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.

Sunday, October 12, 2008

What is Proportional Representation?

While a lot of insiders are fiercely debating Issue 8, which is on this November's Cincinnati ballot and would bring "proportional representation" back to Cincinnati City Council elections, my sense is that the average voter is still not engaged on this issue.

The debate is definitely heating up. The Charter Committee, NAACP and Business Courier have endorsed it, while the Democratic and Republican Parties are in opposition, along with numerous elected officials.

For the proponents' view, provides all the information for the pro-Issue 8 campaign. UPDATE: for the opponent's view, go to:

A good, substantive radio debate took place on it last week between Councilman Jeff Berding and NAACP President Christopher Smiterman: It's worth listening to.

And to their credit, Channel 9's I-Team did a full story on it:

I invite proponents and opponents to weigh in on this blog, and to answer basic questions for the voter who has not quite delved into the details yet:

- what is proportional representation? how would it change the ballot the voter sees, and how that ballot is counted?

- for proponents, why would it improve our Council election process?

- for opponents, why would it detract from our Council election process?
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