Linkages Across Systems: Mental Health, Mental Hospitals, and Jails (King County, Washington) - Morrissey, Steadman

In the 1990s, the imperative to control health care spending led to sweeping changes for people enrolled in Medicaid. State Medicaid programs moved rapidly toward managed care. The dramatic transformation prompted concerns that, in an effort to cut costs, managed care organizations would give fewer services or avoid giving care altogether. Less care, in turn, would shift care to jails, state hospitals, and other non-managed care sites (a concept known as “cost-shifting”). If people with severe illnesses are underserved, the downward spiral begins: their untreated symptoms can lead to homelessness and commission of misdemeanor offenses, which, in turn, can lead to eventual arrest and booking. For this reason, the Network examined the impact of Medicaid managed care on incarceration rates of mentally ill persons in King County (Seattle) Washington. It studied 44,500 individuals and their involvement with Medicaid, county mental health services, state mental hospitals, and jails. The study was conducted over a 5.5-year period that bracketed the adoption of Medicaid managed care on April 1, 1995. The questions being studied were, does being enrolled in managed Medicaid programs lead to higher rates of jail detention or state hospital care? Using a before versus after comparison, the project found that the probability of Medicaid enrollees being detained in jails did increase in the year following the introduction of managed care. Moreover, jail detentions rose steadily for the next two years. The incarceration rate among the group had been 6.5% before managed care’s introduction. It climbed to 6.7%, 8.2%, and 9.1% in the three years afterward, respectively. No shifts in state hospital care were found.

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Last modified: June 1, 2006
©2006 MacArthur Foundation Network on Mental Health Policy Research
Last Revised: June 2006