Equity Implications of the Affordable Care Act Among People With Past-Year Criminal Legal Interactions.

OBJECTIVE

This study examined whether expansions of Affordable Care Act (ACA) coverage led to changes in insurance coverage and behavioral health treatment use among adults with past-year criminal legal interactions.

METHODS

National Survey on Drug Use and Health data and a difference-in-differences design were used to compare changes in insurance coverage and behavioral health treatment use among respondents with a mental or substance use disorder, by past-year criminal legal involvement (N=103,818).

RESULTS

Prior to ACA expansions, respondents with past-year criminal legal involvement (vs. without) were less likely to have insurance (61.5% vs. 79.3%) or to receive mental health treatment (34.7% vs. 36.3%). The ACA coverage expansions reduced insurance disparities for people with criminal legal involvement by almost 5 percentage points. No changes in behavioral health treatment use were found.

CONCLUSIONS

Future policies that help people with criminal legal involvement get connected to coverage and treatment are warranted to address persistent disparities in coverage and treatment receipt.