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Extending Medicaid to Former Prisoners

Posted on Dec 27, 2013 by Ailee Slater ()  | Tags: Medicaid, ACA, Obamacare, expanding Medicaid, prisoners, ex-prisoners, former inmates, former prisoners, mental health care prisoners

Crime is expensive; not just to the victims but also to the society in which they and the criminal live. Police cost money, state-appointed attorneys cost money,  and prisons cost money – a lot of money. One of the best ways to prevent criminals from re-offending is to fund programs that help former inmate adjust to life outside of prison – in terms of housing, employment, and health care. 

Thanks to the Affordable Care Act, in 2014 more former prisoners and detainees will be eligible for health care coverage. That’s because starting on January 1st, 2014, the government-funded insurance program Medicaid will include all adults earning $15,000 or less per year, in states that voted to expand their Medicaid programs. This means that across more than half of the states in the U.S., including California, Rhode Island and New Mexico, 9 million people will join Medicaid, and around 35 percent of those new Medicaid users will be former inmates. 

Advocates for former offenders have expressed their support for bringing more released offenders under the Medicaid umbrella. Funded by the states and the federal government, Medicaid provides health care coverage to low-income families, children and pregnant women. Through Medicaid, qualified users can receive inpatient and outpatient care, dental visits, mental health services and more. Advocates say that, for former inmates, the provision of such health care will help offenders integrate into society and lower the risk of re-offense. 

However, not everyone agrees that Medicaid dollars should go toward the health of former prisoners. In October, two Republican congressmen issued a letter to the U.S. Government Accountability Office for a review of the costs associated with expanding Medicaid and allowing former inmate coverage. The letter, written by Congressmen Fred Upton and Joe Pitts, indicated concerns about Medicaid’s already stretched budget; wondering if expansion to cover those who have broken the law might mean fewer services for those who abide by the law. 

At least one democrat has responded to the letter by saying that it reveals not authentic concerns from the GOP, but rather another attempt to undermine President Obama’s Affordable Care Act. After all, the Republican congressmen’s letter expresses concern about Medicaid dollars going to prisoners, when in reality Medicaid law does not allow its funds to go toward health care for incarcerated or convicted and detained offenders. 

But despite that Medicaid legislation prohibiting funds for prisoners, there is another way that states can divert Medicaid money to help cover the cost of inmate health care. If a Medicaid-eligible woman goes to prison and then experiences a serious medical need, she will be taken out of the prison system and given specialized care. According to a ruling in 1997, if that inmate is out of prison for more than 24 hours, she is eligible to receive her Medicaid coverage once more, or at least part of it. This ruling has proven useful to states scrambling to pay for prisoners’ medical care, but also provoked debate amongst citizens and politicians who, like Congressmen Upton and Pitts, are suspicious of a Medicare budget being made even tighter by funding criminals’ health care. 

Michigan is one state that has not only extended Medicaid funds to support specialized treatment for inmates, but has also opted to expand its Medicaid program in 2014. Advocates of Michigan’s prisoner and former prisoner health programs point to the positive statistics that have accompanied health care funding for offenders: a drop in statewide prison population by nearly 10,000 during the past five years, and a big reduction in re-entry rates of prisoners with recorded mental health issues. 

Keeping prisoners healthy once their sentence is over has always been a concern of inmate advocates. In a 2013 report by the Urban Institute entitled Cost Savings in Inmate Health Care, researchers explain that inmates are often more healthy upon leaving prison than they were upon arrival. If a program such as Medicaid can help former inmates to continue receiving medical care, that could mean money saved for hospitals and public health in the long run. For example, an offender who comes to prison with mismanaged diabetes may also experience glaucoma and nerve damage in the feet. With proper medication  and dietary habits, however, diabetes can be controlled and further, more severe complications avoided. If that medication and dietary assistance cannot be continued outside of prison, however, the patient could end up in the E.R. with kidney failure – a much more expensive ailment to treat. 

Keeping inmates healthy once they leave prison is also important to public health because of transmittable diseases such as AIDS. Inside prison, an inmate will receive medication to fight the illness and boost the immune system, as well as counseling about how to live with the disease and avoid spreading it to others. Maintaining these good health practices once outside of prison is key to keeping that ex-offender healthy for as long as possible, and helping him or her to communicate positively to others about that HIV positive status. 

Mental disorders are another reason that many laud the idea of more Medicaid funding for ex-inmate health care. In an October interview with Fox News, director Brad Brockmann of the Center for Prisoner Health and Human Rights at Brown University estimated that more than half of all people inside the prison system are suffering from some form of mental health disorder. Brockmann noted that extending Medicaid to current or ex-inmates saves states from having to cover this medical burden alone; good mental health care can also keep ex-prisoners from reoffending, which will both save money and lower crime rates.


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