Medicaid expansion improves
services for prison population

With Medicaid eligibility expanding under the Affordable Care Act, prison systems are increasingly supporting prisoners’ enrollment in Medicaid as a way to lower prison system costs and improve prisoners’ access to health care upon release. More

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financial services

Medicaid expansion improves
services for prison population

COURTESY MIRIAM HOSPITAL
These are the findings of a nationwide survey of state prison administrators that was led by Josiah D. Rich, director of the Center for Prisoner Health and Human Rights, based at The Miriam Hospital. The study is published online in advance of print in the American Journal of Public Health.
Posted 1/27/14

PROVIDENCE – With Medicaid eligibility expanding under the Affordable Care Act, prison systems are increasingly supporting prisoners’ enrollment in Medicaid as a way to lower prison system costs and improve prisoners’ access to health care upon release.

These are the findings of a nationwide survey of state prison administrators that was led by Josiah D. Rich, director of the Center for Prisoner Health and Human Rights, based at The Miriam Hospital. The study is published online in advance of print in the American Journal of Public Health.

“This study is unique because of the timing with the expansion of Medicaid. We know that an increasing number of prison systems, although far from all, are helping prisoners enroll in Medicaid in preparation for their return to the community,” explained Rich, who is also a professor at Brown Alpert Medical School. “Enrollment improves access to basic health services, including substance use and mental health services, and can in turn benefit the health of the communities and families to which prisoners return.”

Of the 42 state prison systems that responded to the survey, two thirds employed policies of terminating Medicaid coverage when a prisoner was first incarcerated, while 21 percent suspended coverage. And of those systems that either terminated or suspended coverage, more than two thirds of them provided assistance to help prisoners reenroll in Medicaid once they were released. More than one third assessed whether prisoners requiring community inpatient care during their incarceration might be eligible for Medicaid coverage.

In 2000, nearly all states had policies terminating Medicaid enrollment upon incarceration. Researchers found that reinstating Medicaid benefits in suspension states was not automatic and was challenging, similar to the challenges faced in states where benefits were terminated. Researchers did find that in suspension states resumption of benefits generally occurred within a month of release.

“The difficult reality is that terminating Medicaid during incarceration, which is what is occurring in the majority of prison systems today, can be harmful to this population, as well as costly to the general public,” Rich said. “Instead, we should be moving toward using this period of incarceration as an opportunity to reduce expensive post incarceration emergency room and inpatient hospital care.”

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