By Pasangi S. Perera, Vanessa E. Miller,; Kate Vinita Fitch, et al

Since 2014, Medicaid expansion has been implemented in many states across the US, increasing health care access among vulnerable populations, including formerly incarcerated people who experience higher mortality rates than the general population. OBJECTIVE To examine population-level association of Medicaid expansion with postrelease mortality from all causes, unintentional drug overdoses, opioid overdoses, polydrug overdoses, suicides, and homicides among formerly incarcerated people in Rhode Island (RI), which expanded Medicaid, compared with North Carolina (NC), which did not expand Medicaid during the study period. DESIGN, SETTING, AND PARTICIPANTS A cohort study was conducted using incarceration release data from January 1, 2009, to December 31, 2018, linked to death records from January 1, 2009, to December 31, 2019, on individuals released from incarceration in RI and NC. Data analysis was performed from August 20, 2022, to February 15, 2024. Participants included those aged 18 years or older who were released from incarceration. Individuals who were temporarily held during ongoing judicial proceedings, died during incarceration, or not released from incarceration during the study period were excluded. EXPOSURE Full Medicaid expansion in RI effective January 1, 2014. MAIN OUTCOMES AND MEASURES Mortality from all causes, unintentional drug overdoses, unintentional opioid and polydrug overdoses, suicides, and homicides. RESULTS Between 2009 and 2018, 17 824 individuals were released from RI prisons (mean [SD] age, 38.39 [10.85] years; 31 512 [89.1%] male) and 160 861 were released from NC prisons (mean [SD] age, 38.28 [10.84] years; 209 021 [87.5%] male). Compared with NC, people who were formerly incarcerated in RI experienced a sustained decrease of 72 per 100 000 person-years (95% CI, −108 to −36 per 100 000 person-years) in all-cause mortality per quarter after Medicaid expansion. Similar decreases were observed in RI in drug overdose deaths (−172 per 100 000 person-years per 6 months; 95% CI, −226 to −117 per 100 000 person-years), including opioid and polydrug overdoses, and homicide deaths (−23 per 100 000 person-years per year; 95% CI, −50 to 4 per 100 000 person-years) after Medicaid expansion. Suicide mortality did not change after Medicaid expansion. After Medicaid expansion in RI, non-Hispanic White individuals experienced 3 times greater sustained decreases in all-cause mortality than all racially minoritized individuals combined, while non-Hispanic Black individuals did not experience any substantial benefits. There was no modification by sex. Individuals aged 30 years or older experienced greater all-cause mortality reduction after Medicaid expansion than those younger than 30 years.

JAMA Netw Open. 2024, 12 p.

By Melissa Serafin, Julie Atella, Piere Washington, Sophak Mom

Reentry and community context Within three years of release from state prisons, federal prisons, and local jails, about half of people are reincarcerated and two-thirds are rearrested (Office of the Assistance Secretary for Planning and Evaluation, n.d.). Existing research highlights how challenges to reentry are compounded in rural communities because they are often underserved and under-resourced. Employment, housing, transportation, and limited social and health services are all common barriers for individuals reentering rural communities, and access to reentry programming is often limited (Benavides et al., 2023; Ward et al., 2016; Ward, 2017; Zajac et al., 2014). Additionally, the opioid crisis has significantly impacted rural communities, including those in Maine (Maine Governor’s Office of Policy Innovation and the Future, 2023). The rate of overdose fatalities in Maine increased from 0.3 per 1,000 population in January 2017 to 0.6 in January 2022, and the rate in Waldo County also increased from 0.2 in 2017 (8 total) to 0.5 in 2022 (20 total; Maine Drug Data Hub, 2024). Overdose fatalities most notably increased during the COVID-19 pandemic: the fatality rate in Maine increased 33% between 2019 and 2020, with 83% of deaths in 2020 due to opioids. Without opportunities, resources, and support, people reentering rural communities may experience hopelessness and criminogenic needs contributing to recidivism (Ward, 2017; Pettus-Davis & Kennedy, 2019). The findings from the current project also identified many of these challenges. Limited access to and availability of resources and services like internet, public transportation, health care and insurance, employment options, and affordable housing across counties and the state were stressed as barriers hindering the success of the program. Housing was identified as a particularly significant challenge, and this is compounded by the lack of viable employment options that provide a livable wage. The median cost for a studio efficiency or one-bedroom apartment in Waldo County, Maine in 2023 was $916-$922, and a two bedroom was $1,174 per month (RentData, 2024). According to the Maine Department of Labor (2024), the minimum wage in 2023 was $13.80 per hour in the state. Individuals employed full time, earning minimum wage, and who rent at least a studio efficiency would then be considered “cost-burdened”1 or “severely cost-burdened”2 (Office of Housing and Urban Development, 2014). Rent burden contributes to lacking the means to afford other necessities such as food, clothing, child care and more. Furthermore, the National Low Income Housing Coalition (NLIHC, 2024) notes the extreme shortage of rentals that are affordable to households whose incomes are at or below the poverty guideline or 30% of their area median income. In addition to the shortage of affordable housing and within the vicinity of the VOANNE network—within a four-city radius—there were no homeless shelters, nor mental health facilities with detox beds, and only one sober house. While VOANNE provides tents and camp supplies in more dire cases, and connects some participants with temporary transitional housing (including motels), they have access to very few permanent housing supports. Experiencing housing insecurity and homelessness can also negatively impact substance use. For example, efforts to stay awake to protect belongings and avoid violence is associated with developing and worsening substance use disorders (Mehtani et al., 2023). Existing research and findings from the current evaluation indicate that transportation is often a significant challenge for individuals reentering rural communities (Benavides et al., 2023; Ward, 2017; Zajac et al., 2014). While Maine does have some public transportation, rural areas have limited public transportation. Some communities have fixed route bus services that do not operate 24 hours a day and seven days a week, but these may only be in some counties (Eichacker, 2021). Limited public transportation means limited independence upon reentry to get to and from places like the DMV, a job interview, or to work. Additionally, some participants in the current evaluation did not possess driver’s licenses, further limiting their transportation options. This evaluation also identified how lack of phone service and high-speed internet make communication difficult and pose a barrier to building independence and integrating into society. Previous research has also identified these as significant reentry barriers (PettusDavis et al., 2019). Correctional system initiatives In response to the challenges that individuals face while reentering their communities, VOANNE and their partners have implemented several initiatives. Specifically, VOANNE has prioritized building trusting and collaborative partnerships with law enforcement agencies; this evaluation identified the strength of these partnerships. These partnerships facilitate opportunities to strengthen impact, such as the ability to provide services and programming within county jails while individuals are incarcerated. Additionally, postrelease offices and community spaces provide critical support to individuals who are reentering their communities after incarceration, and VOA’s diversion programming allows VOANNE to serve anyone who could benefit from services (e.g., not just individuals who are or have been incarcerated). VOANNE has also been able to expand to providing services in additional counties and correctional facilities over time.

St. Paul, MN: Wilder Research, 2024. 43p.

By JESSICA REICHERT, RYAN MARANVILLE, EVA OTT HILL

Persons reentering the community after prison face many obstacles that have been shown to reduce recidivism, such as securing employment. Like many states, Illinois operates work release centers allowing prisoners nearing the end of their sentence to work in the community and stay in the correctional facility when not working. Although the research is limited, these programs have been shown to be successful at increasing post-release employment, increasing hours worked, and reducing recidivism. We described characteristics of 1,580 participants in Illinois’ four Adult Transition Centers (ATCs) and examined differences in characteristics associated with rearrest and reincarceration. We found age, gender, and ATC facility were associated with rearrest and reincarceration. We found, as well, that recidivism risk, offense type, prior arrests, prior incarcerations, and length of stay were associated with rearrest. We recommend consistently measuring risk and tailoring services to the needs of the participant population.

Chicago: Illinois Criminal Justice Information Authorisy 2023. 17p.

By Melissa Young, Clarence Okoh, and Jason Whyte

Now more than ever, Congress has a national imperative to advance comprehensive policy reforms that seek to remedy the harms caused by the criminal legal system, heal communities, and restore rights and access to opportunity. The federal Reentry Employment Opportunities (REO) Program has the potential to be a critical programmatic element of a comprehensive effort.

In this brief, the Center for Law and Social Policy (CLASP) and the National Reentry Workforce Collaborative (NRWC) offer a set of recommendations to strengthen and modernize the REO program to ensure that a greater number of people impacted by the criminal legal system have access to quality jobs through effective, equitable, and culturally responsive practices.

Our recommendations are grounded in the perspectives of current REO programs, partners, and intermediaries across the country. Additionally, our recommendations build from two recent proposals to codify the REO program from Senator Gary Peters (D-MI) through the Reentry Employment Opportunities Act of 2020 (Senate Bill 4387) and the House-passed Workforce Innovation and Opportunity Act of 2022 (House Bill 7309).

Washington, DC: CLASP, 2022. 6p.

By Pilar Larroulet, Catalina Droppelm, Paloma Del Villar, et al.

The last decades’ increase in female incarceration has translated into an increasing number of women being released from prison. Understanding their characteristics and criminal trajectories can enlighten us regarding the different needs of women upon re-entering society after incarceration. Drawing on data from the Reinserción, Desistimiento y Reincidencia en Mujeres Privadas de Libertad en Chile study, this article identifies different profiles among a cohort of 225 women who were released from prison in Santiago, Chile, and demonstrates that significant heterogeneity exists among them in terms of their criminal trajectories and the intervention needs to support their transition out of prison.

International Journal for Crime, Justice and Social Democracy, 9(1), pp. 112-125. 2020.

By Vera Institute of Justice

Postsecondary education in prison has positive effects for students who are incarcerated, their families and communities, public safety, and safety inside prisons. Research has demonstrated that postsecondary education reduces incarceration, makes prisons safer places to live and work, and improves employment and wages. Nationally, taxpayers also see major benefits, with every dollar invested in prison-based education yielding more than four dollars in taxpayer savings from reduced incarceration costs. Most people in prison are both interested in and academically qualified for postsecondary education (64 percent), yet only a tiny fraction of people in prison completes a credential while incarcerated (9 percent). This gap between educational aspirations and participation is driven largely by a lack of capacity due to limited funding.

New York: Vera Institute of Justice, 2023. 3p.

By The Council of State Governments Justice Center

This report highlights the significant progress made in reducing recidivism across the country over the past 15 years. Since its passage in 2008, the Second Chance Act has invested in state and local efforts to improve outcomes for people leaving prison and jail, with a total of nearly 1,200 grantees from 48 states and 3 territories administering programs that have served more than 400,000 people.

For the past 15 years, federal, state, local, and Tribal governments, as well as community-based organizations across the country, have been focused on reducing recidivism like never before. This report answers three critical questions:

What progress has been made?

• State-level reincarceration rates are 23 percent lower since 2008.

• Fewer returns to custody mean that more people can rejoin their families and contribute in their communities. States are achieving these rates with changes in policy and by increasing opportunities and resources to support employment and connections to behavioral health care and housing.

How much could states save by reducing recidivism further?

• Despite the progress made, states will spend an estimated $8 billion on reincarceration costs for people who exited prison in 2022.

• Scaling effective policies and reentry models can reduce the economic and human costs of recidivism, while creating meaningful opportunities for returning people to contribute to the workforce and their families and communities.

Are states ready to expand their efforts?

• In the past year, leaders in Missouri, Alabama, North Carolina, and Nebraska have set bold goals for reducing recidivism and improving reentry outcomes further by 2030.

• The goals include increasing access to treatment, mental health services, and medical care; improving individuals’ economic independence by ensuring they are better prepared for work and have access to employment; and increasing access to stable housing.

New York: Council of State Governments Justice Center, 2024.