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Inmates and Medicaid

Other states are doing what Texas has declined to do.

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Being arrested in Chicago for, say, drug possession or assault gets you sent to the Cook County Jail to be fingerprinted, photographed and X-rayed. You’ll also get help applying for health insurance.

At least six states and counties from Maryland to Oregon’s Multnomah are getting inmates coverage under Obamacare and its expansion of Medicaid, the federal and state health-care program for the poor. The fledgling movement would shift to the federal government some of the more than $6.5 billion in annual state costs for treating prisoners. Proponents say it also will make recidivism rarer, because inmates released with coverage are more likely to get treatment for mental illness, substance abuse and other conditions that can lead them to crime.

“When someone gets discharged from the jail and they don’t have insurance and they don’t have a plan, we can pretty much set our watch to when we’re going see them again,” said Ben Breit, a spokesman for the Cook County Sheriff’s Office.

The still-small programs could reach a vast population: At the end of 2012, almost 7 million people in the U.S. were on parole, probation, in prison or locked up in jail, according to the federal Bureau of Justice Statistics. About 13 million people are booked into county jails each year, according to the Washington-based National Association of Counties.

[…]

Medicaid expansion also enables more prisoners to have coverage when they are released. States that don’t expand it can help inmates get subsidized coverage in the insurance exchanges created under the law when they’re released.

Counties in about half the states are responsible for some level of indigent care at hospitals, so getting inmates enrolled can reduce costs, said Paul Beddoe, deputy legislative director for the National Association of Counties.

Cook County has been operating a pilot project to enroll prisoners in Medicaid since April under a federal waiver, while states including Connecticut, Illinois and Maryland and counties such as Multnomah, which includes Portland, have helped hundreds of prisoners apply for coverage under the Affordable Care Act since it took effect Jan. 1. California, Ohio, San Francisco and other jurisdictions are starting programs or considering them.

About 90 percent of inmates are uninsured, and many have never had treatment for their illness, Osher said. They have disproportionate rates of communicable and chronic diseases and behavioral disorders, he said. About 488,000 people in U.S. prisons and jails suffer from a mental illness, according to the National Alliance on Mental Illness in Arlington, Virginia.

[…]

The Ohio Department of Rehabilitation and Correction, which plans to start enrolling inmates during the next two months, expects that it will save $18 million a year on hospitalization alone, said Stu Hudson, managing director of health care and fiscal operations.

Ex-prisoners who have insurance will be more likely to get treatment that would help them avoid committing crimes that got them locked up in the first place, Hudson said.

“They’re provided good continuum of care from incarceration through their release into the community and onward,” Hudson said by phone.

We’ve discussed this before. Putting aside the considerable cost savings to the state, the potential impact on the many people that regularly intersect with the criminal justice system who have treatable mental illnesses could be huge. We could save a bunch more money just from the reduced rate of recidivism. There’s really no downside to this. Unfortunately, without a change in state leadership, there’s also no chance of it happening. I don’t really care about the day to day vicissitudes of the Governor’s race. This sort of thing is the prize I keep my eyes on.

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One Comment

  1. Katy Anders says:

    The ACA is starting to get the states thinking about how they can benefit, and it’s kind of cool.

    Even in Texas, the state is running a pilot program to see whether they should switch its AIDS Drug Assistance Program into an insurance program. Turns out, its probably cheaper to the state to insure eligible people through the exchange than it is to buy all of those AIDS drugs!

    This could turn out okay after all…

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