“Catching Chain” With Medicaid: The Impact of Medicaid Access on Opioid Overdose Mortality in Adults Released From State Detention

Objective: To combat the heightened risk of opioid overdose death for individuals with criminal justice involvements, enhanced access to Medicaid remains paramount. This study examines the effect of a 2017 policy change in Pennsylvania that allowed for suspension, rather than termination, of Medicaid coverage while in prison on post-release opioid overdose mortality risk (OOMR) for adults released from Pennsylvania prisons. Methods: This retrospective cohort study utilizes administrative records from the Pennsylvania Department of Corrections for adults ≥18 years diagnosed with opioid use disorder (OUD) released in either 2015 or 2018. Death certificate data were used to compare OOMR within a year after release, both prior to and following the policy change. Demographic, treatment, and death characteristics were assessed with bivariate analyses. Multivariable logistic regressions were used to examine the association between qualification of Medicaid suspension and post-release crude mortality and OOMR. Results: Qualification for Medicaid suspension was not associated with a significant decrease in OOMR (OR = 0.82, 95% CI [0.47–1.46]) or crude mortality (OR = 1.02, 95% CI [0.67–1.57]) within 1 year after prison release for individuals diagnosed with OUD. In addition, the risk of opioid overdose mortality after release from prison for adults with an OUD increased from 2015 to 2018 (0.6%–1.7%; p < 0.0001), particularly from synthetic narcotics (57.1%–83.1%, p < 0.001), and drug overdose remained the leading cause of death (74.0%) within the initial year of release. Conclusions: These findings underscore the need for ongoing research in overdose prevention tailored to criminal justice populations. This includes a deeper analysis of policies intended to enhance post-release insurance continuity and their effect on individuals diagnosed with OUD after prison release.