By Marcia M. Meis, Director, Administrative Office of the Illinois Courts
As I write, Congress is considering major changes to Medicaid - the public insurance program that covers around 70 million low-income and disabled Americans. Medicaid is the largest payer of healthcare services in Illinois and across the United States, serving as the primary payer for behavioral health services. Putting aside the obvious direct impact the legislation would have on this sizeable population, the potential impact on Illinois state courts is certainly worthy of our time and attention.
First, let’s look at the criminal courts. It is widely estimated that 70% of individuals involved in the criminal justice system have a mental illness or substance use disorder. Symptoms of untreated mental illness and/or addiction - erratic behavior, disorientation, or impaired judgment - all too often lead to arrests for, most often, minor offenses (disorderly conduct, petty theft, or trespassing) but felony offenses, too. Cuts in Medicaid funding would likely reduce current access to critical behavioral health treatment services, such as substance use disorder treatment, that has been shown to reduce crime. Worsening symptoms, in turn, contribute to criminal conduct and recidivism. It is not a stretch to predict that less treatment will result in more criminal cases on our state court dockets.
Access to healthcare also impacts civil courts. Medicaid cuts would likely increase cases related to financial distress and healthcare access. If more people are facing financial difficulties, there will be more cases on dockets over debt, eviction, and healthcare-related issues. We saw this occur during the Covid-19 pandemic and made adjustments, for example, in how eviction cases were handled.
Medical debt is recognized as a leading cause of bankruptcy in the United States. Health issues that worsen due to a lack of care can also lead to family instability, meaning more divorces and other family law cases. In short, within both criminal and civil contexts, an increase in court cases seems inevitable should Medicaid access be dramatically limited.
Increased caseloads have a systems ripple effect. And numerous courts in Illinois, especially those in less populated counties, are already facing strains on local resources. Although Medicaid status does not automatically guarantee the appointment of a public defender, it creates a strong presumption of indigency. If individuals lose Medicaid and become justice-involved, one expects to see a rise in the demand for indigent defense. Any such increase only worsens the shortage of public defenders and public defender resources throughout much of Illinois. State’s Attorney Offices will undoubtedly also be strained with increased caseloads. Judges will have more cases and less time to spend on each case to get through their larger dockets.
Research shows a correlation between treatment and adherence to court orders. Many people in pretrial status or on probation in Illinois are either Medicaid recipients or eligible beneficiaries due to their low-income status. Of the actively supervised cases open in the Office of Statewide Pretrial Services, 24.3% reported having no insurance and 33.8% are receiving some form of public assistance. Pretrial clients no longer receiving behavioral health services are more likely to miss court dates and less likely to adhere to pretrial supervision requirements.
Although no state-specific data exists at present, nationally more than a quarter (28%) of adults under community supervision were enrolled in Medicaid between 2015 and 2019. This number is likely higher in Illinois, as Probation and Court Services Departments in our state concentrate on helping probationers apply for Medicaid. Similar to pretrial, experience shows that individuals with behavioral health disorders, who often struggle to understand legal proceedings, can communicate more effectively with their probation officer – and better comply with court orders – if receiving treatment.
Finally, Medicaid-funded services and federal grants support public health and safety initiatives, including problem-solving courts (such as drug courts, mental health courts, and veterans’ courts). These courts work with healthcare and human services to address issues like substance use, mental illness, housing instability, and financial insecurity that contribute to criminal behavior. By providing tailored treatment and supervision plans, they seek to break the cycle of reoffending. Cuts to Medicaid would challenge their capacity and effectiveness.
In sum, many court users rely on Medicaid to maintain their health and stability. The state courts nationally – not just in Illinois – often serve as a last resort when healthcare systems and social supports fail, thereby necessitating legal action to maintain public safety, individual well-being, or the protection of vulnerable populations.
Recognizing this interconnectedness is a practical reality for our courts and court users. Whatever the ultimate outcome on Medicaid funding, justice stakeholders are no doubt watching closely and thinking about how to prepare for these potentially devastating impacts.