Local Officials Want Feds to Scrap Policy Blocking People in Jail From Medicaid

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A federal law can lead to breaks in health care benefits for those awaiting trial. Counties and sheriffs plan to lobby for this to be changed.

LAS VEGAS — County officials and sheriffs from around the U.S. are ramping up an effort to press for changes to a federal policy that strips Medicaid coverage and other federal health care benefits from people who are in jail but who have not been convicted of crimes.

Counties and their local taxpayers end up covering medical expenses for people locked up pretrial. But the federal government and states share the cost of people on Medicaid, which provides health coverage for low-income Americans

Those involved in a new initiative focused on the issue say they’re not only concerned about money. The federal policy, they say, is also disruptive for the people it affects—who are disproportionately poor, minorities, or coping with mental illness and substance abuse.

“It’s something I know I’ve heard about for years,” said Commissioner Nancy Sharpe, of Arapahoe County, Colorado. “It’s a huge cost to the counties and isn’t really the best solution for the individuals coming into our jails.”

“It truly is an error in federal law,” she added.

Sharpe made her remarks during the National Association of Counties annual conference that is taking place here this weekend. NACo and the National Sheriffs’ Association have jointly launched a new task force focused on health care in jails. Sharpe is co-chairing the panel.

The task force plans to lobby at the federal level for a change in the so-called Medicaid inmate exclusion policy that would allow detained people awaiting trial to continue receiving benefits.

The current policy is codified in the Social Security Act and restricts the use of federal funds and services—including Veterans Affairs programs, the Children’s Health Insurance Program, or CHIP, and Medicaid—from being used to provide medical care for inmates.

As it stands, there’s no distinction under the law between convicted inmates in prison and people jailed awaiting trial.

In light of the federal policy, some states opt to terminate Medicaid enrollment for people booked into jails. When this happens it can take months for these individuals to get back onto the program even after they’re released, resulting in gaps in health care coverage.

Other states suspend coverage rather than fully terminating it.

Interruptions in treatment for mental health conditions and addiction problems can contribute to re-arrests and recidivism, the counties and the sheriffs contend.

On any given day, they say, local jails house about 465,000 people who aren’t convicted of any crime. They also say about 9,000 young people in juvenile facilities are affected by the CHIP provision.

“This issue is simply about policy makers at the federal level not understanding the difference between prison and jail,” said Matt Chase, NACo’s CEO and executive director.

Chase highlighted what he called a “double standard,” when it comes to who gets kicked off the programs and who does not, and suggested this raises possible constitutional issues.

“If you are arrested and you post bail, or you are released back into the community, you retain your federal benefits. But if you are housed within the county jail, you automatically lose them,” he said. “It should simply continue until you’ve been adjudicated.”

Sheriff Jerry Clayton, of Washtenaw County, Michigan, also raised issues along these lines. He pointed out that the people who are frequently unable to post bail are those who are lower-income or from minority communities. “That is unfair,” he added.

Clayton said a topic that has come up in the task force’s initial discussions is the need for additional data to back up the positions that the group will take in its advocacy efforts, and to track the outcomes that will result from any eventual policy changes.

But there are some unique challenges with assembling this data given the number of jails across the U.S., disconnects between criminal justice and health care records, and sensitivities and privacy restrictions surrounding personal health information. 

Officials in the audience shared some of their ideas on the task force. Michael Daniels, justice policy coordinator for Franklin County, Ohio, cautioned against allowing the debate about the Medicaid exclusion policy to morph into one about bail reform. 

He noted that his county is working to address equity concerns related to bail. But he said it’s not always possible to release people awaiting trial if they’re accused of serious crimes. “For those folks accused of violent crime, this Medicaid exclusion still comes into play,” he said.

Daniels also said when people are jailed and counties take over their medical costs, there’s a risk of treatments becoming inconsistent. This can be a serious issue for people taking a set of drugs for a mental illness or other reasons, who end up receiving less expensive alternatives while in jail.

“Some of those drugs and cocktails are extremely expensive,” Daniels said, adding that his county spends about $2 million to $3 million a year to maintain consistent treatment for people.

Steven Jackson, a commissioner from Louisiana’s Caddo Parish, said his community was budgeting about $5.5 million, with costs on the rise, for health care for pretrial inmates. 

He suggested that if there is not a way to fully revoke the Medicaid inmate exclusion policy, perhaps the federal government could partially reimburse counties for some of their costs.

NACo has recently flagged at least five pieces of legislation in Congress that would make changes to federal law that are in line with what the group and the sheriffs are seeking.

One bill, introduced by U.S. Rep. Alcee Hastings, a Florida Democrat, would remove limitations on Medicaid and other health care benefits for pretrial inmates. That legislation has 19 co-sponsors, all of them are Democrats.

Clayton, the Michigan sheriff, described work his county has done mining data and adopting new measures to cut down on the number of people with mental health problems, who are ending up back in jail due to technical violations of their probation.

“If we have someone with a mental health issue, substance abuse disorder, and they end up in jail,” he said, “I think we qualify that as a societal failure.”

“We know we’re going to have some folks in jail,” Clayton added. “So let’s advocate for the change in the Medicaid and the exclusion. But also let’s think about how do we keep them out of jail to begin with and not build up more space in the jail for people with mental health issues.”

Bill Lucia is a Senior Reporter for Route Fifty and is based in Olympia, Washington.

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