Health Care Needs and Utilization Among New Yorkers with Criminal Justice System Involvement

Research Objective

People with a history of incarceration have high rates of physical and behavioral health conditions as well as increased hospitalizations and emergency department visits. This research extends the existing literature about the health profile of individuals with a history of justice involvement by examining patterns of Medicaid utilization and costs.

Study Design

We linked New York State Medicaid and New York City Department of Correction Data from 2012–2016 and examined patterns of jail utilization, health care utilization (including inpatient, emergency department, and outpatient use) and health care cost by categories of service, as well as the prevalence of chronic physical and mental health disorders. We selected two sets of comparisons, any jail contact vs. no jail contact and high jail contact vs. low jail contact.

Population Studied

Individuals with at least one jail admission in 2012 were defined as having any jail contact. Individuals with only one jail admission between 2012–2016 are defined as having low jail contact. Those who were in the top 10 percentile of number of jail admissions are defined as having high jail contact. The no jail contact group is defined as Medicaid recipients matched with individuals with any jail contact on age, sex, race/ethnicity, Medicare status and number of Medicaid enrollment months.

Principal Findings

Comparing to individuals with no jail contact, any jail contact was associated with a higher prevalence of both chronic physical and mental health conditions; those with any jail contact had a doubling in the risks of mortality and of health care resource use; the average number of hospitalizations was 4 times higher among people with any jail contact; people with jail contact had Medicaid costs that were 3 to 7 times greater, with inpatient costs largely driving these differences for people with the most frequent jail contact. Compared to individuals with low jail contact, individuals with high jail contact had drastically higher prevalence of both chronic physical and mental health conditions, triple the number of hospitalizations, and quadruple the number of emergency department visits. The annual inpatient expenditure of an individual with high jail contact is $12 k higher than that of an individual with low jail contact; total Medicaid expenditures of high contact individuals averages over $33 k per year and are twice as high as those of low contact individuals.

Conclusions

The prevalence of physical and mental health conditions was very high among individuals with high jail contact, as were their health care costs. Only a small fraction of costs for this group were for outpatient primary care, behavioral health treatment, and case management that could help to address these needs and prevent hospitalization.

Implications for Policy or Practice

These findings highlight the need for more effective health care engagement strategies for people with a history of incarceration. Specifically, preventative, primary care and behavioral health care services — particularly outpatient substance use services — that are tailored to the needs of this population could lead to more effective health care engagement, reduced health care costs, and improved health and well-being for individuals who have had some contact with NYC jails.

Primary Funding Source

The Robert Wood Johnson Foundation.