In 2017, 2.3 million people were incarcerated in our nation’s prisons and jails — a staggering 500% increase over the last 40 years. Those who are incarcerated also represent some of the most high-need, high-cost individuals requiring medical care. A high proportion of those incarcerated are Medicaid beneficiaries or are Medicaid-eligible when they enter custody.
Profile of jail populations:
- 64% suffer from mental illness
- 68% struggle with substance abuse
- 40% suffer from a chronic health condition
- 40% depend on prescription medication
- Sicker than the general population: 4-9x higher rate of active tuberculosis (TB), HIV infection, and Hepatitis C
What happens to Medicaid beneficiaries once they become incarcerated?
Incarcerated individuals are unable to access their federal Medicaid benefits from the moment they are booked into jail, in accordance with a federal law known as the Medicaid Inmate Exclusion Policy (MIEP). Each state determines how best to comply with MIEP, under the common goal of identifying and avoiding improper claims made by incarcerated (i.e., ineligible) individuals, while encouraging continuity of beneficiaries’ medical care upon release:
- 16 states + D.C. suspend/reclassify Medicaid coverage for duration of incarceration
- 15 states suspend/reclassify Medicaid for specified period of time (e.g., 30 days or one year)
- 19 states terminate Medicaid altogether
The theory behind MIEP is sound, but, like anything, putting it into practice can prove difficult, especially when you are considering such a large population. A common goal and need within the Medicaid community is to best ensure that incarcerated beneficiaries receive seamless continuity of care−from the time they are booked, throughout their incarceration, and upon release− and that the appropriate parties finance this care at each of these junctures.
Once suspension or termination of Medicaid benefits have been processed for the incarcerated, this status can be difficult to “undo” once inmates are released−often resulting in a gap in beneficiaries’ medical and behavioral care regimens. Accessing benefits upon re-entry is especially problematic and can involve months-long re-approval paperwork and bureaucracy, leaving a medically vulnerable population uninsured during this critical time. This gap in coverage is detrimental to patients, health care systems, and the broader community.
Regression in treatment
Medicaid coverage gaps exacerbate health conditions by creating interruptions in care. Chronic diseases can go unchecked and/or under-treated. The recently incarcerated also end up relying on emergency rooms for medical care, shifting cost to hospitals and city or state agencies.
Public health hazard
Over 95% of local jail inmates eventually return to their communities, bringing their often-compromised health conditions with them.
Increased rates of recidivism
Medicaid can help reduce rates of recidivism for those with serious mental illness by preventing escalation that can lead to incarceration.
Higher rates of emergency room use, death, and suicide
The risk of dying for former inmates sharply increases in the two weeks immediately following release, driven by drug overdose, cardiovascular disease, liver disease, HIV-related conditions, and suicide.
What can be done?
Increase continuity of care through greater integration and sharing of knowledge between justice agencies, state Medicaid agencies, and healthcare providers. Knowing, in real-time, when inmates are booked into custody, released from custody, or have been incarcerated for a certain “length of stay” can prevent gaps in coverage or care.
Be proactive and plan for re-entry. Assigned care coordinators and discharge planners can help soon-to-be released inmates by developing re-entry care plans in conjunction with health care providers, explaining critical re-enrollment paperwork, confirming medications, and scheduling appointments. Chronic conditions can be managed and monitored from day of release, preventing costly ER visits, hospital stays, and potential re-entry into the prison system.