Beyond its enormous implications for our health care system, State Question 802, the ballot measure to expand Medicaid in Oklahoma, is also a significant criminal justice issue. Nearly a decade of evidence shows that expanding Medicaid increases access to mental health and substance use treatment, supports diversion programs, and even correlates with reduced crime rates, particularly for communities of color and rural communities. Passing SQ 802 is a great opportunity to move our state’s work on criminal justice reform forward.
If passed by voters, Medicaid expansion would bring more than a billion federal dollars into the state every year for health care, including mental health and addiction treatment. Four in five Oklahomans who enter prison with non-violent offenses need mental health and addiction treatment. If voters approve SQ 802, more than 200,000 working-age adults will gain access to necessary health care including mental health, trauma and addiction treatment that would provide better resources for law enforcement and communities while saving taxpayers millions in incarceration and treatment costs long term.
Investing in treatment reduces crime and supports law enforcement
The experience of Medicaid expansion states suggests that we can expect Oklahoma’s rates of violent and property crime to fall if we approve SQ 802. Since 2012, the 37 states (including the District of Columbia) that have opted to expand Medicaid have seen both violent and property crime rates fall, with the largest declines in states with higher uninsured rates prior to expansion as Oklahoma currently does. Researchers attribute these drops in large part to investments in substance abuse and mental health treatment, estimating that each additional treatment facility reduces the social cost of crime in a county by $4.2 million.
If Oklahoma expands Medicaid, federal dollars can be invested in hiring more mental health professionals to respond to mental health crisis calls instead of relying on law enforcement to fill these needs. States like Colorado have used Medicaid expansion dollars to help fund innovations like crisis response teams, where a team of trained mental health and emergency care professionals lead the response to mental health 911 crisis calls with police back-up if necessary. Tulsa has piloted a similar program a few days a week, but an influx of federal expansion dollars could dramatically improve the scope of such reforms across the state. These types of investments can help reduce the massive amounts of time law enforcement spends transporting individuals to and from treatment facilities.
Improving access to treatment would also help stabilize many patients experiencing mental health issues before they reach crisis levels. Deficits in funding mean Oklahomans in need of mental health services are regularly turned away, and often those with the greatest need don’t get care until they are in the midst of a crisis. That can lead to dangerous and tragic results: People with untreated mental illness are 16 times more likely to be killed during a police encounter than other civilians approached or stopped by law enforcement.
Treatment investments save public safety dollars long term
Oklahoma could save millions on drug treatment and dramatically reduce the prevalence of deadly chronic illnesses by expanding Medicaid. By law, Medicaid can only pay for the care of prison or jail inmates who have been hospitalized longer than 24 hours, but Medicaid coverage greatly reduces costs for justice agencies. States that have expanded Medicaid have produced savings in their jail and prison health care budgets as a result of increased coverage for incarcerated individuals. Colorado, Michigan, and Ohio already have seen savings between $10 to $19 million a year since expansion.
Oklahoma’s prisons would benefit enormously from this injection of funds, especially when it comes to treating hepatitis C. About 1 in 12 Oklahoma inmates has hepatitis C, a potentially fatal liver disease. The Oklahoma Department of Corrections requested $91 million for treating the disease in its FY 2020 budget, but the Legislature only approved enough funding to treat fewer than a quarter of them. In 2019, Louisiana leveraged Medicaid expansion to help deploy a payment scheme called the “Netflix model” to save state taxpayers $500 million in hepatitis C treatment costs and to dramatically increase access to the life-saving drug regimen throughout infected populations inside and outside of state prisons.
Other states have saved huge sums by funneling new funds into preventative treatments. Washington state used expansion dollars to provide different groups of low-income adults with alcohol and drug treatment. A decline in arrests saved local law enforcement, jails, courts, state corrections agencies, and crime victims between $9,000 to $18,000 for each person treated, for a total of $275 million.
Treatment investments reduce health care disparities that impact public safety
Expansion would disproportionately benefit groups that are overrepresented in our justice system, particularly low-income communities of color and rural communities. Oklahoma has the highest per capita Black incarceration rate in the nation, and significant disparities persist in the incarceration rates of Native and Latinx Oklahomans. Rural counties have the highest prison and jail admissions rates in the state, and the problem has only grown worse in recent years. The jail population increased 111 percent in Oklahoma’s 59 rural counties from 2000 to 2015.
Research shows that expansion could help reduce the prevalence of several economic and social factors that contribute to these justice disparities. Expansion is associated with decreased mortality overall, as well as reductions in rates of food insecurity, poverty, and home evictions. It also has proven to improve self-reported health and healthy behaviors. Medicaid expansion has shown the most dramatic reduction in the uninsured rate among Black and Latinx Americans, and health care experts have long argued that expanded coverage helps prevent rural hospitals and treatment facilities from closing.
SQ 802 will help reform Oklahoma’s justice system
Expanding Medicaid through SQ 802 will provide affordable health care to hundreds of thousands of the most vulnerable Oklahomans. Oklahoma can expect to see many positive effects on our justice system, just as expansion has done in other states. This includes greater access to mental health treatment leading to declining crime rates, and better coverage for incarcerated individuals which helps reduce the cost of jails and prisons. These benefits will be felt especially by the rural communities and people of color that are disproportionately harmed by our justice system. The impact of more than 200,000 Oklahomans gaining access to health care will improve Oklahoma for decades to come.