Enrolling inmates in Medicaid makes sense for jail and prison systems | Behavioral Healthcare Executive Skip to content Skip to navigation

Enrolling inmates in Medicaid makes sense for jail and prison systems

February 17, 2014
by Alison Knopf, Contributing Writer
| Reprints
By increasing access to healthcare, states and counties expect lower costs, lower recidivism rates
Medicaid doesn’t cover medical costs for people who are incarcerated – unless they are admitted to inpatient medical treatment, off-site, for 24 hours or more. This is significant because the corrections system is responsible for paying the cost of an inmate’s care, a cost that can become financially devastating to the budget, especiallyfor a small jail. As a result, states that have expanded Medicaid – to include, for example, childless adults (mainly men) – are now looking at Obamacare as a way to manage these costs. 
There are two main benefits of enrolling inmates in Medicaid: saving costs for corrections systems while inmates serve their sentences, and reducing rates of recidivism for ex-inmates with mental illness or substance use disorders, since these individuals would would finally be able to access treatment. Today, according to a Bloomberg report, corrections systems spend more than $6.5 billion annually for inmate medical and behavioral care. Although only 25 states have expanded Medicaid so far, those who did are finding that many of those who are most likely to end up in jail or prison, due to untreated behavioral health problems, qualify for it. If, for example, a newly-enrolled inmate needs a long-term care in a off-site psychiatric facility (or long-term medical care in a hospital), the jail or prison would be able to pass on those costs to Medicaid, covered by the federal government under the Affordable Care Act 100% for the first three years. 
In states that did not expand Medicaid, additional help for treating some inmates is a longer-run process that can begin when an inmate is released. These states can help inmates get enrolled in private insurance through the “affordable insurance marketplaces, the state-based insurance exchanges that are operated by the federal government in states that refused to create their own marketplaces. Again, helping former inmates to access affordable health insurance will help some get the mental health or SUD treatment needed to begin recovery and avoid recidivism.
Because 9 out of 10 inmates have no insurance, and few of these have any means to afford it, few inmates have had access to medical care. Given the significant numbers of inmates with untreated mental illness or addictions, some state and local governments see a win-win in enrolling inmates in Medicaid as soon as they enter a jail or prison system, and have obtained Medicaid waivers to operate such enrollment programs.
In Cook County, Illinois, this means that right after individuals are booked, they complete a Medicaid application with the help of Treatment Alternatives for Safe Communities, a Chicago-based advocacy organization.  To date, 18,000 inmates have been enrolled. 
The jail in Multnomah County, Oregon has enrolled about 800 inmates in the Medicaid program. Its enrollment effort concentrates on enrolling inmates with mental health, addictions, or other chronic medical problems because they have the highest treatment costs.
While some critics say it is the responsibility of local government to pick up the costs for inmates, others say that not only does the concept of enrolling inmates in health insurance make financial sense, but because it can reduce recidivism it enhances public safety as a result.