When individuals are incarcerated, most states terminate Medicaid benefits. Problems arise, however, as prisoners are about to be released. Administrative delays and state regulations often result in a gap of several weeks before coverage resumes — a critical period of time for former inmates struggling with mental illness, addiction or a host of high-level chronic conditions. Just a one-month stay in jail could result in many months without health care upon release, during which time former inmates must rely on much more expensive emergency room treatment or simply not receive needed care.
The sooner coverage begins or resumes — preferably on day 1 of release — the sooner at-risk former inmates can receive services that will provide stability as they re-enter society. Such an approach offers treatment immediately rather than after conditions deteriorate, improving overall health and reducing cost.
According to Bureau of Justice statistics, an estimated 11.7 million people were admitted or released just from local jails between July 2012 and June 2013. Average jail incarcerations are less than 40 days and involve frequent movement between jails and the community. Because of the length of time it takes for Medicaid reinstatement, a percentage of this population will churn through emergency rooms, safety-net mental health systems and community-based social support organizations. Many will receive no care at all, their conditions festering and worsening until the cost of treatment is much higher and outcomes significantly poorer. Suspended, rather than terminated, Medicaid benefits may be the answer.
Expanded Medicaid eligibility under the ACA offers states a unique opportunity for criminal justice and health agencies to connect and address the physical and behavioral health needs of former inmates. High federal matching rates may be leveraged to create specialized programs for this group.
By developing and implementing creative approaches to health care for the jail involved, states can improve outcomes and reduce recidivism, strengthen public safety and more prudently spend taxpayer dollars.
To learn more about new opportunities for states to address the health care needs of the recently released, jail-involved population, read “New tools to improve health of jail-involved population.”
About the author
David Hanig is a vice president at the Lewin Group, a health and human services research and policy group. He has more than 30 years of experience in health care policy and operations. As senior policy analyst to the Health and Long-Term Care Committee of the Washington state senate, Hanig worked on bills implementing the Affordable Care Act and establishing the state’s health benefit exchange and health information exchange. Hanig worked for more than 20 years for the Washington state Department of Social and Health Services — primarily at the state Medicaid agency. He helped oversee implementation of Medicaid managed care and the expansion of programs, including CHIP. Hanig supervised the Eligibility Policy Office, which developed Medicaid policies and procedures for the state’s community services offices and developed an award-winning Medicaid outreach program that enrolled an additional 130,000 children in two years.