Feb 3 2014
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NACo Conference: Transitioning Jail Inmates to Community Care

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A key session at the National Association of Counties (NACo) Health Initiatives Forum held last week in San Diego focused on the opportunities and implementation challenges of the Affordable Care Act for inmates of county jails.

Most county jail inmates are there awaiting trial because they can’t afford bail, and a large percentage have physical and/or mental health problems. While in jail, the cost for their health care falls to the county; Medicaid and other benefits inmates have in the community end once they enter the jail system, and many have no benefits. Typically, the care inmates received in jail ends on release since there is generally no entity to help them transition to community benefits and care.

And benefits under the Affordable Care Act are generally elusive for inmates—and counties—desperate for care and a break on the high cost of health care for inmates. While just about all inmates would qualify for coverage under the Affordable Care Act either through health insurance marketplaces or Medicaid expansions in those states that have changed their Medicaid rules under the health law—expanding Medicaid benefits to those without children who qualify financially because of low incomes—current laws do not permit inmates to be covered for health care costs under Medicaid while in jail, except for hospitalizations while they’re incarcerated.

Many counties in states that have expanded Medicaid to include low-income adults without children have petitioned their state Medicaid offices to amend current rules and allow coverage for health care under Medicaid during incarceration.

However, counties are taking initiative to help inmates sign up for coverage that will kick in on their release, reducing the chance for recidivism and improving the chance for healthier and more productive lives. For example, last week in San Francisco the city sheriff sent a bill to the city’s Board of Supervisors that would make the sheriff’s office responsible for helping inmates sign up for the Affordable Care Act.

At the NACo meeting, Farrah McDaid Ting, Associate Legislative Representative for Health and Human Services at the California State Association of Counties, said a key issue both for county budgets and for the health of people released from jail into the community is that without benefits and a transition to care, often care was only sought afterward and delivered when there is a crisis. Ting says among the requests being made in California is to have Medicaid suspended rather than terminated for people in jail under a year, which would allow a person to transition back to care immediately on release.

Another critical need in jail is technology infrastructure to allow inmates to be signed up. Some counties in California, according to Ting, are using outside nonprofit groups to sign up eligible inmates before release.

“What we want to reduce is that person ending up back in jail,” said Ting.

Tags: Community Health, Medicaid and CHIP