Health Policy- Policy Brief

by Keziah Babu

Policy Brief

To:  Professor Janet Guidi
From:  Keziah Babu
Date:  July 9, 2021
Re:  Federal Mandate for Expanded Coverage of Mental Health Services for the Incarcerated

Statement of the Issue:  Of those who are incarcerated, approximately 37% of those in state and federal prison and 44% of those in jails suffer from mental illness. Unfortunately, jails and prisons were not structured to provide prisoners with adequate mental health services. Federal law prohibits prisoners from receiving coverage via Medicaid, via the Medicaid Inmate Exclusion Policy. This policy terminates Medicaid benefits that would have been available to the prisoner, even if the person was only briefly imprisoned (Medicaid Coverage for People Who are Incarcerated, n.d.).

  • Incarceration leads to disrupted health care. When a person is incarcerated, their healthcare becomes the responsibility of the state and local government, rather than Medicaid. This transition between healthcare systems can lead to inconsistencies in treatment (Medicaid Coverage for People Who are Incarcerated, n.d.).
  • Incarcerated individuals who suffer with a mental illness are likely to be convicted again, compared to those who don’t suffer from mental illness. Studies have shown that up to 64% of felons with mental illness were arrested again within 18 months of release, compared to 60% among those without mental illness. This phenomenon is due to the lack of coordination of care and treatment between jail and society (Interventions for Adults With Serious Mental Illness Who Are Involved With the Criminal Justice System, 2012). 
  • The Medicaid Inmate Exclusion Policy places financial burdens onto the jails. Financial burdens along with administrative burdens will inevitably lead to less favorable outcomes for the patients (Bryant, 2021).

Policy Options

  • Passing a federal mandate such as the Medicaid Reentry Act can help reduce the rates of recidivism. The implementation of this bill would allow prisoners to be covered by Medicaid in the last thirty days prior to release from prison (Medicaid Reentry Act, n.d.)
    • Advantages: Allowing prisoners to be covered by Medicaid within the last 30 days of release will allow for an easier transition of care between prison and society. This will better prepare prisoners with mental illnesses to re-enter the “real world” and reduce their chances of returning to prison (Medicaid Reentry Act, n.d.)
    • Disadvantages: Although this Act would improve upon the issue of fragmented care amongst prisoners, it doesn’t completely resolve the issue at hand. During the time served prior to the thirty final days, the prisoner’s care is still in the hands of the prison, along with the financial burden of providing care to prisoners.
  • Supporting a similar legislation to the Medicaid Reentry Act called the SUPPORT Act; along with providing coverage 30 days prior to release, this Act will also ensure that incarcerated individuals are covered by Medicaid upon release (Musumeci, 2018).
    • Advantages: Transition of care from prison to the community will run much more smoothly. Additionally, this Act will assist and educate incarcerated individuals on how to enroll for Medicaid, thus empowering prisoners to seek care that may keep them out of jail (Musumeci, 2018).
    • Disadvantages: There is an age restriction for this Act, limiting the widespread benefit of this legislation amongst the incarcerated community. Eligibility for this legislation includes individuals under the age of 21, as well as former foster care individuals up to the age of 26 (Musumeci, 2018).
  • Implementing training programs that educates physicians, PAs and NPs on the experiences of the incarcerated population, the health needs that are specific to them, and how to provide proper care for them (Medicaid’s Evolving Role in Advancing the Health of People Involved in the Justice System, n.d.)
    • Advantages: Providers will know how to provide proper mental health care to those who have been released from prison. This can improve the transition from prison to society, as the care provided to them is specifically catered for them.  
    • Disadvantage: Implementing such programs can be costly, considering that the incarcerated population is miniscule compared to the general population. Because of this, most primary care providers may deem this program as unnecessary and a waste of time, when in reality, it has the potential to serve the community in a positive manner.

Policy Recommendation: The unfortunate reality of incarcerated individuals having their Medicaid benefits rescinded has played a role in the increasing cases of mental illness among those released. It is also tied to increasing re-conviction cases (Interventions for Adults With Serious Mental Illness Who Are Involved With the Criminal Justice System, 2012).  Enforcing the SUPPORT Act is the best option to tackle this issue. Through this legislation, the patient is most taken care of, as care is coordinated for them while still in prison and outside of prison (Musumeci, 2018). With the downside being that the Act has an age restriction on who it provides continued Medicaid for, I believe the appropriate method of action to tackle this issue would be to petition for more inclusivity for this Act. By providing evidence of the effectiveness of continued Medicaid on reducing re-conviction, there can hopefully be support towards the idea of expanding the Act to all incarcerated individuals upon release.

Works Cited

Bryant, B. (2021, June 28). NSA Joint Task Force Report: Addressing the Federal Medicaid Inmate Exclusion Policy. NACo. https://www.naco.org/resources/featured/naco-nsa-joint-task-force-report-addressing-federal-medicaid-inmate-exclusion-policy.

Interventions for Adults With Serious Mental Illness Who Are Involved With the Criminal Justice System. Effective Health Care Program. (2012, September 13). https://effectivehealthcare.ahrq.gov/products/mental-illness-adults-prisons/research-protocol#toc_js_5.

Medicaid Coverage for People Who are Incarcerated. NAMI. (n.d.). https://www.nami.org/Advocacy/Policy-Priorities/Improving-Health/Medicaid-Coverage-for-People-Who-are-Incarcerated.

Medicaid’s Evolving Role in Advancing the Health of People Involved in the Justice System. Medicaid’s Role Advancing Health People Involved Justice System | Commonwealth Fund. (n.d.). https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/medicaid-role-health-people-involved-justice-system.

Medicaid Reentry Act. COCHS. (n.d.). https://cochs.org/medicaid/reentry-act/.

Musumeci, M. B. (2018, October 5). Federal Legislation to Address the Opioid Crisis: Medicaid Provisions in the SUPPORT Act. KFF. https://www.kff.org/medicaid/issue-brief/federal-legislation-to-address-the-opioid-crisis-medicaid-provisions-in-the-support-act/#:~:text=The%20SUPPORT%20Act%20prohibits%20states,and%20restore%20coverage%20upon%20release.