Opportunities for Enrolling Justice-Involved Individuals in Medicaid

Health insurance options now available through the Affordable Care Act (ACA) offer new opportunities to enroll individuals involved in the criminal justice system into coverage. In states that have expanded Medicaid, many newly eligible will be young, low-income males, some with involvement with the criminal justice system. Justice-involved individuals especially could benefit from coverage as they often have rates of mental illness, substance abuse, and other health conditions as much as seven times higher than the general population. Additionally, because approximately 70 to 90 percent of the 10 million individuals released each year from prisons or jails lack health insurance, coverage can enable these individuals to receive appropriate treatment services, potentially contributing to lower recidivism rates.
The ACA did not change existing federal law, which prohibits using federal Medicaid funds to pay for medical care provided to incarcerated individuals unless the inmate is admitted to an inpatient facility for at least 24 hours. Despite these Medicaid payment restrictions, Medicaid-eligible individuals who become incarcerated retain their eligibility for the program. While some states suspend Medicaid enrollment upon incarceration, the majority simply terminate it. This results in individuals having to reapply for Medicaid after their release from a correctional facility, and the process of regaining benefits can be lengthy and delay access to care. But enrollment processes can begin prior to an inmate’s release as part of any discharge planning services or at other points during an individual’s involvement with the correctional system, and a number of states are already implementing efforts to do this. For example:

• Illinois began planning efforts soon after passage of the ACA to leverage the new health coverage options for justice-involved individuals. In 2011, the Governor’s Office established the Workgroup on Justice Populations (WJP) and convened multiple interagency and regional meetings among state and local health and human services agencies, correctional authorities, and key advocate groups.  These meetings helped identify collaborative strategies to enroll individuals involved in the criminal justice system into health coverage. To help put these ideas into practice, the WJP developed a resource guide designed for criminal justice personnel and community partners. The guide provides background information about relevant ACA policies along with detailed process maps outlining steps to implement enrollment procedures in correctional facilities and other settings. Cook County, IL has moved forward with enrolling offenders at intake, and as of January 2014 over 12,000 applications had been initiated at the county’s jail.

• In Utah, Salt Lake County’s Division of Behavioral Health Services reached out to state Medicaid officials prior to 2014 to explore options for enrolling eligible individuals in the criminal justice system into coverage. Presently, some justice-involved individuals leaving Salt Lake County’s jail who are currently eligible for Medicaid are being enrolled as part of their community reentry services. The county directly employs a small number of state Medicaid eligibility determination workers by paying the Medicaid administrative match rate to the state. At the state level, one of the prisons has implemented procedures to begin the Medicaid eligibility determination process 30 days prior to an inmate’s release. Planning efforts led by the county’s Criminal Justice Advisory Council to broaden these initiatives are outlined in the county’s FY2015 Area Plan for Behavioral Health Services. These plans included convening a training session to assist state and local criminal justice stakeholders in developing policy related to enrolling justice-involved individuals. In December 2014, Utah’s governor released a Medicaid expansion proposal, but the plan needs both state legislative and federal approval. As of early January 2015 the state has not officially implemented expansion, but if the state moves forward even more justice-involved individuals would become eligible for Medicaid.

• In Washington, the Health Care Authority (HCA) has created a memorandum of understanding (MOU) to establish agreements between HCA and correctional facilities that outline processes for enrolling incarcerated individuals in Medicaid prior to their release. In jails that have established these arrangements, selected staff members are being trained to become certified application assisters through the state’s marketplace.

California, North Carolina, Ohio, and Rhode Island are just some of the other states that have also established these types of enrollment processes within their correctional systems. To support these efforts, the Centers for Medicare and Medicaid Services created a fact sheet on the ways that correctional systems can help connect justice-involved individuals to coverage. Because there are inherent challenges such as staff capacity issues, states are developing new, broad-based partnerships among correctional personnel, health and human services agencies, organizations providing ACA consumer assistance, and other state and local officials. For example in Cuyahoga County, OH, one of the navigator entities, the Cuyahoga Health Access Partnership, is working closely with the county jail to enroll inmates.
Has your state considered or established processes to enroll individuals involved in the criminal justice system into health coverage? Through support from the Jacob & Valeria Langeloth Foundation, in the coming months NASHP will develop an online toolkit and host a webinar to help state officials learn about promising practices in states successfully implementing these types of initiatives. Share your state’s efforts in a comment below or on our discussion page on inmates.