Helping the Justice-Involved Population Enroll in Affordable Care Act Coverage
In recent months, there’s been an increased interest in improving access to health care for people who are recently released from incarceration or otherwise involved in the criminal justice system. While incarcerated, people generally cannot get access to health care through Medicaid or the marketplace. But when they are released, many are eligible. Assisters in a number of states are working to help what is known as “the justice-involved” population enroll in health coverage, both through the marketplace and in Medicaid.
Enrollment assisters and navigators can help people re-joining society after incarceration to sign up for health coverage
To ensure that those in the justice population get covered when they are released, many navigators and other assisters have been collaborating with advocates who work with the justice-involved community. Families USA asked Kentucky and Oregon to share how they’re reaching out to justice-involved populations and connecting these consumers to coverage. Listen to a webinar we recently hosted on this topic.
Three reasons it makes sense to focus enrollment efforts on justice populations
When we think of good potential populations to assist with enrolling in health coverage, it is hard to think of a population with more potential for successful outreach than the justice population. Here is why:
- Eligibility for coverage: A large number of individuals re-entering society are eligible for Medicaid and marketplace coverage. The number of people within the justice population who are eligible for Medicaid is much greater in states that have expanded eligibility for Medicaid, but many people also stand to gain from marketplace coverage with financial assistance. The good news is that this population is not hard to identify or reach.
- Need for care: The justice population has disproportionately high rates of chronic conditions, mental illness, and substance abuse disorders. For example, the Urban Institute found that an estimated 8 in 10 male prisoners and 9 in 10 female prisoners have some type of chronic health condition requiring treatment or management.
- High uninsured rates: This population has very high uninsured rates, thus limiting their ability to access health care despite their high need. As a result, many delay receiving needed care or instead receive costly care in emergency settings.
To ensure continued Medicaid coverage, states should adopt “suspension” rather than ‘termination”
One policy that helps the justice population keep coverage is the suspension—rather than termination—of Medicaid coverage when someone becomes incarcerated. This allows someone’s coverage to be temporarily suspended when he or she enters jail or prison, so when that person re-enters society he or she can have this health coverage more easily reinstated. Termination of coverage, on the other hand, would require the person to submit and process a new application and have their eligibility re-determined. The suspension policy is easier on the individual, and it is also is a much more efficient process for the state Medicaid agency.
Most states currently terminate Medicaid when someone is incarcerated, but many states have seen the benefits of changing their policies. New Mexico, for example, recently passed legislation to allow for the suspension of coverage, and many other states are considering following suit. We hope to see more states continue to move in this direction.
Strategies for outreach and enrollment will vary depending on your state
Models and approaches to this work vary from state to state and county to county, and our recent webinar provides an overview of some of the different ways assisters can help. For example, in Oregon, some county jails have dedicated staff in-house to provide application assistance to those who will soon be released. Others in the state have developed partnerships with community organizations or county staff who then work with the jails to provide application assistance.
In Kentucky, many groups have come together to create a coalition that focuses on enrolling justice-involved populations. The Health Reentry Coalition, known as HRC, has engaged assisters, the marketplace, providers, health plans, and jails in the coalition. An important piece of their work concerns ensuring that those who enroll understand how to use their coverage and that they get the care they need. For example, making referrals to community health centers is one important piece of their enrollment process. HRC has put together great lists for different types of partners—such as county jails, judges, and probation officers—identifying 10 activities they can pursue to help enroll this population. The coalition has worked hard to educate officials within jails about the importance of this work, so when assisters reach out to them for partnerships, the coalition has already laid the groundwork for the conversation.
If you have innovative ideas of ways to work with the justice-involved population or have questions about getting involved in this work, we’d love to hear from you. Please email Assisters@FamiliesUSA.org.
It’s important for us all to remember that there are opportunities year-round for consumers to sign up for health coverage. Assisters provide help throughout the year, working to educate, raise awareness, and ultimately help consumers understand their health coverage. Our blog last week highlighted some of the life-changing events that qualify consumers for a special enrollment period.