By Lisa Bernard-Kuhn
Landing time in an Ohio prison could also soon get you help enrolling into health care coverage under Obamacare.
Ohio is among a small but growing number of states working to enroll prisoners into Medicaid when they get sick and as they are being released.
The move could save the state nearly $18 million this year alone in costs of providing health care to prisoners — money that would be shifted onto the federal government’s tab.
Longer term, prison and health care officials say it also could help curb the number of repeat offenders as more ex-prisoners gain access to needed mental health services and substance abuse programs, benefits now required to be covered under the health reform law, the Patient Protection and Affordable Care Act.
“It is a huge benefit for the state and for the individuals because they’ll have a continuum of care and we can link them with the benefits they need,” said Stuart Hudson, managing director of health care for the Ohio Department of Rehabilitation and Correction.
Similar efforts are under way in Illinois, Maryland, Minnesota and Oregon, said Maeghan Gilmore, director of health and human services for the National Association of Counties.
“The real challenge for all of them is whether there are available resources and capacity because, largely, they are not in the business of enrolling individuals into health care,” Gilmore said. “But they all recognize how this might impact their numbers in terms of keeping individuals from coming back over and over again.”
In Ohio, as many as 95 percent of the roughly 20,000 prisoners released every year are expected to be eligible for Medicaid, Hudson said. Nationally, about 13 million individuals spend time in county jails annually, according to the association of counties.
Within the next two months, Hudson said, he hopes to have a formal enrollment process in place for prisoners as they’re released.
“We’re working with Medicaid to come up with the exact tools to help them sign up,” Hudson said. “We feel we can do it with the current resources we have.”
State, local costs shift to federal government
Among the most substantial changes ushered in by Obamacare is the expansion of Medicaid — the jointly funded state-federal health insurance program for low-income residents.
The health reform law gave states the option to extend Medicaid benefits starting this year and beyond to include anyone who makes up to 138 percent of the federal poverty level — about $15,800 for an individual and $32,500 for a family of four.
Until this change, states had excluded most childless adults from coverage. Medicaid covered only children, pregnant women, very low-income parents, people with disabilities and the elderly.
Ohio is among the 26 states that chose to expand Medicaid. The costs incurred by people who are newly eligible will be be paid exclusively by federal tax dollars through 2016, which will drop to at least 90 percent of the cost after that.
That should shift to the federal government millions of dollars spent on prisoner health care by Ohio’s prison system, Hudson said. The most immediate savings to the state, he said, would be Medicaid coverage for prisoners who spend more than 24 hours in a hospital.
By 2022, the state savings could be as high as $34 million a year, according to a 2013 study by the Health Policy Institute of Ohio and Ohio State University.
Access to care, lifestyle key to long-term savings
Nationally, about 90 percent of state prisoners are estimate to have no insurance, according to the Council of State Governments.
One in every 8 is estimated to suffer from a mental health disorder, and it costs taxpayers as much as $15 billion annually to treat individuals in jail and prison who suffer from psychiatric disorders.
Unknown, however, is the potential effect of keeping ex-offenders healthy long-term.
“Coverage is just one aspect of health care. You also need access, and you need to want to access that care,” said Amy Rohling McGee, president of the Health Policy Institute. “There are a lot of intercepting parts that have to do with lifestyle choices.”
Whether improved health will curb recidivism rates and cut down on costs overall remains to be seen, she said.
“One can imagine that, if people get coverage and are able to access care for their conditions, it will prevent costs down the road, but it’s not something you would expect to see the results of even in the next five to 10 years,” she said. “It will be further out than that before we know.”