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States Use Medicaid Expansion under Obamacare to Lower Prison Healthcare Costs, Reduce Recidivism

by Joe Watson

Despite constant backlash against the Affordable Care Acts (ACA), states across the country are depending on the federal legislation to not only reduce healthcare costs for prisoners and parolees, but also to help lower recidivism.

Passage of the ACA – better known as Obamacare – included an expansion of Medicaid, the jointly funded state-federal health insurance program for low-income residents, which states now have the option of extending to anyone who earns up to 138% of the federal poverty level, or about $15,800 for an individual and $32,500 for a family of four.

About 35% of the people who will qualify in states electing to expand Medicaid coverage, according to the U.S. Department of Justice, will be former prisoners and detainees. And many of those states – including Ohio, Michigan, Illinois, Maryland, Minnesota and Oregon – have begun enrolling offenders even before their release.

“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,” said Dr. Josiah Rich, director of the Providence, R.I. – based Center for Prisoner Health and Human Rights. “There is a possibility that there will be decreased recidivism as people get treatment for their mental illness and addiction.”

Of the approximately 750,000 people released from prisons in the U.S. annually, 40% of the men and 60% of the women released have mental health, substance abuse or physical health problem, according to 2012 report from the National Governors Association that studied the potential impact of Medicaid expansion.

Further studies have shown that providing former prisoners with immediate access to healthcare upon release has a direct impact on reducing recidivism. A 2007, study, for example, of two counties in Washington and Florida linked ex-prisoners’ access to Medicaid with 16% drop in recidivism.

Consequently, Illinois’ Department of Corrections is implementing automatic Medicaid enrollment in a system wide technology upgrade. Hamilton County, Ohio approved in early 2014 hiring a sole employee dedicated to enrolling jail prisoners into Medicaid.

And, anticipating Medicaid expansion under Obamacare, Maryland added eight nurses to its prison healthcare contract in 2012 specializing in release/re-entry planning. Another give coordinators with the state’s online healthcare marketplace are expected to help make doctors’ appointments for newly-released prisoners and follow up with parolees, efforts other states are also reportedly stepping up.

“In general, states haven’t been as aggressive about doing that in part because this is a relatively new phenomenon in which prison administrators see their responsibilities extend beyond the prison walls,” said Fred Osher, director of health services and systems policy at the Council of State Governments Justice Center. “There’s a recognition that re-entry is the responsibility of the entire community.”

Although the Medicaid law, passed in 1965, denies federal matching funds for approximately 1.5 million people held in prisons nationwide and another 750,000 jail prisoners, the federal  matching funds for approximately 1.5 million people held in prisons nationwide and another 750,000 jail prisoners, the federal government has allowed matching Medicaid funds to pay for specialized hospital care for 24 hours or more outside the prison system for those enrolled in or eligible for Medicaid before they were incarcerated since 1997.

As a result, more states are providing prisoners with the necessary healthcare they require on the federal government’s tab.

In fiscal year 2013, Michigan’s Department of Corrections received $8 million in federal matching funds for providing prisoners with specialized care. The state could receive another $20 million in 2014. And by enrolling prisoners approaching release into Medicaid under Obamacare, Michigan could save $250 million in the ACA’s first decade of implementation.

“Coverage is just one aspect of healthcare. You also need access, and ou need to want to access that care,” said Amy Rohling McGee, president of the Health Policy Institute of Ohio, where enrolling prisoners in Medicaid could save the state $273 million by 2012. “There are a lot of intercepting parts that have to do with lifestyle choices.”

Such variables, McGee said, make it difficult to predict how dramatically Obamacare will help to reduce recidivism and lower the costs of prison healthcare.

“One can imagine that if people get coverage and are able to access care for their conditions, it will prevent costs down the road, but it’s not something you would expect to see the results of even in the next five to ten years,” she said. “It will be further out than that before we know.”

Sources:;; The Washington Post;