State Prepares for Former Inmates to Sign Up for Medicaid

By Christopher Goins,

ANNAPOLIS--State officials are working to make sure people being released from prison will sign up for benefits during the 2014 Medicaid expansion.

When the enrollment date for individual health plans rolls around in October, former inmates will also be eligible for health plans offered in state health care exchanges, another part of the “Obamacare” Affordable Care Act implementation. But health advocates say that at best it’s more likely they’ll be signing up for Medicaid, because of their low incomes.

About 9,000 to 10,000 inmates are released from Maryland prisons annually.

“Statistically a majority of the people we see, we help enroll into the Primary health care program,” said Sheila Mackertich, vice president of Health Care Reform Initiatives at Health Care Access Maryland. “Most of our people are either low income or no income.”

Vincent DeMarco, president of Maryland Citizens’ Health Initiative, believes it wouldn’t make any economic sense nor would it be fair to bar inmates from increased benefits.

“We want them to become citizens as part of our community and not just go back to jail and one of the best ways is to keep them healthy,” he said.

State trains release planners to help inmates get medical care

The Department of Public Safety and Correctional Services, in anticipation of new Obamacare regulations, has hired and trained eight “release planners” — registered nurses who are supposed to make sure inmates have the right medical services to transition back to society, said spokesman Mark Vernarelli.

DPSCS said they also held planning meetings with the state’s Department of Health and Mental Hygiene which included talk about outreach to inmates. Officials also met with the Department of Human Resources and the Open Society Institute, which has received a grant to perform early outreach for prisoners with short sentences in Baltimore City.

Vernarelli said “top inmate health officials” will be meeting with OSI again later in July to discuss health outreach for inmates.

“Accordingly, the DPSCS is well-positioned to provide proper release planning services to the sentenced and jail population to include applying for medical services to these new and expanded programs,” Vernarelli said.

Increased Medicaid benefits

Inmates were allowed to sign up for Medicaid before the Affordable Care Act, but only if they had children and incomes at or below 116% of the federal poverty level. Single adults were only eligible for the limited Primary Adult Care program, which covered only primary care, outpatient substance abuse care and mental health care.

“They signed up for the Primary Adult Care program but they didn’t have a lot of benefits so people didn’t,” DeMarco said. “If they don’t have kids, they’ll be able to get the Medicaid benefits as of January 1 and I think the vast majority will sign up.”

After Jan. 1, Primary Adult Care will go away. Beneficiaries will be transferred over to full Medicaid. All adults making up to 133% of the federal poverty level, including former inmates, will be eligible — a change from the current income limit of 116% of the poverty level. That’s a decision that justs makes a lot of sense, DeMarco argues, since society will no longer have to pay for emergency hospitalization instead.

Because the automatic transition from the limited adult care program is coming, there is an effort underway for people to sign up now, so officials won’t be backlogged in January.

Should inmates qualify for plans?

Since the law exists, Senate Minority Leader E.J. Pipkin doesn’t think inmates should be ineligible for the plans offered in the exchange and the subsidies offered with it.

“I don’t think on the face of it that if they completed their sentence they should be excluded necessarily,” Pipkin said. “On the face of it I don’t have an objection to someone who has paid their debt to society to have eligibility.”

Don’t think for a second that Pipkin now supports the law — eligibility for former inmates is “just another item” buried in the bill coming to light before the Jan. 1 start date. Pipkin still thinks Obamacare is an intrusion into the private lives of citizens and will increase premiums. He cites Blue Cross Blue Shield’s request for a 25% premium hike this year.

Last Friday, the U.S. Department of Health and Human Services decided to run only random checks to verify the income of people who are applying for subsidies in 2014. That is instead of using comprehensive, systematic checks.

“It basically strips the program of any significant rules at all,” Pipkin said. “There’s a concern that that’s going to significantly add to the costs of the program for people who don’t qualify applying and not being verified,” Pipkin said.

Del. Susan Krebs, R-Carroll, pointed out another concern: some prisoners could sign up for Medicaid now but they don’t and instead use a more costly option — going to emergency rooms. She cited a bill passed a few years ago where prisoners could sign up and get their medication before they left prison but claimed they didn’t even do that.

Advocates for the incarcerated argue that inmates should be signed up for Medicaid or state health plans at the time of release so they don’t get lost in the system, said Ellen Weber, a University Maryland law professor who created the Drug Policy Clinic.

“The biggest impact is because all individuals have to have insurance coverage, there’s going to be a much greater effort to get everybody enrolled and that includes people who are leaving jails and prisons,” said Weber, adding that it’s a well recognized fact that former inmates have significant health problems, such as drug, alcohol, mental health problems, and will be in need of healthcare services.

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