National study finds that prison systems are increasingly aiding prisoners’ enrollment in Medicaid, both during incarceration and in preparation of
As Medicaid eligibility expands under the Affordable Care Act, prison systems are increasingly supporting prisoners’ enrollment in Medicaid as a way to
help 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, MD, MPH, 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. “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.
There is a possibility that there will be decreased recidivism as people get treatment for their mental illness and addiction.”
As the basis for their study, researchers surveyed state prison system administrators from December 2011 through August of 2012. Administrators were asked
about Medicaid enrollment practices within their prison system with a focus on four areas -- was Medicaid terminated or suspended when an individual was
first incarcerated; was assistance provided to help those prisoners being released reenroll in Medicaid; the challenges related to reenrolling; and
screening previously non-enrolled prisoners for potential Medicaid eligibility.
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.”
The survey also showed that most state prison systems had policies in place that identified prisoners who were potentially eligible for Medicaid, but not
enrolled previously, and provided assistance with the Medicaid applications. In 15 state prison systems, Medicaid applications were submitted so that
benefits could be used during incarceration to pay for inpatient care received in the community.
Researchers noted that with several states planning to expand Medicaid eligibility in 2014, the number of released prisoners with access to routine care
could increase dramatically. Medicaid expansion could also increase financial incentives for state prison systems to provide Medicaid enrollment assistance
to prisoners requiring hospital inpatient care during their incarceration.
They also noted that future research should look at the state prison systems that successfully help prisoners enroll in Medicaid to determine the
characteristics of those programs and the financial implications of enrollment for prisons and the Medicaid program.
Study co-authors include David L. Rosen, Institute for Global Health & Infectious Diseases, University of North Carolina, Chapel Hill; Dora M. Dumont
and Bradley W. Brockmann, Center for Prisoner Health and Human Rights, Miriam Hospital, Providence; Andrew M. Cislo, Center for Public Health and Healthy
Policy, University of Connecticut, East Hartford; Amy Traver, Human Biology Program, Brown University.
Funding for this study was received from the National Institute for Drug Abuse.
The principal affiliation of Josiah D. Rich, MD, MPH is The Miriam Hospital (a member hospital of the Lifespan health system in Rhode Island). Rich
is also a professor of medicine and epidemiology at The Warren Alpert Medical School of Brown University.