How Does the ACA Affect Prisoners and the Reentering Population?

Today, the Supreme Court held that the Affordable Care Act’s individual mandate is constitutional and that states have a choice whether to participate in the ACA’s Medicaid expansion. What will elements of the ACA, including the Medicaid expansion, mean for prisoners and the reentering population?

ACA’s Overall Approach: 
“Require most U.S. citizens and legal residents to have health insurance. Create state-based American Health Benefit Exchanges through which individuals can purchase coverage, with premium and costsharing credits available to individuals/families with income between 133-400% of the federal poverty level (the poverty level is $18,310 for a family of three in 2009) and create separate Exchanges through which small businesses can purchase coverage. Require employers to pay penalties for employees who receive tax credits for health insurance through an Exchange, with exceptions for small employers. Impose new regulations on health plans in the Exchanges and in the individual and small group markets. Expand Medicaid to 133% of the federal poverty level.” Source: Summary of New Health Reform Law, Kaiser Family Foundation

The Medicaid Expansion in a Nutshell:
“A key element of the Affordable Care Act (ACA) is the expansion of Medicaid to nearly all individuals with incomes up to 138 percent of the federal poverty level (FPL) ($15,415 for an individual; $26,344 for a family of three in 2012) in 2014. Medicaid currently provides health coverage for over 60 million individuals, including 1 in 4 children, but low parent eligibility levels and restrictions in eligibility for other adults mean that many low income individuals remain uninsured.” For states that choose to participate, “[t]he ACA expands coverage by setting a national Medicaid eligibility floor for nearly all groups. By 2016, Medicaid, along with the Children’s Health Insurance Program (CHIP), will cover an additional 17 million individuals, mostly low-income adults, leading to a significant reduction in the number of uninsured people…To qualify for Medicaid prior to health reform, individuals had to meet financial eligibility criteria and belong to one of the following specific groups: children, parents, pregnant women, people with severe disability, and seniors. Non-disabled adults without dependent children were generally excluded from Medicaid unless the state obtained a waiver to cover them.” Source: Who Benefits from the ACA Medicaid Expansion?, Kaiser Family Foundation
(For a more extensive summary of the ACA: Summary of New Health Reform Law, Kaiser Family Foundation)

The following are articles addressing how the ACA, including the Medicaid expansion, could affect the prisoners, the reentry population, and corrections organizations:

Frequently Asked Questions: Implications of the Federal Health Legislation on Justice-Involved Populations” from The Council fo State Government’s Justice Center

Individuals cycling through prisons and jails—many of whom have significant health needs, but are not currently enrolled in Medicaid—will soon be eligible for enrollment. Although the most significant changes to Medicaid eligibility do not take effect until 2014 (or earlier, if a particular state opts to accelerate implementation), state officials, including criminal justice system officials, are now planning to put protocols in place in time to meet the new federal requirements under the [ACA].

This publication from the The Council of State Government’s Justice Center also answers fundamental questions like: What are the health needs of incarcerated people? What are common barriers to receiving health insurance for justice-involved individuals?

Key Elements of the Affordable Care Act: Interface With Correctional Settings and Inmate Health Care” from Corrections Today, February 2012

Several provisions of the [ACA] have direct and indirect effects on the corrections profession, inmate health care and reentry provisions, thereby making it essential that correctional leaders carefully engage their state governments and community partners…This document provides an overview of the key elements of the Affordable Care Act that affect correctional organizations and inmate health care, now and in the future.

This article from Corrections Today addresses elements of the ACA, beyond the Medicaid expansion, that will affect prisoners, the reentry population, and corrections organizations including: Coverage for Children Up to Age 27, Subsidized Nongroup Coverage, and Health Insurance Exchanges.

Medicaid Expansion Seen Covering Nearly All State Prisoners” from the Pew Center on the States, October 2011

The federal health law’s controversial Medicaid expansion is expected to add billions to states’ already overburdened Medicaid budgets. But it also offers a rarely discussed cost-cutting opportunity for state corrections agencies. Starting in 2014, virtually all state prison inmates could be eligible for Medicaid coverage of hospital stays-at the expense of the federal government. In most states, Medicaid is not an option for prison inmates. But a little known federal rule allows coverage for Medicaid-eligible inmates who leave a prison and check into a private or community hospital. Technically, those who stay in the hospital for 24 hours or more are no longer considered prison inmates for the duration of their stay…

 “Medicine and the Epidemic of Incarceration in the United States” from the New England Journal of Medicine, June 2, 2011

Perhaps foremost among these is that opened up by health care reform: the Affordable Care Act will permit most former prison­ers to receive health insurance coverage, which will offer them greater access to much­needed medical care. Such access could redirect many people with seri­ous illnesses away from the re­volving door of the criminal jus­tice system, thereby improving overall public health in the com­munities to which prisoners re­turn and decreasing the costs as­sociated with reincarceration due to untreated addiction and men­tal illness.

Here for summary of the Supreme Court’s opinion on the individual mandate

Here for a summary of the Supreme Court’s opinion on the Medicaid expansion


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