Coverage Gap Impacts 70,000 Inmates

Inmates released in states that did not expand Medicaid may find themselves in a healthcare coverage gap.

Inmates released in states that did not expand Medicaid may find themselves in a healthcare coverage gap.

The state in which a prisoner resides impacts their access to healthcare, according to researchers at the University of North Carolina at Chapel Hill.

Prisoners have higher rates of chronic diseases, substance abuse, mental health conditions and infectious diseases. Through the expansion of Medicaid, the Affordable Care Act (ACA) was projected to provide coverage to most male state prisoners with a chronic health condition. Yet, states that did not expand Medicaid have pushed thousands of inmates into a coverage gap. These findings were published in the journal PLoS One.

“Without healthcare coverage, many released inmates do not have a regular source of healthcare, and they tend to either go without care or they seek care at emergency departments, which can be quite costly,” says David Rosen, Ph.D., M.D., Research Assistant Professor of Medicine in the Division of Infectious Diseases.

Rosen along with Catherine Grodensky, M.P.H., Project Manager, of the Prison Medicaid study, co-lead the Criminal Justice and Health Working Group at UNC.

“People with prison records already face considerable obstacles to obtaining the most basic necessities of survival such as housing and employment,” says Grodensky. “To deny the poorest among them means of maintaining basic health care after release will lead to considerable personal suffering and societal cost, which should be preventable.”

The team studied the 643,290 male prisoners in the US aged 18-64 with a chronic health condition. Using ACA income guidelines along with information on pre-arrest social security benefits from a nationally representative sample of prisoners, the researchers were able to predict the number of prisoners who would be eligible for healthcare coverage upon release from prison. They found 73 percent of prisoners in Medicaid-expansion states would qualify for Medicaid or tax credits.

Yet in states where Medicaid was not expanded, only 54 percent of inmates would qualify for tax credits. These are inmates earning between 101 and 400 percent of the federal poverty limit. Poorer inmates, comprising approximately 22 percent with incomes less than or equal to 100 percent of the federal poverty limit, would be ineligible for any ACA-mediated healthcare coverage. That means the roughly 70,000 poorest inmates would fall into the coverage gap after prison release, receiving no federal assistance for healthcare coverage.

“As a society, we must ask ourselves if it is realistic to expect released inmates to succeed in the community if they don’t have the proper tools to do so,” says Rosen. “There is mounting evidence that access to healthcare is one of those necessary tools. Short of Medicaid expansion, we really need to think hard about alternative systems of care for people being released from the criminal justice system. Otherwise, we’re probably setting them up to fail.”

The National Institutes for Health funded this study.