San Francisco Becomes Newest Jurisdiction to Enroll Inmates in Medicaid

Two months ago, the Department of Justice (DOJ) announced a three year pilot program that would enroll prison and jail inmates in Medicaid before their release and that would subsequently track the usage, employment, and recidivism data for those enrolled individuals after release. Even before that announcement, many jurisdictions, both on the state and local level, had begun to help inmates sign up for the program in anticipation of their release. Recently, San Francisco joined the ranks of these jurisdictions and passed legislation allowing the San Francisco Sheriff’s Office to assist the incarcerated in enrolling in health insurance available under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148).

DOJ Reentry Project

According to statistics cited by the DOJ Associate Attorney General Tony West , more than 90 percent of the individuals that have some kind of involvement with the criminal justice system. Moreover, inmates tend to experience higher rates of certain conditions than the rest of the population. For instances, incarcerated individuals suffer from mental illness at a rate that is three times higher than the outside population and suffer from substance abuse issues at a rate that is four times higher than the rest of the non-incarcerated population. In addition to helping enroll inmates in health insurance coverage, the DOJ also announced that it would be accepting proposals from state and local governments to “maximize Medicaid and marketplace resources on behalf of justice-involved individuals.”

San Francisco Bill

The San Francisco Board of Supervisors approved Assembly Bill 720, which was signed by the Governor back in 2013. The Bill provides that “an inmate’s ineligibility while in custody does not preclude processing an application for a health insurance program by or on the behalf of the inmate during incarceration.” Similar to the DOJ announcement, the press release announcing the Sheriff’s pursuance of this legislation also cited that “the majority of inmates have no health insurance or the resources to pay for medical care upon release, yet a significant proportion of them suffer from chronic health problems including mental illness and addiction disorders.” According to the San Francisco Sheriff’s Office, the medical cost saving that will be realized once each inmate is enrolled and released from custody is $2,500 per person annually.

Other Efforts

As the ACA roll-out began in the beginning of this year, states and localities were reported to have enacted the same practices that had recently been adopted by San Francisco. In particular, one source described the recent practice of Cook County, Illinois, stating that “[b]eing arrested in Chicago for say, drug possession or assault gets you sent to the Cook County Jail to be fingerprinted, photographed and X-rayed. You’ll also get help applying for health insurance.” The same source noted that, at the time of publication, at least six states and counties across the country had adopted similar practices. Interestingly, according to that article, this practice does not only have the effect of insuring a large group of previously uninsured, but it also “would shift to the federal government some of the more than $6.5 billion in annual state costs for treating prisoners.” Not surprisingly, Vermont, which has been a proponent of not only expanding Medicaid but other unique extensions on health care coverage under the ACA, has also approved legislation that specifically provide for assistance to inmates in obtaining health care coverage “and connecting them with chronic disease management, mental health and substance abuse services.

Expert opinions, revealed in previous commentary, expressed the idea that the ACA could affect positive changes in health care for inmates and those involved in the criminal justice system. While changes for the currently incarcerated are yet to be seen, the act of enrolling individuals in anticipation of release is not only gaining momentum but may have the effect of shifting financial burdens and reducing recidivism rates.