US Medicaid spending and health insurance coverage for people involved in the criminal legal system as children

Abstract

INTRODUCTION: Early involvement in the US criminal legal system (CLS) is linked to persistent health disadvantages, including reduced health insurance coverage in adulthood.

OBJECTIVES: The current study examined the influence of increases and cuts to federal and state Medicaid expenditures on health insurance enrollment among individuals with varying levels of CLS involvement before age 18.

RESEARCH DESIGN: The current study is a cohort study of individuals who participated in the National Longitudinal Survey of Youth 1997 (2003-2021).

PATIENTS AND METHODS: The total sample included 8240 participants. This study applied Bayesian lagged random-intercept logistic regression to assess associations between Medicaid spending and uninsurance among individuals with and without CLS contact before age 18.

MEASURES: Federal and State Medicaid expenditures were measured in total dollars spent by the federal government and state governments, respectively. Contact with the CLS before 18 was measured as arrested before 18, incarcerated in a juvenile facility before 18, or incarcerated in an adult facility before 18. Uninsurance was measured as the absence of insurance on the date of the interview.

RESULTS: Greater CLS severity was associated with higher odds of being uninsured, while higher federal Medicaid expenditures were associated with a lower uninsurance rate. Simulations indicated that a 50% federal Medicaid spending cut could increase uninsurance for those with CLS involvement before 18, whereas a 20% spending increase would increase the probability of insurance.

CONCLUSIONS: Findings highlight the federal Medicaid's role in mitigating coverage inequities and suggest that reducing expenditures could exacerbate ongoing health disparities rooted in early CLS involvement.