State Strategies for Establishing Connections to Health Care for Justice-Involved Populations: The Central Role of Medicaid

Before the Affordable Care Act (ACA), most adults leaving prison or jail — despite their poverty and poor health — were not eligible for Medicaid because coverage generally was not available to most childless low-income adults. But as of June 2018, 33 states and the District of Columbia had expanded Medicaid to all adults with incomes below 138 percent of the federal poverty level (FPL), creating a significant opportunity to provide coverage to people after their release from jail or prison. Many states have focused on enrolling eligible adults into Medicaid before they leave, ensuring that coverage begins immediately upon release. As states gain more expertise enrolling these individuals into Medicaid, it is becoming clear that simply signing people up for coverage is not enough. To take full advantage of the opportunity created by Medicaid expansion, it is important to determine how to effectively deliver care to people leaving prison, especially given their high rates of mental illness, substance use disorders, and physical health problems, as well as the numerous barriers to securing housing, food, and other social supports that affect health outcomes (Exhibits 1 and 2). Such strategies can help to reduce recidivism and related costs — average annual cost per prison inmate was $33,274 — and unnecessary emergency department visits and hospitalizations.

– The Commonwealth Fund

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