Kentucky Jail Signs up Exiting Inmates for Health Insurance
By Chris Kenning
LOUISVILLE — After three months in jail on a theft charge, Vincent Garcia had prepared last week to collect his wallet and keys and turn in his orange scrubs upon release.
But the 26-year-old will leave jail with something else — free health insurance.
Louisville Metro Department of Corrections last week began holding daily sign-ups for exiting inmates, and Garcia was among those qualifying for the newly expanded Medicaid under the Affordable Care Act.
It's part of a growing push nationwide by prisons and jails trying to take advantage of expanded health care to curb rapidly rising medical costs in a setting where many are poor, unhealthy and uninsured.
Their motivation is twofold: Expensive inmate hospitalizations lasting more than 24 hours can be billed to Medicaid, cutting local and state costs. And it provides coverage to a population whose high rates of chronic disease, substance abuse and mental illness often land them back in jail, where they are expensive to treat.
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"I know some people will think, 'I can't afford health insurance myself. Now a person in jail gets access to health care?' " said Mark Bolton, director of the jail that houses roughly 2,000 inmates. "But taxpayers are paying for these people anyway."
In Louisville, Metro Department of Corrections' health care costs make up $9 million of its $52 million budget — a result of treating medical conditions including diabetes, heart disease, infections and drug problems.
That investment is often lost when repeat offenders fail to continue treating their conditions when released because of a lack of health insurance, officials said.
But the idea of signing up inmates doesn't sit well with some Affordable Care Act critics.
Increasing the burden
Senate Minority Leader Mitch McConnell, R-Ky., said signing up those leaving jail or prison will add burdens to an already strained Medicaid program that is hard pressed to find enough doctors willing to accept Medicaid patients.
"This is yet another disturbing aspect of a profoundly troubling piece of legislation," said McConnell.
Federal rules ban use of Medicaid while someone is incarcerated, but that doesn't apply to inmates hospitalized for at least 24 hours. And all prisoners are constitutionally guaranteed health care while behind bars.
Advocates said getting Medicaid for inmates who qualify could cut the costs of treating neglected illnesses, help keep the mentally ill on their medications once released or provide treatment for the addicted — reducing recidivism.
Barbara Gordon, of the Kentuckiana Regional Planning & Development Agency, which is providing "kynectors" to help people sign up in the Louisville region, is partnering with the jail as an "experiment, and we do plan to expand it" to other jails in the 16-county area they cover or other parts of the state, she said. There is no specific enrollment goal.
Nationally, at least 70% of the roughly 10 million people released from prison or jail each year are uninsured, according to the Washington, D.C.-based nonpartisan Council of State Governments Justice Center.
Dr. Fred Osher, director of health systems and services policy for the council, said it's estimated that about one-third of people going in or out of prisons and jails would qualify for expanded Medicaid, and 24% more for subsidized health insurance.
Jails and prisons are working to enroll current and former inmates in states such as Colorado, Oregon and Illinois, including at Chicago's Cook County jail. Among their targets are inmates who are single, since single people previously didn't qualify for Medicaid.
"Everyone is trying to figure out ... how best to take advantage of the law and improve health and public safety outcomes," he said.
Last year, the Center for Health Care Strategies predicted that people cycling in and out of jail could represent 30% of the health care law's Medicaid expansion.
Regan Hunt, executive director of Kentucky Voices for Health, a health coalition, said her group plans to reach out to county officials and jails in a state where health care costs have grown by 134% over the last eight years, according to a state analysis.
The Kentucky Department of Corrections projects that shifting the costs of those extended hospitalizations to Medicaid would save the state prison system more than $5 million a year. That is significant in a department that has seen health costs rise to more than $54 million this year from $34 million in 2004, officials said.
Medicaid will pick up the tab because a prisoner who has been in an inpatient medical facility for 24 hours is no longer considered incarcerated. The inmate also can be signed up for coverage at the hospital.
The department is working on the idea of helping connect or inform exiting inmates about Medicaid or subsidized insurance plans.
"Health care costs, just like our inmate population, is a key piece of our budget that we have little control over," said state Corrections Commissioner LaDonna Thompson. "A savings of $5.6 million next fiscal year, and $5.8 (million) in fiscal year 2016 ... would help us in our mission to do everything possible to reduce our budget, while still protecting the citizens of the commonwealth."
For two hours a day during the week, a kynector is now signing up uninsured inmates in Louisville.
On the first day of the sign up, kynector Rensha Reeder helped those who were set to be released at the intake and release center.
After entering their information and verifying their release, most found they qualified for Medicaid. One man, who declined to give his name, said he hadn't been to a doctor in 20 years.
A woman, 30-year-old Jaime Milligan, said she worked as a waitress before being arrested but hadn't had insurance for years. After qualifying, Milligan said she planned to see a doctor and dentist as soon as she could.
"I haven't been able to see the doctor or anything," she said.
Garcia, an out-of-work warehouse employee, said not having insurance meant he owed a "stack of doctor bills" for various injuries and ailments, and he was happy to get help signing up for the Medicaid expansion he'd heard about on the news.
Officials said that after the first four days, they had processed 18 applications, mostly for Medicaid.
Bolton admits that health insurance alone won't necessarily get people to treat mental illness, addiction or health issues.
That's why he and social service agencies recently began an Assertive Community Treatment program, which assigns a team to monitor and house chronic offenders whose issues of homelessness, mental illness and substance abuse often lead them back to jail.
But he said health coverage is a start.
"If we can intervene on the front end" with preventive and affordable health care, he said, "then we don't have to on the back end ... and maybe we can help keep these people from coming back in."