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Access in Brief: Health Care Needs of Adults Involved with the Criminal Justice System

While Medicaid’s role is limited with respect to those who are incarcerated, it plays an important role in the treatment of mental illness and substance use disorders for adults under community supervision. Historically, most justice-involved adults were uninsured. But, with the expansion of Medicaid to the new adult group under the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended), more individuals involved with the criminal justice system became eligible for Medicaid. From 2015 – 2019, 28 percent of adults under community supervision were enrolled in Medicaid. Even so, about one quarter of adults under community supervision remain uninsured.

This issue brief uses five years (2015 – 2019) of data from the National Survey on Drug Use and Health (NSDUH) to analyze the treatment needs and access to behavioral health services for adults age 18–65 who reported that they were under community supervision in the past 12 months. Specifically, our analysis examines selected demographic and health characteristics, and prevalence and treatment rates for behavioral health conditions among these adults, comparing the experience of adults with Medicaid to adults with other forms of coverage.

Relative to their privately insured peers, Medicaid beneficiaries under community supervision were more likely to be Black or Hispanic. They were also more likely to be female. With few exceptions, Medicaid beneficiaries under community supervision reported higher rates of behavioral health conditions than their privately insured or uninsured peers.