Justice Outcomes Explorer
Data Story
Explore how the Affordable Care Act (ACA) changed Medicaid coverage among those leaving prison across the U.S.

JOE, for the first time, can help us understand how recent policy changes have affected coverage rates in this population.

Historically, few justice-involved individuals were eligible for or have taken-up health insurance. Health insurance coverage, though, is the first step towards addressing mental health conditions and substance use disorders, which are highly prevalent in the justice system. Such barriers, when left untreated, may contribute to elevated crime rates.

Medicaid coverage among inmates leaving prison between 2005 and 2017

The ACA afforded states the opportunity to expand Medicaid eligibility to adults with incomes up to 133 percent of the federal poverty level. In this plot of 1 year outcomes of successive prison release cohorts, we can observe the results of expansion efforts in three participating states.

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Washington 1 expanded eligibility in 2014

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Pennsylvania 2 in 2015,

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and Montana 3 in 2016. Together, Medicaid coverage increased by roughly 50 percentage points within years of the expansion efforts.

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Coverage rates in Texas 4 and North Carolina 5, who did not elect to expand coverage, however, remained flat over time.

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Geographic variation in Medicaid coverage in recent years

Not all states elected to expand Medicaid eligibility as afforded through the ACA. In the JOE mapping tool, you can observe the stark difference in Medicaid coverage among the 2017 prison release cohort between expansion and non-expansion states.

Expansion states (shown as dark green) average a Medicaid coverage rate of close to 80%…

…while non expansion states (shown in light blue) average Medicaid coverage rates of roughly 20%.

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Such data visualizations help capture the overall impact of major policy reforms on the justice-involved population.

You may be interested in how specific subsets of the population, by race, age, or sex, were differentially impacted. All of these data frames can be reproduced for specific demographic groups, or you can compare outcomes across groups through the "All Demographics" tabular view.

Likewise, you might want to explore how employment or recidivism outcomes changed in response to these changes in Medicaid coverage. The "All Statistics" tabular view supports this type of investigation, showing all outcomes together in one table.

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Any conclusions expressed herein are those of the authors and do not reflect the views of the U.S. Census Bureau. All results were approved for release by the Disclosure Review Board of the U.S. Census Bureau (Data Management System number: P-7500378, Disclosure Review Board (DRB) approval numbers: CBDRB-FY23-0516, 9/29/2023.