Some opponents of health reform’s Medicaid expansion have cited an estimate that 35 percent of adults newly eligible for Medicaid have been involved in the criminal justice system in the past year. This figure is highly inflated.
In reality, only about 17 percent of newly eligible adults who enroll in Medicaid will have been in jail or prison. But even though they will make up about one-sixth rather than one-third of new Medicaid enrollees, their number is significant — and connecting these low-income adults to the health care system can help them avoid returning to jail or prison, as we explain in a new paper.
On any given day, about 750,000 people are in jail; about 75 percent of them for nonviolent offenses. As many as 90 percent of people in jail are uninsured. This figure isn’t surprising; until health reform’s coverage expansions took effect this year, there was no pathway to health coverage for poor and low-income adults who weren’t parents living with their minor children, pregnant women, seniors, or people with disabilities. Not many people with prison or jail stays fall into these categories.
Health reform opened up Medicaid eligibility for all adults with incomes below 138 percent of the poverty line. So far, 26 states and the District of Columbia have decided to expand coverage. In addition, adults who aren’t eligible for Medicaid or employer coverage and have incomes between 100 and 400 percent of the poverty line can qualify for premium tax credits to help them afford private coverage through the new health insurance marketplaces. Roughly half of people leaving jail can qualify for coverage through Medicaid or the marketplaces. (This figure takes into account that about half of the states have adopted the Medicaid expansion and half have not.)
A number of states and counties are working to connect people released from jail to health coverage for the first time, with a particular focus on people with mental illness and substance-use disorders, given the prevalence of these conditions in this population and the role of these conditions in increasing criminal activity.
States considering whether to expand Medicaid should consider the growing evidence that connecting the jail-involved population to treatment for mental illness and substance abuse can lower the rate at which they return to jail or prison.
For example, a study of a Michigan program to help recently released prisoners obtain community-based health care and social services found that it cut recidivism by more than half, from 46 percent to 21.8 percent. Similarly, a study that the Justice Department funded in Florida and Washington found that “in both states, 16 percent fewer jail detainees with serious mental illnesses who had Medicaid benefits at the time of their release returned to jail the following year, compared to similar detainees who did not have Medicaid.”