Research shows a link between increased health care coverage and reductions in crime, particularly how often people commit a new crime after getting out of prison or jail. An APD prisoner transport vehicle sits in front of the Bernalillo County Public Safety Center in Downtown Albuquerque in late August, 2021. (Photo by Shelby Wyatt / Source NM)
If authorities end the public health emergency in the fall and allow people to lose access to health care, it could lead to an increase in violent crime in New Mexico, a state lawmaker said in a hearing last week.
Since the federal government declared the COVID-19 pandemic a public health emergency, people on Medicaid have been able to stay enrolled in the program and get free health care — even if their coverage is up for renewal or their income changed.
But New Mexicans are at risk of losing Medicaid coverage when national public health emergency status is expected to expire in October, KUNM reports.
Sen. Siah Correa Hemphill (D-Silver City) raised the issue during a July 20 hearing in her district about ways to reduce violent crime in New Mexico.
“This is gonna have a ripple effect across our state in terms of economics, as well as mental health support, possibly an increase in violent crime,” Hemphill said. “We really need to be thinking about this proactively because that could happen at any time.”
This is supported by research showing a link between increased health care coverage and reductions in crime, particularly how often people commit a new crime after getting out of prison or jail, according to a report by Legislative Finance Committee staff. The analysts say it’s because Medicaid coverage can boost access to mental health care and substance use disorder treatment.
Nearly half of New Mexicans are enrolled in Medicaid, and more people in the state count on Medicaid than anywhere else in the nation, they wrote.
LFC Senior Fiscal Analyst Ellen Rabin, one of the report’s authors, said during the hearing that lawmakers should expand ways for people who get caught in the criminal legal system to enroll in Medicaid so they can get medication-assisted treatment.
The state’s seen double digit drops in recidivism when people who return home after being incarcerated get on Medicaid, the LFC wrote.
Young adults see substantial benefits from being on Medicaid, and when they lose it, they have a much higher risk of incarceration, the LFC’s July 20 report states. Children on Medicaid also see reduced rates of incarceration later on in life.
“That risk is even higher for individuals with mental health issues,” the analysts report.
There is evidence from South Carolina that cutting off Medicaid when people turn 19 made it more likely that they would be incarcerated within the next two years by 15%, said Jennifer Doleac, associate professor of economics at Texas A&M University.
“Just kicking them off of Medicaid when they became an adult increased their incarceration rates,” Doleac said.
This was especially true for people with histories of mental health problems, and more people who used Medicaid to buy medication related to their mental health treatment were likely to end up in jail or prison, she said.
There is some disconnect though, between spending to expand health care coverage and immediate results, according to the LFC.
“Although research would suggest such coverage should reduce the state’s crime rates, New Mexico had the highest overall crime rate and the second-highest violent crime rate in the country in 2020,” the analysts wrote.
That points to barriers preventing even people on Medicaid from getting the substance use disorder and mental health treatment they need, the LFC wrote. And it’s worth noting, too, that throughout 2020, people around the U.S. struggled to access mental health care and substance use services.
“Even as the state tripled its spending on core substance use services between 2014 and 2020, its violent crime rate rose 30%,” the LFC wrote.
The year before that, then-Gov. Susana Martinez froze Medicaid payments to behavioral health providers around the state, alleging fraud. Though the providers were eventually cleared of those accusations, much of the state’s mental health care system was destroyed in the process.
In 2018, the state Department of Health found that 134,000 New Mexicans needed treatment but were not getting it.
DOH found the problem persisted into 2020, and that the biggest gap in treatment was for people with alcohol use disorders, making up over 73,000 people left without care. Use of methadone and residential treatment went down between 2018 and 2020, the LFC wrote.
“Over the same period as the state increased its spending on these services and increased service delivery by 85%, drug overdose and alcohol-related death rates rose by 43% and 49%, respectively,” the LFC wrote.
“Although several DOH facilities offer evidence-based programs, some are operating at less than half their licensed bed capacity,” the LFC wrote.
Not enough psychiatrists, doctors and nurses
There are also huge shortcomings in mental health care for all of New Mexico, not just people on Medicaid. Patients in New Mexico need at least 117 more psychiatrists, according to research on the state’s health care workforce published last year.
And it’s not just mental health: New Mexico’s entire health care system is plagued by shortages, and nearly every county in the state does not have enough primary care physicians or nurses, researchers from the state’s Health Care Workforce Committee told lawmakers.
Doleac told the committee about 44% of people in jail and about 37% of people in prison have a history of mental health problems.
“This can lead to self-medication, including alcohol and drugs,” she said.
About 42% of people in jail and 47% of people in prison have some kind of substance use disorder, she said.
“Increasing access to mental health care is extremely beneficial,” Doleac said. “We now have a lot of evidence for this, that increasing access to mental health care prevents violent crime.”
Expanding Medicaid to include low-income childless adults gave them better access to mental health care and treatment, and reduced violent crime by 5% to 6%, she said.
Increasing the availability of treatment centers for substance use disorders reduces homicide, Doleac said.
“Just opening one additional treatment center in a county reduced homicide rates by 0.2%,” she said.
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