Prior to the Affordable Care Act (ACA), many individuals leaving prison or jail were not eligible for Medicaid because coverage was not available to most childless low-income adults. The ACA changed this dynamic, and for states that expanded Medicaid coverage (including Nebraska since October 2020), the vast majority of those incarcerated are eligible for Medicaid upon release, including an estimated 80% in New York and 90% in Colorado.1 However, the federal “inmate exclusion” bans Medicaid payment for services provided to individuals of public institutions unless the individual is treated in a hospital or other medical institution outside the prison or jail for 24 hours or more.2 Since correctional facilities are obligated by law to provide health care, this Medicaid exclusion means that state-funded correctional systems absorb the lion’s share of health care costs for incarcerated people.
In Nebraska, the health care situation for the justice-involved has recently become quite dire. In fiscal year 2015, Nebraska’s state prisons ranked sixth in the nation in health care spending by paying $8,583 per person.3 However, in March 2019, Nebraska state correctional facilities were at 160% capacity, and the state’s Diagnostic and Evaluation Center was at a staggering 336% capacity.4,5 By 2020, the state had the second most overcrowded state correctional system.6 This overcrowding has resulted in poor health care outcomes that disproportionately impact individuals of color.
However, Nebraska could improve the lives of thousands of individuals and save millions of dollars by more effectively leveraging the Medicaid program to share data, streamline enrollment, and support transitions of care.
In this paper, we will:
- Outline the dire nature of Nebraska’s health care services in correctional facilities.
- Recommend solutions that take advantage of the Medicaid program.
- Provide examples of other states leveraging Medicaid with the approaches listed above.