Last month we looked at some of the new opportunities for services to the “justice-involved consumers” – see A New Opportunity To Serve Justice-Involved Consumers and The ROI Of Recidivism Prevention. This might` turn out to be a large group as “contact with the criminal justice system” could describe up to 30% of people in the Medicaid expansion population, according to recent federal data (see Federal Estimates Indicate Former Inmates & Detainees Will Constitute About 30% Of People In The Medicaid Expansion Population).
Historically, most adults involved in the criminal justice system did not have access to Medicaid benefits, as most childless adults did not qualify for coverage. However, the Medicaid expansion provision of the health care reform legislation changes that fact. It is estimated that up to seven million ex-offenders could potentially qualify for Medicaid as part of the expansion population – and a streamlined eligibility process while incarcerated enables newly released prisoners to gain access more easily, and makes them eligible for services as soon as they are released back into the community.
Just as the Medicaid expansion is being implemented differently from state to state, newly released prisoners’ access to coverage will vary as well. There is no “auto-enrollment” for this population, or even specific language in the PPACA that changes state and county responsibility to provide medical care to incarcerated individuals.
Newly released prisoners have access to Medicaid benefits through two different paths, depending on their state:
- In Medicaid expansion states, many newly released prisoners will become part of the expansion population (childless adults making under 138% of the federal poverty level), and qualify for Medicaid benefits when they would not have before. Some counties in these states are using the prison system as a touch point to enroll newly eligible consumers in the Medicaid program (see Medicaid Expansion Seen Covering Nearly All State Prisoners).
- In states that did not expand Medicaid, prisoners must continue to meet their state’s eligibility requirements (household size and income, or other factors including pregnancy, family situation, and disability) to be eligible upon release. This group has always been eligible if they meet the requirements; however, few newly released prisoners do (see Medicaid for prisoners: States missing out on millions).
Under both of these options, newly released prisoners are free to apply for Medicaid coverage at any time, pursuant to their state’s process. There is no limited enrollment period for Medicaid (see Getting coverage outside open enrollment).
Many states have seized the Medicaid expansion opportunity, and are looking for ways to help newly released prisoners to enroll in Medicaid. An example of this developing scenario we are tracking here at OPEN MINDS is in Illinois – last month, the state Medicaid agency, the Department of Healthcare and Family Services (HFS) began permitting inmates likely to qualify for Medicaid to apply any time before release. And, the Cook County Jail is now enrolling eligible inmates as part of the intake process after they are arrested (see More Than 25% Of Inmates At The Cook County, Illinois Jail Have Mental Health Disorders). Similar programs, in which states are actively helping prisoners to enroll in Medicaid upon release are taking place in California, Connecticut, Ohio, and Maryland.
Where is all this heading? As with much of health care reform, we are still feeling the initial effect. Stay tuned as we continue to monitor the roll out of the Medicaid expansion, and how states are using health care reform to help gain coverage for different segments of their population.