Most prison systems in the 31 states that have expanded Medicaid under the Affordable Care Act have either not created large-scale enrollment programs or operate spotty programs that leave large numbers of released inmates – many of whom are chronically ill – without insurance, reports the Marshall Project and Kaiser Health News. Local jails that process millions of prisoners a year, many severely mentally ill, are doing an even poorer job of getting health coverage for ex-inmates. Jail enrollment is especially challenging because the average stay is less than a month and prisoners are often released unexpectedly.
Former inmates with the worst chances of getting insurance and care are in 19 states that did not expand Medicaid. Only a small number qualify for coverage, and enrollment efforts by their prisons and jails are almost nonexistent. Sixteen state prison systems have no formal procedure to enroll prisoners in Medicaid as they reenter the community. Nine states have only small programs in select facilities or for limited groups of prisoners, like those with disabilities. These 25 states collectively release 375,000 inmates each year. Failure to link exiting inmates to health insurance is a missed opportunity to improve health and save money by cutting recidivism and hospital emergency room visits, advocates say. Studies have showed Medicaid access in Florida and Washington reduce return jail trips by the mentally ill 16 percent. President-elect Donald Trump has vowed to repeal the health law and replace it with something else, leaving the Medicaid expansion and eligibility for ex-prisoners in doubt.