Further Marginalization: The Link Between Incarceration Rates and State Medicaid Enrollments

Abstract

Although the penal system and public assistance programs play significant roles in the lives of disadvantaged populations in the United States, the relationship between the two institutions is not well understood. This is particularly true of publicly financed health care coverage. In this article, the authors study how state-level incarceration rates shape the provision of publicly financed health care and health insurance (Medicaid), using two theoretical frameworks as a guide: a collateral consequences model and a punitive regime model. The authors use state-level panel data to estimate how the size of the incarcerated population is related to Medicaid enrollments across states and within them over time. These analyses suggest that incarceration rates do have a substantial and positive effect on Medicaid rates within states over time. Across states, the relationship is less clear. On average, states with higher incarceration rates had somewhat fewer Medicaid enrollments until the early 1990s. After this point, Medicaid enrollments began to increase with the size of the incarcerated population. These findings suggest that though states’ efforts to control crime and poverty may be linked, whereby states that use incarceration liberally are also stingy with Medicaid, the collateral consequences of mass incarceration undermine these efforts by producing greater demands for social welfare services.