Medicaid access and the impact on individuals with criminal legal involvement: a scoping review

People with criminal-legal involvement (CLI) face disproportionately high morbidity and mortality. Policies like the Affordable Care Act (ACA), Section 1115 waivers, and other state-level initiatives have extended Medicaid coverage to millions in this population, aiming to improve outcomes. Our objective was to map the literature for studies assessing the association of policies that increase Medicaid access with key health (e.g., utilization, mortality) and non-health (e.g., recidivism) outcomes among people with CLI.

We searched eight academic databases for experimental or quasi-experimental studies published through April 1, 2025.

Of the 4,845 studies identified, 62 met inclusion criteria. Policies expanding eligibility consistently increased insurance coverage, particularly when paired with prerelease enrollment assistance. However, impacts on healthcare utilization and health outcomes were mixed. While targeted enrollment efforts promoted greater use of outpatient and behavioral health services, Medicaid expansion alone did not consistently increase care utilization. Many quasi-experimental studies linked Medicaid expansion to reduced recidivism, though others found null or inconsistent results. Conversely, one study of a large-scale Medicaid disenrollment found that coverage loss was associated with increased crime, particularly non-violent offenses.

Expanding Medicaid eligibility is an essential first step to increasing health care access for people with CLI, but its potential is only realized when policy changes are paired with targeted implementation strategies that bridge coverage to care. Critical gaps remain in the literature as few studies examined equity, long-term outcomes, or key subgroups like women and older adults. Future research is needed to determine how to operationalize insurance coverage into improved health and social outcomes for this population.