mental health services following jail release reduces future arrests.With funding from the National Institute of Justice, administrative data from two large urban counties— Pinellas County (Clearwater/St. Petersburg), Florida and King County (Seattle), Washington— were examined to assess the extent to which Medicaid benefits lead to service receipt and the extent to which receipt of services serves as a deterrent to subsequent jail incarcerations in a one-year post-release interval for persons with severe mental illness. The data encompass the period 1998-2000 in Pinellas County and 1997-1998 in King County. Administrative data included Medicaid enrollment records, jail incarceration records, inpatient and outpatient mental health and substance abuse treatment utilization records, and state hospital utilization records.A case-control research design was employed with cases defined as persons with severe mental illness who leave jail with Medicaid benefits (i.e., Pinellas and King) and controls as persons with severe mental illness who leave jail without Medicaid benefits. In total, 1210 (2,419 detentions) detainees with severe mental illness in Pinellas County, Florida and 2,095 (5,189) detainees with severe mental illness in King County, Washington were followed for 12 months. In both King and Pinellas Counties, detainees who had Medicaid at release averaged fewer detentions (p < .001 and p < .05, respectively) and spent more time in the community prior to re-arrest (King County, p < .01) than those without Medicaid. Also, behavioral health services delayed re-arrest in both counties (p < .001).Having Medicaid and utilizing behavioral health services delayed but did not prevent re-arrest for many persons with severe mental illness in this study. Thus, Medicaid benefits alone are not sufficient to prevent re-arrest for mentally ill patients in jail. Further research is needed to determine whether access to more intensive evidence-based treatments, stable housing, and other community supports can prevent recidivism of this vulnerable population.