Mixed Method Evaluation of Louisiana’s Prerelease Medicaid Enrollment Program, 2017–2019

Abstract

Background: Over 600,000 people leave US prisons annually. Many are eligible for Medicaid upon release but may need support to enroll. Carceral facilities in nearly half of states have implemented systems to facilitate Medicaid access for those leaving incarceration, but there is limited information on program implementation models or outcomes. Objectives: To evaluate implementation and initial outcomes of Louisiana's prison-based Prerelease Medicaid Enrollment Program. Methods: In this mixed-methods study, we assessed enrollment in Louisiana Medicaid at time of release from prison in the 2 years (2017-2018) after Program implementation, as well as reasons for Medicaid closure (ie, loss of coverage) and health services use 6 months postrelease. In May-June 2019, we conducted interviews statewide with program implementers (n = 16) and focus groups in New Orleans, Louisiana with formerly incarcerated Program participants (n = 16).Results: A total of 4476 people were included in the quantitative analysis. There was a 34.3 (95% confidence interval: 20.7-47.9) percentage point increase in Medicaid enrollment upon release. Nearly all (98.6%) attended at least 1 outpatient visit and almost half (46.7%) had 1 emergency department visit within 6 months of release. Not responding to information requests was the most common reason for Medicaid closure. Program implementers and formerly incarcerated participants identified Program strengths, barriers, and suggestions for improvement. Conclusions:The program was successful in rapidly increasing Medicaid enrollment at the time of prison release and facilitating the use of health care services.

Health services use among formerly incarcerated Louisiana Medicaid members within one year of release

“…We conducted a retrospective cohort study of Louisiana Medicaid claims data crosslinked with Louisiana Department of Public Safety and Corrections data. To create the dataset, all available Louisiana Medicaid claims data were matched with all available Louisiana Department of Public Safety and Corrections data by social security number, as in a previous analysis [ 24 ]. Data were fully anonymized prior to analysis.…”

“…A recent evaluation of the Program found that it was initially successful in increasing Medicaid enrollment [ 24 ]. While gaining access to health coverage after contact with the criminal legal system may not be sufficient to ensure use of some health services [ 25 ], there is some evidence that Medicaid coverage upon release facilitates use of health care [ 24 , 26 ], including among people with a history of substance use [ 27 ] or serious mental illness [ 28 ]. With limited exception [ 29 ], there is a paucity of information about whether the timing of enrollment (i.e.…”