Saturday, October 18, 2008

Good News on Medicaid, Crime, and Jail Overcrowding

A couple months ago, readers of this blog were surprised and concerned to read that, under state and federal policy, Medicaid benefits are cut off from people shortly after they arrive in our jail (including before any trial takes place--if one ever does).

This not only shifts the cost of medical care to local/county taxpayers, a multi-million dollar cost shift (both for inmate medical care, as well as a cost to our Indigent Care levy for any medical care after they leave the jail since they have no other coverage), it also means that over the course of a year, presumably thousands of people leave the jail without Medicaid benefits they previously received. And the process of reinstatement takes time, if it's ever pursued at all.

For many, this cuts them off the very types of treatment that could help them deal with the underlying cause of their criminal behavior--whether it be a mental illness, or substance abuse. And of course, they may suffer other medical ailments that need attention and treatment. The net effect of all this, of course, is a high rate of recidivism (repeat criminal behavior), and higher costs to county taxpayers.

For all these reasons, I have become a broken record on the need to change this:

1. We have written our federal delegation to request they support proposed legislation that would at least maintain Medicaid benefits until the trial has occurred and found an inmate guilty. This is basic fairness.

2. Here in Hamilton County, we have begun a process of identifying Medicaid-eligible inmates, and beginning the reinstatement process before they leave the jail so they are reinstated as soon as possible after they leave. This has been up and running for several months.

3. Finally, we have reached out to the state--through the County Commissioners Association of Ohio and state legislators like State Sen. Bill Seitz--to request that rather than terminating Medicaid benefits, that they be suspended during incarceration. This means rather than going through the lengthy and complex process, and waiting in line, to reinstate terminated beneftis, Medicaid benefits are automatically reinstated on release, a hugely positive effect. Six other states have already passed legislation to this effect.

HERE'S THE GOOD NEWS: We have recently been informed through the County Commissioners Association that restoring Medicaid Benefits to individuals being released from jail has risen to the attention of Governor Strickland. While there was initial bureaucratic resistance (one excuse was that the computer system could not handle a "suspension" process), the Governor weighed in and is pushing to resolve this issue sooner rather than later.

The goal is that the state will be given 24-hour notice that a Medicaid eligible individual is being released from jail. With such notice, that individual’s Medicaid would be benefits reinstated upon their release.

While it is pretty common sense, this is a critical policy and procedural change that I believe will have a significant impact on reducing crime and the overcrowding of jails and prisons. I'll provide a final update when the new process/policy is put in place once and for all.

Kudos to the Governor for recognizing the importance of this issue.


Paul Komarek said...


It is good to hear that the medicaid re-enrollment processing snafu is finally getting the attention it deserves.

Delaying Medicaid to returning prisoners just increases society's costs. People without coverage end up in hospital emergency rooms -- increasing everybody's health insurance premiums. And if they need treatment to help control their behavior, they have a higher risk of re-offending.

Even if a person returns from jail having learned his lesson, few programs can offer much beyond "a kind word and a waiting list" unless there is some way to pay.


Eli said...

Kudos to you for becoming a broken record on this issue.

A 2007 article found that "having Medicaid at release was associated with a 16% reduction in the average number of subsequent detentions." The researchers tracked approximately 7,000 people in two counties in Washington state and Florida. Other studies point in that direction.

Source: Morrissey JP, Cuddeback GS, Cuellar AE, Steadman HJ. The role of Medicaid enrollment and outpatient service use in jail recidivism among persons with severe mental illness. Psychiatric Services. 2007 Jun;58(6):794-801.

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