Congress Requests Cost Data on Expanding Medicaid to Inmates Cycling Out of Jail

Fred Upton (R-Mich), Chairman of the House Energy and Commerce Committee, and Joseph Pitts (R-Penn.), Chairman of the Health Subcommittee, have sent a letter to Gene L. Dodaro, Comptroller General of the United States, requesting that the Government Accountability Office (GAO) review the projected Medicaid costs associated with jail inmates due to the Patient Protection and Affordable Care (PPACA) (P.L. 111-148) expansion. In their letter, the Congressman cite a recent webinar by the Center for Health Care Strategies (CHCS), Inc., entitled “Preparing for Medicaid Expansion: Ensuring Health Care Access for Individuals with Criminal Justice Involvement,” as a basis for their concern that the Medicaid expansion under PPACA will divert Medicaid benefits from their originally intended purpose, the assistance of children, pregnant women, the disabled, and low-income seniors. The Congressman specifically request that the GAO analyze federal Medicaid costs and enrollment data for: (1) inmates and detainees for costs associated with allowable inpatient treatment and (2) for inmates that have been released into the community and are newly eligible for Medicaid due to the PPACA expansion.

Effect of Medicaid Expansion

According to CHCS, approximately 90 percent of those entering jails today have no health insurance, with health costs paid predominantly by states or counties. Despite the fact that Medicaid funding under PPACA is not available for health care services provided within jails or prisons, the center predicts that: (1) six to seven million individuals cycling out of jails are likely to qualify for Medicaid because approximately 60 percent of jail inmates have a pre-arrest income of less than 138 percent of the federal poverty level (the new PPACA eligibility level); (2) depending on state decisions to expand Medicaid, three to four million could enroll in Medicaid; and (3) individuals cycling out of jails could represent up to 30 percent of the total 2014 Medicaid expansion.

Behavioral Health and Substance Use Disorders

CHCS estimates that among individuals involved in the criminal justice system: (1) more than 50 percent of the jail-involved have a diagnosable substance use disorder; (2) 14.5 percent of men and 31 percent of women in jail have a serious mental illness; and (3) over 70 percent of people in jails with serious mental illness also have a co-occurring substance-use disorder. The center believes that these disorders contribute to the high rate of recidivism among inmates and suggests that improved treatment of these disorders through Medicaid coverage could lower the recidivism rate. In its webinar, CHCS suggests that jails and other correctional centers could serve as Medicaid enrollment centers through the use of HHS and Department of Corrections staff along with state and community assistance.

Challenges Remain

CHCS recognizes several challenges remain in the enrollment and treatment of prison inmates in Medicaid, including: (1) staff training, (2) funding, (3) identity verification, (4) unknown release date for non-sentenced population, (5) potential lag prior to health plan enrollment, and (6) provider competencies in treating justice-involved populations.


CHCS is a non-profit health policy resource center dedicated to improving services for Americans receiving publicly financed care. CHCS is funded by HHS and through private donations.