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Report: Maintaining Medicaid eligibility for Ohio's incarcerated can improve health, public safety


Ohio could reduce recidivism and improve public safety by taking advantage of new federal guidance that provides states a mechanism to allow incarcerated people to keep their Medicaid coverage, according to a new report from the Center for Community Solutions.

The report released earlier this month points to a Medicaid provision known as the "inmate exclusion," which dictates individuals are no longer eligible for coverage once they are incarcerated. The Centers for Medicare and Medicaid Services issued guidance in April allowing states to waive this exclusion.

"It certainly is a really huge opportunity for any state and any county who's really thinking about how to tackle some of these thorny issues around mental health and substance use," said report author Dan Mistak, of Community Oriented Correctional Health Services, a nonprofit organization that works to build connectivity between jails and community health care providers.

The waiver presents a way to improve health and public safety by helping eliminate gaps in mental health and substance abuse care for inmates, Mistak said.

Such issues also speak to race-based inequality, he said.

"The inequities inside of our justice system mirror the inequities inside of our health system," Mistak said. "Our health system has much poorer outcomes for low-income people, people of color."

Those two groups are both more likely to be Medicaid-eligible and involved with the justice system, he said.

"We have this example of where the justice system is sort of playing this shadow role inside of our health system," Mistak said. "Because it's so disconnected from our broader health systems, it's really increasing these disparities."

Mistak said the inmate exclusion contributes to a gap in proper care for individuals who had been incarcerated, many of whom suffer from mental health issues and are eligible for Medicaid.

"This ends up being hugely disruptive to the lives of people who are involved with the justice system because 40% of people have a diagnosed mental health condition who enter into our county jails every year, and those are just diagnosed mental health conditions," he said. "Many more people actually often are incarcerated because of their untreated or undiagnosed mental health conditions or even substance use disorder."

Allowing incarcerated people to remain eligible for Medicaid would help ensure they access to the mental health, substance abuse and other healthcare they need after release from prison, avoiding the problems that could arise from a prolonged gap in such care, Mistak said.

A study out of Washington state showed that in the two weeks post-incarceration, individuals are 129 times more likely to die of a drug overdose compared to the general populace, he said. He pointed to another study that showed those leaving incarceration are 12 times more likely to die in the short term than the general populace.

"That is a really huge and stunning data point that just shows that the transition out of incarceration is a major health event," Mistak said.

He explained providing proper care not only helps the former inmate avoid a cycle of imprisonment but increases public safety by ensuring they get the mental health care they need.

"People often end up inside of jail over and over again because they have untreated mental health or substance use conditions that actually results in either criminal or criminalized behavior," Mistak said.

Mistak said a waiver of the Medicaid exclusion can save local governments money by having the federal government shoulder a portion of the cost of these individual's care, rather than the county jail under the exclusion.

The Ohio legislature must approve the waiver. But Mistak said efforts to make this a reality are just in the initial stages. Right now, Mistak said his group and the Center for Community Solutions are involved in researching how the waiver has played out in other states, building a coalition of support for the effort and gauging the legislature's interest in the effort.

Stephen Langel is a health reporter with Ideastream Public Media's engaged journalism team.