OBAMACARE GAVE most low-income people Medicaid coverage, extending the health-care plan to the poor and near-poor. But when they are jailed or imprisoned, an old federal law means their Medicaid coverage disappears. This callous policy must change.
The problem is not that those in custody would get no health care while locked up. The Supreme Court ruled that jails and prisons must provide health services to those they are holding, because they are wards of the state. Doing anything else would be cruel and unusual. But state and local officials complain they can only do so much when their jails and prisons are bursting with people struggling with addiction and mental health issues — people who, without consistent and appropriate care, are at high risk of reoffending and returning to custody.
An end to the inmate exclusion policy and an infusion of Medicaid funding would help dramatically. But it would do more than just shift some of the financial burden onto the federal budget.
It would right a serious inequity. Federal law requires that even those who are jailed while awaiting trial — that is, people who cannot afford bail — lose their Medicaid coverage. About 60 percent of people in jail have not been convicted. The state has not proved that these people did anything wrong. It is heartless as well as foolish to revoke their health-care coverage because they cannot make bail. Even if they get out relatively quickly, it often takes time for their Medicaid coverage to restart. That can be disastrous for someone trying to get clean or stay on a mental-health regimen. It is all the more insulting that jailed people who are slightly wealthier, and who qualify to buy private health insurance on Obamacare’s marketplaces, do not lose their government-subsidized coverage while awaiting trial.
Ending the Medicaid exclusion for jailed and imprisoned people would also boost the care they receive. As University of Michigan experts explained, “Hospitals and clinics in the civilian sector that receive federal funding from Medicaid must abide by guidelines set by the Center for Medicaid & Medicare Services. Prisons and jails don’t. Repealing the exclusion policy would improve the quality of care provided in jails and prisons because they would have to adhere to federal health care standards.”
And allowing Medicaid coverage to continue for those in custody would make it far easier for people with chronic health problems to receive continuous care — when they enter jail or prison and when they leave.
When Congress enacted the inmate Medicaid exclusion, the Medicaid program was much narrower and the problem of revoking coverage less pronounced. Now, however, federal lawmakers can no longer ignore the unwise and unjust system they have created. It is time to end the exclusion.