As a result of the Affordable Care Act, there have been a variety of changes to the Medicaid program as it is administered federally. Oklahoma, like several other states, has not adopted all changes allowed by the federal government. One of the changes would allow soon-to-be released inmates to sign up for Medicaid before their release.
Medicaid was expanded under the ACA to include low-income residents. The expansion would cover those from 19 to 65 with an income below 138 percent of the federal poverty level (FPL). Nationally, about 35 percent of those newly-eligible individuals would have histories with the criminal justice system, according to health care experts.
Oklahoma remains one of 20 states to opt-out of this expansion, citing budget issues. This opt-out means only adults with kids under 19, adults older than 65, individuals who are blind or have other disabilities, children under 19, or pregnant women or women needing breast/cervical cancer treatment are covered by the state Medicaid services. The SoonerPlan is available to individuals older than 19 who need family planning services.
While incarcerated, individuals are not required to have health insurance under the ACA. They cannot buy private insurane through the Healthcare.gov marketplace, but will not be fined for not having insurance during their imprisonment. As for those who qualify for Medicaid, individuals cannot receive those benefits during their incarceration.
The federal government does allow inmates to sign up for Medicaid during their incarceration, however, which allows coverage to begin immediately after release. Individuals may sign up for the program online, through a paper application or through the state Medicaid office.
But because of Oklahoma’s opt-out of the Medicaid expansion, it does not participate in a program that allows prisoners to sign up before their release. Thus, the Department of Corrections cannot do much for individuals transitioning to re-entry, according to Terri Watkins, spokeswoman for the state Department of Corrections.
Oklahoma spent about $84.7 million on inmate medical costs last year. This figure is up from 2005 to 2013, which saw figures between $60 million and $71
There are several reasons for the increase in medical spending. Often, individuals enter prison with health issues, which then become the state’s problem. An aging prison population is also to blame.
In 1994, about 822 of the 13,700 inmates were over 50, according to Dr. Donald Sutmiller, chief medical officer for the Oklahoma State Department of Corrections. Currently, over 5,000 inmates are at least 50 years old. About 220 of those use a wheelchair at any one time, according to Sutmiller. This all contributes to the state’s budget issues.
Signing up inmates before release, some argue, could help the state’s issues rather than exacerbate them. Individuals with a Medicaid card are eligible for health care, mental health services and prescription drugs. In Oklahoma, inmates are released with an “appropriate supply of medication.” But without insurance, a steady supply of these prescription medications may be unavailable.
For those with mental health or addiction issues, this delay can be significant. Other states, such as Ohio, have decided to allow individuals to sign up while still imprisoned for this reason.
Officials hope that this will reduce visits to the emergency room, which is extremely costly for the state, and possibly lower recidivism (relapse in criminal behavior following release) rates, if receiving medical services helps with their re-entry.
Since Medicaid enrollment in the state occurs through a mostly real-time system, according to Jennie Melendez, a spokeswoman for the Oklahoma Health Care Authority which delivers Medicaid, there wouldn’t be a lag for inmates who are able to sign up for the program. Thus, released individuals who qualify for the program can gain services quickly, so the worry about delays in receiving medication would not be a big issue in the state. With Oklahoma’s opt-out of the expansion, however, most individuals will not qualify.