Pre-Release Medicaid Enrollment Program for Offender Population
Author: Jennifer Katzman, Medicaid Program Manager
Numerous studies show that access to mental health, substance use and other health care services helps former offenders better integrate back into their communities, lessening the likelihood of these individuals committing future crimes. Now, because of Medicaid expansion, the Louisiana Department of Health and the Department of Corrections are helping incarcerated individuals enroll into Medicaid, with coverage beginning once the individual’s sentence is complete and they transition out of prison.
Nationwide, as well as in Louisiana, offenders enter prison with high rates of mental illness, substance use disorders, chronic health conditions and infectious diseases. While incarcerated, offenders receive care, but studies show that almost all offenders who leave prison do not have health care coverage, nor are they likely to find employment that offers coverage. Because continuity of care is critical to better health, this is an especially vulnerable population.
Under Medicaid expansion, states such as Louisiana can use enhanced federal funding to make health care coverage available to individuals who are transitioning out of prison. Coverage begins when the offender completes their sentence and leaves prison. As we developed our program, we found other states that already started similar programs found health coverage contributes to better care continuity and also reduces the use of emergency rooms this population typically uses for basic care.
The program is open to offenders between the ages of 19 and 64 who become income-eligible for Medicaid while incarcerated under expansion. Income changes (increases) will be considered once the offender is released.
In conjunction with the Department of Corrections (DOC), our agency will implement pre-release enrollment of the offender population in phases starting at the state level and then proceeding to local jails. There are currently seven operating state prison facilities and 106 local jails that house state offenders. In addition, local jails house local offenders.
The initiative started in January with DOC offenders in DOC facilities. We are expecting that approximately 2,800 offenders will be enrolled in Medicaid each year in Phase 1. Phase 2 will apply to DOC offenders housed in local facilities (approximately 15,000 annually) and the final phase will target offenders in local jails.
“This is a key solution to reducing Louisiana’s high incarceration rate, reducing the state’s recidivism rate, keeping citizens safe, and saving taxpayer money,” said Department of Public Safety and Corrections Secretary James M. Le Blanc. “Nearly a quarter of the state’s offenders have serious mental health issues, and 75 percent have substance use disorders. For every dollar we spend toward treatment in the community, we save six dollars toward criminal justice costs.”
The Department of Health and Department of Corrections began planning for this program in late 2015. LDH and DOC developed an automated enrollment process that allows the agencies to share information about offenders who are set for release within the next nine months, and get them enrolled in Medicaid and linked to a health plan pre-release. This enrollment process ensures that the health plan insurance card is mailed to DOC in time for release so that the former offender knows who to contact for access to care after release.
Dr. Raman Singh, DOC medical director, added that DOC identifies offenders who have a high need for health care services for the Healthy Louisiana plans to perform case management activities immediately prior to their release to ensure a more seamless transition of care. This includes offenders who use a wheelchair, or have a serious mental illness, co-occurring substance use disorders, two or more medical conditions, HIV or other chronic health conditions.
“As these individuals are identified, information is shared with the Medicaid managed care plans which then develop care plans that include doctor appointments and prescriptions. This is all included as a component of the prison discharge planning,” said Dr. Singh.
LDH and DOC implemented phase one of the pre-release enrollment initiative in January for offenders in the seven DOC state facilities. As of March 18, 2017, 450 offenders have been linked to a health plan, with about 77 who are eligible for case management.