Improved Medicaid Access for Released Prisoners Reduces Recidivism

Under the Affordable Care Act, more than 112,000 people released from incarceration have been eligible to receive health care coverage, however, with Medicaid expansion thousands more can qualify as well.

Researchers at John Hopkins Bloomberg School of Public Health conducted a study published in Health Affairs that suggests Medicaid enrollment process programs should be expanded to reach more jurisdictions. This would allow for thousands more people who were previously in jail to access health care.

This expansion could help improve not only health and well-being, but also help reduce the number of people who relapse into criminal activity.

Currently, there are only 30 states and the District of Columbia with expanded Medicaid eligibility. Furthermore, most of the jurisdictions in the 30 states do not have programs that are designed to enroll individuals released from prison.

A study conducted in 2007 published in the New England Journal of Medicine found that the initial days and weeks after a prisoner is released can be the most dangerous for them.

The results of the study showed that 2 weeks after release, the rate of mortality was 13 times higher for prisoners than the general public, with drug overdoses representing the leading cause of death.

Many released prisoners have substance abuse problems and mental illnesses, according to the study. Researchers say that upon release, when their medication runs out they may end up having minor run-ins with the law that land them back in jail.

"Typically, men who have serious health conditions ranging from schizophrenia to heart disease to diabetes who received medication while in prison or jail are released with as little as a week or 2 supply of medication and no access to a doctor," said study lead Colleen L. Barry, PhD, MPP. "Now, depending on where they live, many are qualifying for health insurance through Medicaid as they leave jail or prison. We found that a handful of innovative programs have been created to enroll people in Medicaid and connect them with medical care upon release."

Prior to the enactment of the Affordable Care Act in 2014, only certain groups of low income people, including pregnant women, children, and disabled, were eligible for Medicaid.

Currently, nearly all low income participants who earned less than 138% of the federal poverty level could qualify for Medicare, including those with an annual income of $16,000 for a single and childless adult, and $33,000 for a family of 4. These guidelines went into effect in 2015, which allowed for more people to qualify for health insurance, including those released from prison.

Researchers included in the study an evaluation of the programs that helped incarcerated people enroll in Medicaid upon their release. The results showed there were only 64 programs established as of January 2015, with just 42 of them keeping data on enrollees.

In these programs, 112,000 individuals were enrolled in Medicaid as of January 2015, with most of these enrollees being male. However, researchers believe it’s likely that the actual number of enrollees far exceeds that figure, since not all programs track enrollment.

Research shows that if released prisoners are given health care and continued medication access, they were more likely to avoid re-arrests. If there were greater focus on providing health care to incarcerated individuals with serious mental illnesses or substance abuse issues after they are released, they would be much more likely to avoid running afoul of the criminal justice system again, according to the study.

For those who serve time in prison or jail, their health benefits are taken away because federal law prohibits them from receiving Medicaid. The only treatment they would receive is from the corrections system.

However, there are some states and counties that suspend prisoner benefits rather than terminating them. Once prisoners are released, the Medicaid is automatically reinstated instead of taking months for new enrollment.

Researchers believe that the community needs to help former inmates get appointments with doctors who take their insurance when they need immediate medical care.

"If this change is going to make a difference, it's not enough to give people insurance," said study co-author Sachini N. Bandara, MS. "You need to facilitate access to health care providers. This is a population that has been largely ignored as they have fallen through the cracks in the system. These new Medicaid eligibility requirements are a huge opportunity to make a real difference in the lives of poor men."