Medicaid managed care and drug court outcomes

Medicaid managed care and drug courts both grew dramatically during the 1990s. Yet heretofore there has been little or no evaluation of potential impact of Medicaid managed care on drug court participants. This chapter defines drug court, briefly reviews the history of this innovation, and describes one of earliest of such programs. The chapter reviews development of Medicaid managed care in Oregon and shows how there might be impact of Medicaid managed care on substance abuse treatment services for drug court participants. Using before versus after (Medicaid managed care) analyses the project described here tested hypotheses about possible managed care influences on drug court participants. Study subjects included individuals eligible for (but not necessarily participants in) drug court before versus after Medicaid managed care. Under managed care, less time was invested in treatment, especially for participants who chose but did not complete the drug court program. However, there were no more drug court program failures in the managed care period. Moreover, managed care had no effect on measures of recidivism, such as survival time to first arrest and days in the community for drug court participants. Analyses focused on Medicaid eligible drug court participants suggested, overall, that managed care had no impact on this group's numbers of arrests during follow-up, time to first follow-up arrest, or days in the community during follow-up. In summary, implementation of Medicaid managed care appeared not to be detrimental for drug court participants.