Public Health Insurance, Mental Health, and Impacts to Crime

There has been much speculation that the expansion of state Medicaid programs through the Affordable Care Act will lead to improved access to care for mental health conditions. This improved access is believed to lead to societal impacts through reductions in crime rates, prison rates, and inappropriate emergency room use. Earlier research has sought to evaluate the impacts of improvements in mental health through increased access to specific treatment programs and has found reductions to the rate of crime. Few studies, however, have investigated the impact of health insurance on mental health treatment utilization and impacts for society. This paper seeks to evaluate the effects of the OBRA86 Medicaid expansions for individuals with disabilities on mental health services utilization and the rate of crime. Mental illness can qualify as a disability under Medicaid and is often tied to other common disabilities. These expansions are arguably the closest pre-ACA Medicaid expansions that would target a population with a higher tendency for mental health issues. Early estimates suggest a reduction in crime, with increased spending on mental health services.