5 Medicaid Trends Impacting Continuity of Care for Incarcerated Beneficiaries

As the state of Medicaid evolves, certain industry trends emerge. Detrimental effects of such trends, if not addressed properly, can include disruptions in continuity of care for vulnerable populations (e.g., incarcerated Medicaid beneficiaries), as well as increased societal costs.

Trend 1: Personal responsibility reforms  

The Medicaid Reform and Personal Responsibility Act of 2017 requires state Medicaid programs to establish work requirements for beneficiaries who are able to work and have no dependents. This new requirement will directly affect those Medicaid-eligible individuals moving in and out of incarceration. Many of these individuals struggle to maintain employment due to criminal records, probation requirements, and other limitations.

Medicaid beneficiaries across the United States must work a minimum of 20 hours per week. Beneficiaries can also perform a work equivalent, such as volunteering or receiving work training. For various reasons, approximately 9.8 million Medicaid enrollees do not/cannot work. One third of non-working Medicaid-eligible individuals may no longer receive care as they report that illness prevents them from working. However, they do not qualify for Social Security disability insurance. Another 30% do not work and may lose eligibility because their presence in the home is necessary. For example, they may have to care for young children or elderly relatives. 15% of Medicaid enrollees are going to school. 9% are retired. And only 6% are unable to find work.

Trend 2: State-by-state variability will continue to impact quality and continuity of care

Medicaid implementation variabilities by state will continue in the future, as states accept or reject the Affordable Care Act (“ACA”) expansion, roll back eligibility requirement levels, and seek waivers or adjustments to personal responsibility reforms.

Thirty-seven states have expanded coverage under the ACA. The ACA remains vulnerable to changes or complete dissolution by lawmakers. Income eligibility may be stricter in some states than others, and those who relocate may find their continuity of care disrupted by new requirements or expansion differences in their new state. Work requirements vary by state, with some offering waivers and others not.

Trend 3: Increased focus on health-related social factors

As states seek new ways to save money or increase the reach of health care dollars, they are focused on addressing social factors that impact health such as poverty, crime, and the economy. Typical social factors include income and other economic challenges, area of residence, education, nutrition and community. Such social factors correlate strongly with incarceration and recidivism rates.

States are seeking new opportunities to support beneficiaries by directing them to community-based services via their health care providers, streamlining care, and expanding care to formerly disenfranchised individuals. States, such as Washington, California, and Michigan, are already tackling social challenges in innovative ways, such as leveraging waivers to expand funding. Addressing social factors will create full-spectrum, continuous care that reduces overall spending and greatly advances societal outcomes.

Trend 4: Increased focus on behavioral health reform  

More than 68 million Americans struggled with psychiatric issues or drug addiction in 2017. Half of individuals with behavioral health challenges do not receive the services they need, and many more receive insufficient care.

Behavioral health has become a critical focus for Medicaid due to its high expense and dramatic impact on all other areas of health. Improving mental health support for incarcerated beneficiaries post-release decreases overall expenses for their care, reduces recidivism, and improves outcomes for these individuals, as well as the broader community.

Trend 5: Medicaid’s role in combating the opioid epidemic will expand

Opioid addiction is a leading concern for both health care and government agencies, with deaths increasing each year and significant societal issues caused by abuse and addiction. Over 1.7 million people in the United States suffer from opioid addiction, and more than 115 people die each day from opioid overdose. Overdose deaths are 4x more prevalent today than they were in 2001.

Currently, only half of the states have provided easier access to drugs that reverse the effects of opioid overdoses. With deaths increasing each year and the societal issues caused by abuse and addiction, Medicaid programs will need to increase their intervention and treatment strategies across the United States and work to include more under-served populations, expand treatment strategies, and increase spending.

Access to comprehensive, timely incarceration information can help Medicaid agencies proactively counter the potentially devastating effects that such trends can have on individuals and the broader society.



Appriss Safety’s Incarceration Intelligence solution allows agencies to monitor their active beneficiary lists in real time, receiving an automated alert when a beneficiary is booked into or released from custody.

This information allows stakeholders (incarceration facilities, health care facilities, caregivers, and Medicaid agencies) to more seamlessly communicate and plan for beneficiaries’ continued care, provide necessary resources, and inform the appropriate treatment strategies.

Upon release, Medicaid-eligible individuals (and those that care for them) are presented their specific options, helping break down the barriers that deter these individuals from seeking necessary care.

Incarceration Intelligence eases agencies’ administrative burden, enabling the establishment of internal process efficiencies—while ensuring patient care remains uninterrupted and that it is financed by the appropriate parties.

Benefits for State Agencies

Updating Beneficiary Status

Medicaid payments can be suspended or terminated when beneficiaries become incarcerated, and reinstated upon release–preventing overpayments and eliminating lapses in care.

Improve Continuity of Care

Seamless continuity of care supports and informs beneficiaries’ healthcare providers and helps beneficiaries suffering from behavioral health issues avoid future incarceration.

Save Taxpayer Dollars

Beneficiaries who have been released from incarceration, and whose coverage has been reinstated, are less likely to rely on costly emergency care, easing the financial burden on taxpayers.

Ray Atencio, Partner Development Representation


Ray Atencio, Partner Development Representation

Ray Atencio helps government agencies achieve program integrity through access to criminal justice data. His areas of focus at Appriss include UI, Medicaid, child support, and SNAP / TANF. Ray began his career in public safety in 1990 as a law enforcement officer with the Albuquerque Police Department. Ray worked in a myriad of capacities over his two decades with the APD, notably, serving as a crisis negotiator, a Bomb Squad Sergeant, and supervising over the Information Technology Unit. Retiring from law enforcement in 2010, Ray began the second leg of his career in public safety software sales. Ray’s passion for utilizing technology to benefit community safety led him to Appriss in 2014, inspired by the company’s mission of “Knowledge for Good.” Ray is motivated by the integrity of Appriss’ solutions, knowing that through them, he can help keep communities all across the nation safe and informed. Ray is a life-long resident of Albuquerque, New Mexico. Ray enjoys spending time with his wife, children, and grandchildren. Ray is a 1988 graduate of the University of New Mexico, where he earned a Bachelor of Arts in Criminal Justice.

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