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Some states ramping up efforts to enroll inmates in Medicaid

by Grant Gregory ~ July/August 2015 ~ Stateline Midwest »
As Indiana Rep. Charlie Brown sees it, a new plan to enroll eligible inmates in Medicaid has the chance to be a win-win for his state and its taxpayers: Reduce recidivism by giving more people the health services they need, and cut long-term costs in the criminal justice system.
Signed into law earlier this year, HB 1269 (of which Brown was a co-sponsor) received overwhelming legislative approval, and it is part of a broader trend that has states looking for new ways to improve outcomes for state and local inmates, who have disproportionately high rates of mental illness and substance abuse.
In Indiana, for example, an estimated 17 percent of the general prison population has a mental health diagnosis, and up to 85 percent of this group has a history of significant substance abuse. A bill passed in Illinois earlier this year has a similar objective to the Indiana law: ensuring that inmates receive the treatment they need upon their return to the community.
HB 3270 was still awaiting the governor’s signature as of July, but Illinois’ largest local jail system, Cook County, has already been enrolling uninsured, eligible individuals in Medicaid. Medicaid eligibility among formerly incarcerated people has jumped in states that have chosen to expand the health insurance program under the Affordable Care Act. (Indiana and Illinois are among the expansion states, along with Iowa, Michigan, Minnesota, North Dakota and Ohio in the Midwest.)
That is because states’ expanded Medicaid populations can now include all adults with incomes up to 133 percent of the federal poverty level; in contrast, the health program previously only applied to certain low-income individuals (the elderly, children, parents, pregnant women and people with disabilities).
In Illinois, an estimated 95 percent of inmates would qualify for Medicaid upon release.
For individuals still incarcerated, the use of Medicaid is greatly restricted by a provision in federal law known as the “prisoner’s exemption.” Instead, the cost of care is borne by state prison systems or local jails. But even with this provision, there is a new opportunity for states and their local governments to defray some of the costs of inmate care. Under federal rules, if a prisoner spends more than 24 hours in a hospital or other health setting, the cost of the care can be charged to Medicaid.
And with eligibility rising in expansion states, the potential cost savings for prisons systems have become greater.
“States have an unprecedented opportunity to improve health outcomes, maintain continuity of care and reduce their health care costs for the criminal justice population,” according to a 2013 policy brief by The Council of State Governments’ Justice Center.