The feds boot some inmates from Medicaid, forcing local jails to pick up the tab

Brad Carlyon and David Clouse
·3 min read
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Counties are required to provide health care to inmates, even before they've been convicted. But they are ineligible for federal health care benefits, like Medicare and Medicaid.
Counties are required to provide health care to inmates, even before they've been convicted. But they are ineligible for federal health care benefits, like Medicare and Medicaid.

The facts are stark.

Two in 5 adults in jail or prison have a history of mental illness, and an estimated 65% of the United States prison population has an active substance use disorder.

As Navajo County attorney and Navajo County sheriff, we’re deeply concerned about the statistics and the impact the Medicaid Inmate Exclusion Policy has on our county and the more than 4,300 individuals who go through our jail system each year.

This policy, found in the federal Social Security Act, denies access to federal health benefits to people who are arrested and jailed for an alleged crime, before conviction.

Pre-trial inmates, including those with mental health and substance use disorders and chronic health conditions, can linger days, weeks or even months in jail awaiting trial, cut off from the treatments prescribed under their federal health benefits.

This absence of care and services has had significant adverse consequences for both the inmates and the greater community.

Inmates need care to manage conditions

Counties are required by federal law to provide adequate health care to inmates, regardless of whether they are awaiting trial or have been convicted.

However, the Medicaid Inmate Exclusion Policy prevents eligible pre-trial detainees in our local jails from accessing federal benefits such as Medicaid, Medicare and the Children’s Health Insurance Program.

The policy greatly limits our ability to provide coordinated care for unwell detainees and may result in poor health outcomes in the long term, increased pressure on the health care system and greater costs for taxpayers.

More than 95% of prisoners eventually return to the community.

It is in all our interests to ensure detainees have access to necessary health care and treatment to manage their conditions while incarcerated, as it increases the odds of successful reintegration into the community and reduced recidivism upon release.

Additionally, access to federal health benefits while awaiting trial aligns with an individual’s constitutional rights to due process, equal protection and access to health care.

It's expensive to provide care locally

Many individuals who are incarcerated have complex medical needs that require ongoing treatment and medication.

Without access to federal health benefits, these costs fall entirely on local taxpayers, leading to increased overall health care costs and less available funds for other critical county services.

The average medical expenditure by the Navajo County Jail is $2.4 million each year and rising.

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Providing inmates who haven’t been convicted access to federal health benefits allows for improved coordination of care and decreases short-term costs for local taxpayers and long-term costs for the federal government.

As leaders in Navajo County, we believe that providing access to federal health benefits for those awaiting trial and verdict decisions is not only the right thing to do but also smart.

Tell Congress to change this policy

We urge Congress to amend the Medicaid Inmate Exclusion Policy and provide eligible pre-trial detainees in our local jails with access to federal health benefits by supporting Senate Bill 971, the Due Process Continuity of Care Act.

The bill would greatly improve the care coordination for individuals suffering from mental health, substance abuse disorders and other chronic health conditions — ultimately promoting better health outcomes and reducing health care costs.

We believe adopting this legislation on behalf of non-convicted individuals is an important step toward improving our health care system and promoting public safety.

We urge everyone to ask Congress to amend the Medicaid Inmate Exclusion Policy by supporting Senate Bill 971.

Brad Carlyon is Navajo County attorney and David Clouse is the county sheriff. Reach them at bradley.carlyon@navajocountyaz.gov and sheriff@navajocountyaz.gov.

This article originally appeared on Arizona Republic: Medicaid Inmate Exclusion Policy costs our Arizona county millions