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.
- © 2020 Russell Sage Foundation. Fry, Carrie E., Thomas G. McGuire, and Richard G. Frank. 2020. “Medicaid Expansion’s Spillover to the Criminal Justice System: Evidence from Six Urban Counties.” RSF: The Russell Sage Foundation Journal of the Social Sciences 6(2): 244–63. DOI: 10.7758/RSF.2020.6.2.11. The authors thank Lisa Callahan and Brian Case of Policy Research Associates for their assistance in obtaining the data used for this project and leading the site visits. We also thank Laura Hatfield and participants at Harvard University’s Health Policy PhD seminar for helpful comments. Funding for this research was generously provided by the Russell Sage Foundation. Carrie Fry was also supported by NIMH T32 MH019733. All views expressed represented here are the authors’ and do not necessarily represent the views of any funding organization. Direct correspondence to: Carrie E. Fry at carrie_fry{at}g.harvard.edu, 14 Story Street, 4th Floor, Cambridge, MA 02138; Thomas G. McGuire at mcguire{at}hcp.med.havard.edu, 180A Longwood Ave., Boston, MA 02115; and Richard G. Frank at frank{at}hcp.med.harvard.edu, 180A Longwood Ave., Boston, MA 02115.
Open Access Policy: RSF: The Russell Sage Foundation Journal of the Social Sciences is an open access journal. This article is published under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.