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RESEARCH OBJECTIVE: Evidence suggests that expanding eligibility for in‐kind public welfare programs may improve health, economic, and crime‐related outcomes for former prisoners. The Affordable Care Act increased benefits for this population by authorizing expanded Medicaid eligibility. Coverage may increase access to treatment for conditions that impede employment and increase risk of recidivism (a health channel). By improving financial security, coverage may alter the incentives to commit crime (a financial channel). We estimate the effects of Medicaid coverage on employment and recidivism for adults released from state prison. STUDY DESIGN: We study sequential natural experiments in Wisconsin that expanded Medicaid availability to released prisoners, expansion of Medicaid to childless adults with income below 100% FPL, and the introduction of prison‐based Medicaid enrollment assistance. Using person‐level longitudinal data that links Corrections, Medicaid, and Unemployment Insurance data, we implemented two‐stage least squares instrumental variables (IV) analysis. Three variables comprised the key instruments corresponding to three policy periods: eligibility expansion; a 3‐month enrollment assistance implementation period; and the fully operational enrollment assistance program. The key assumption is that timing of release is unrelated to the outcomes, conditional on the other variables in the model. Outcomes included reincarceration within 6‐ and 12‐months, and post‐release quarterly employment status and earnings. POPULATION STUDIED: The population includes adults ages 19–64 incarcerated by the state who were released to the community between January 2013 – June 2017 (N = 32,846 individuals). The primary sample includes all releases; the secondary sample includes the first release per person. PRINCIPAL FINDINGS: The instruments were highly correlated with Medicaid enrollment in the month of release (F‐statistic of 7104). Relative to the baseline period, the percentage point (pp) increase in the likelihood of enrollment associated with expanded eligibility, the program implementation period, and the fully operational enrollment assistance program were 30.1, 47.6 and 61.1 respectively (p

Objective To estimate the association between the implementation of parity in coverage for mental health and substance use disorder (MHSUD) services within the Medicaid program and MHSUD service use. Data sources/study setting Wisconsin Medicaid enrollment and claims data from 2013 to 2015. In April 2014, Wisconsin Medicaid transitioned childless adult beneficiaries from coverage with limited MHSUD services to parity-consistent coverage. Preparity, they only had Medicaid coverage for MHSUD visits to psychiatrists and the emergency department, while parent beneficiaries had parity-consistent coverage. Study design The study uses a difference-in-differences design to compare outcome changes for childless adult and parent beneficiaries. Data collection/extraction methods We identified 76, 569 childless adult and parent beneficiaries aged 18-64 who were continuously enrolled for the 2-year study period. Principal findings Introducing parity-consistent coverage within Medicaid was associated with increased utilization of Medicaid-reimbursed MHSUD services: outpatient, prescription medication, ED, and inpatient. Increased MHSUD outpatient visits were driven by increased visits to nonpsychiatrists. Conclusions Parity's effects on MHSUD service use have been studied in the context of private insurance, but its impact among Medicaid beneficiaries has not. Our findings suggest that parity implementation in Medicaid could increase access to effective MHSUD services in a high-need population.

Objective This study measures the change in health care use after enrollment into a new public insurance program for low-income childless adults. Data Sources/Study Setting The data sources include claims from a large integrated health system in rural Wisconsin and Medicaid enrollment files, January 2007–September 2012. Study Design We employ a regression discontinuity design to measure the causal effect of public insurance enrollment on counts of outpatient, emergency department, and inpatient events for 2 years following enrollment for a sample of previously uninsured low-income adults in rural Wisconsin. Principal Findings Public insurance enrollment led to substantial increases in outpatient visits including preventive visits, but not mental health visits. Public insurance enrollment also led to increases in inpatient stays, but the study is inconclusive on whether it led to an increase in ED visits. Conclusions Public insurance expansions to childless adults have the potential to impact the use of health care. The large increase in Medicaid coverage and reduction in rates of uninsurance anticipated to result from the Affordable Care Act should increase the use of inpatient and outpatient services, but they will have an uncertain impact on the use of ED among rural populations.

Wisconsin's BadgerCare Plus (BC+) program was designed to ensure access to health insurance coverage to virtually all Wisconsin children and to bolster coverage for parents and other caretaker adults. The program, launched in February 2008, expanded upon BadgerCare (Wisconsin's Children's Health Insurance Program) and Medicaid. BC+ combines its predecessor programs into one streamlined umbrella program and its introduction was characterized by the following reforms: an eligibility expansion augmented with an autoenrollment initiative; simplification of eligibility rules and enrollment and verification processes; and an aggressive marketing and outreach campaign. This paper provides estimates of the impact of the reform effort on program enrollment and the continuity of coverage. We find that the introduction of BC+ was associated with increases in enrollment and decreases in exit rates, suggesting that the Wisconsin experience may be instructive for other states interested in achieving similar aims.