Medicaid expansion under Obamacare improves health care; prisoners’ enrollment lowers prison system costs

Medical Daily

By Susan Scutti

Medicaid, the health care insurance program that is jointly funded by federal and state governments, has been enlarged under the Affordable Care Act, alternately referred to as ACA and Obamacare, and now covers more low-income earning adults including those included within the prison population. A new nationwide survey of state prison administrators found that with the expansion of Medicaid eligibility prison systems have begun to support prisoners’ enrollment in Medicaid as a way to help lower prison system costs while also improving prisoners’ access to health care after release. “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,” Dr. Josiah D. Rick, director of the Center for Prisoner Health and Human Rights at the Miriam Hospital, said in a press release. “There is a possibility that there will be decreased recidivism as people get treatment for their mental illness and addiction.” The study appears in the American Journal of Public Health.

Medicaid Before and After the ACA

Prior to the Affordable Care Act, Medicaid routinely provided coverage for adults if they were disabled, 65 or older, or, in cases of non-elderly adults, if they were low-income parents, other caretaker relatives, or pregnant women. Some people who did not fit those requirements also received Medicaid in about half of the states, which were able to provide coverage, often in some but not all cases, through state-funded programs. Under the previous laws, then, a health care insurance coverage gap existed for low-income adults.

To fill in gaps in coverage for the poorest Americans, provisions under the Affordable Care Act created a minimum Medicaid income eligibility level across the country.Beginning in 2014, individuals under age 65 with incomes below 133 percent of the federal poverty level (calculated as $11,490 for an individual in 2013) became eligible for Medicaid in every state, with eligibility extended to non-disabled adults under the age of 65 without dependent children.  Those eligible for Medicaid will receive a benchmark benefit or benchmark­ equivalent package that includes the minimum essential benefits provided by the insurance exchanges. Along with a benchmark plan, benefits also include prescription drugs, preventive and obesity-related services, tobacco cessation programs, and health homes for those enrollees suffering from chronic conditions. Medicaid under ACA also promotes prevention, wellness, and public health and helps people receive long-term care services and support in their home or the community.

Medicaid, then, has expanded not only eligibility but also services and the impact on various populations remains to be seen, and for this reason one particular team of researchers chose to explore potential effects and benefits for the prison population.

Study Results

Under the constitution, prisoners have a right to adequate medical attention, which comprises a significant expense of prison financing; in 2008, a Pew Charitable Trust survey based on Bureau of Justice statistics revealed that out of $36.8 billion in overall institutional correctional expenditures, nearly $6.5 billion went to prison health care in 2008. Although a small percentage of prisons provide some health care services for select prisoners under Medicaid, most do not and in 2000 — prior to enactment of the ACA — nearly all states had policies terminating Medicaid enrollment upon incarceration.