Increased Assistance with Medicaid Enrollment is Associated with a Rise in Formerly Incarcerated People Seeking Health Care Services Upon their Release

Findings from a JCOIN Accelerator Supplement

Medicaid Eligibility paperwork on desk.

Medicaid enrollment opportunities for incarcerated people differ based on the type and availability of enrollment assistance at a correctional facility and the state’s Medicaid expansion status. A 2018 federal law sought to increase Medicaid enrollment among eligible incarcerated people before their release to raise substance use disorder (SUD) treatment rates and lower overdose rates. Researchers from the University of Wisconsin led the first study exploring how the provision of prison-based Medicaid enrollment assistance affected this trend.


The University of Wisconsin study focuses on the Wisconsin Department of Corrections (DOC) statewide prison-based Medicaid enrollment assistance program that began in January 2015. The program incorporated Medicaid enrollment assistance into the usual discharge planning process with the assistance of paralegal staff to guide incarcerated adults through the Medicaid enrollment process. In their retrospective cohort study, the researchers examined post-incarceration health care use among 18,265 adults aged 19 to 64 with a history of SUD, who were released from a Wisconsin state prison between April 1, 2014, to December 31, 2016. The researchers relied on person-level data from Wisconsin agencies: the DOC, the Division of Medicaid Services, the State Lab of Hygiene, and the Electronic Data Surveillance System in the Institute for Research on Poverty’s Wisconsin Administrative Data Core. Moreover, the researchers cross-referenced participants’ DOC risks and needs assessment tool, the Correctional Offender Management Profiling for Alternative Sanctions (COMPAS), to determine a person’s history of substance use.

The study found three key findings:

  • A statewide prison-based Medicaid enrollment assistance program led to a large absolute increase in the likelihood of having an outpatient visit for any cause within 30 days after release.
  • Despite a large relative rise in outpatient visits associated with SUDs, the absolute levels of SUD treatment use in the 30 days post-incarceration remained low.
  • Medicaid enrollment assistance programs did not reduce hospital-based care.

The researchers emphasized social barriers, logistical challenges and competing priorities may deter formerly incarcerated people from accessing care and their study may only be generalizable to Wisconsin as Medicaid programs and enrollment processes differ by state.


This study was led by Dr. Marguerite Burns, Steven Cook, Lars Brown, Dr. Laura Dague, Dr. Steve Tyksa, Karla Hernandez Romero, Cici McNamara, and Dr. Ryan Westergaard from the University of Wisconsin.


Read the journal article


This summary is based on the findings from the following publication:

Burns, M. E., Cook, S., Brown, L. M., Dague, L., Tyska, S., Hernandez Romero, K., McNamara, C.,
& Westergaard, R. P. (2022). Association between assistance with medicaid enrollment and use
of health care after incarceration among adults with a history of substance use. JAMA Network
Open, 5(1), e2142688.