Medicaid enrollment and mental health service use following release of jail detainees with severe mental illness

Objective: This study assessed the extent to which Medicaid enrollment increased access to and use of services by persons with severe mental illness after their release from jail. Methods: A prospective cohort design was used that linked administrative data from several agencies in two large urban areas: King County (Seattle) from 1996 to 1998 and Pinellas County (Clearwater and St. Petersburg), Florida, from 1998 to 2000. Access to and use of community mental health services within 90 days after release from jail was examined, depending on whether persons were enrolled in Medicaid at the time of their release. All analyses were based on detentions, rather than unique persons. The effects of Medicaid status (enrolled or not enrolled) on four dependent variables (probability of use, days to first service, number of services used, and rate of service use) were estimated separately for each county. Results: A total of 1,210 persons who had 2,878 detentions were identified in Pinellas County: 2,215 of these detentions represented persons with Medicaid and 663 represented those without Medicaid. For King County, the corresponding numbers were 1,816 persons and 4,482 detentions: 2,752 of these detentions represented persons with Medicaid and 1,730 represented those without Medicaid. In both counties, those who had Medicaid at the time of their release were more likely to use services (p <. 001), accessed community services more quickly (p <. 001), and received more days of services (p <. 001) than those without Medicaid. Conclusions: Medicaid enrollment enhanced receipt of community services after jail release in these two large urban counties. These are the best currently available data, and the data suggest that efforts to enroll persons with severe mental illness in Medicaid and ensure enrollment upon jail release will improve their access to and receipt of community-based services after release.