Medicaid expansion will facilitate easier access to care for justice-involved Oklahomans

[Download Full Report PDF: Medicaid Can Improve the Lives of Justice-Involved Individuals & Save Oklahoma Money]

The passage and implementation of Medicaid expansion in Oklahoma provides a unique opportunity to further address the state’s crisis of incarceration, as some 200,000 more Oklahomans are now eligible for comprehensive mental and physical health care through Medicaid. Our state, county governments, and community-based organizations can leverage this new coverage option to divert more individuals from the justice system and streamline access to health care as people return to their communities. These efforts will likely generate cost savings, reduce recidivism, and increase quality of life for impacted Oklahomans. 

Easier access to care will save money and improve outcomes

States are required to provide health care to people residing in prisons and jails. The Oklahoma Department of Corrections spent more than $85 million on health care in the fiscal year ending June 2021, and county jails spent countless more. Data sharing between correctional facilities and the Oklahoma Health Care Authority, as well as using an administrative mechanism to simply suspend Medicaid coverage during incarceration, would make it easier for Medicaid to pay for eligible expenses and then to reinstate coverage upon release. 

The total cost of incarceration is much higher, as Oklahoma has such a high incarceration rate: 1,079 per 100,000 people, a number that is disproportionately high for our communities of color. Providing pre-release enrollment assistance would prevent gaps in coverage and facilitate easier access to care upon release.  

Before Medicaid expansion became reality in Oklahoma, many people leaving incarceration did not meet the Medicaid eligibility requirements, and therefore lost access to care upon release. With 38 percent of people residing in Oklahoma prisons suffering from a serious mental illness and many more with chronic health conditions, this loss of access could be life-threatening. Indeed, the mortality rate in the first two weeks after release from prison is 12 times that of the general population. Medicaid expansion means that many more people leaving incarceration will become eligible for coverage. Community-based follow-up can help connect people immediately to necessary care. 

Federal efforts will compound these benefits

The American Rescue Plan Act (ARPA) can be used to further enhance these efforts. The federal pandemic relief bill provides $3 billion for states to support mental health services and substance use treatment. Treatment investments will be particularly transformative in rural Oklahoma where many have no access to care. Between 600,000 and 900,000 adult Oklahomans are in need of mental health or substance use care, but current funding only allows 1 in 3 of those Oklahomans to access care. In many parts of Oklahoma jails and prisons are easier to access than treatment. Eighty-two percent of Oklahomans entering prisons for nonviolent offenses have mental health or substance use treatment needs. 

The $1.9 billion in state and local fiscal relief provided to Oklahoma via ARPA also creates an opportunity to fill these gaps and to divert more struggling Oklahomans from incarceration to care. This is particularly important as behavioral health experts expect the pandemic to create an increased need for crisis care, mental health care, and suicide prevention efforts. State policymakers should invest in infrastructure and technology solutions like tablets for incarcerated individuals that can be used to connect those Oklahomans with treatment and community resources. More robust community mental health infrastructure is proven to reduce the cost of crime. This is the perfect time for policymakers to make these treatment investments. Hundreds of thousands of Oklahomans are finally gaining access to mental health care through Medicaid expansion, which creates a sustainable path to funding this treatment infrastructure for the long term.

Oklahoma has a unique opportunity to improve access to care for all 

OK Policy’s newest report, “Medicaid Can Improve the Lives of Justice-Involved Individuals and Save Oklahoma Money,” dives deeper into realistic steps the state can take to make this a reality in Oklahoma. From streamlined Medicaid enrollment to community-based case management, these policy recommendations will help build on recent success to lower costs, reduce recidivism, and improve health outcomes. 

[Download Full Report PDF: Medicaid Can Improve the Lives of Justice-Involved Individuals & Save Oklahoma Money]


Emma Morris worked as Oklahoma Policy Institute's Health Care and Fiscal Policy Analyst from April 2021 to January 2024. She had previously worked as an OK Policy intern and as the Health Care Policy Fellow. Previous experience included working as a case manager with justice-involved individuals and volunteering as a mentor for youth in her community. Emma holds dual bachelor’s degrees in Women’s and Gender Studies and Public and Nonprofit Administration from the University of Oklahoma, and is currently working on a Master of Public Administration degree from OU-Tulsa. She is an alumna of OK Policy’s 2019 Summer Policy Institute and The Mine, a social entrepreneurship fellowship.

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