06/30/2014 by Courtney M. Fowler
Reevaluating role of California jail systems as health care providers
(photo: Wikimedia Commons)
With most of the Affordable Care Act (ACA) having taken effect nationwide in January, there are still many questions about how the new law will impact some formerly hard-to-reach Americans. One demographic in particular that’s being targeted more than ever is the prison population, which includes both current inmates and those who’ve been recently released.
“We know, based on the research, that the prison population is at a significantly higher risk of infectious diseases and more likely to be suffering with substance abuse and mental health issues,” said Mia Bird, Public Policy Institute of California (PPIC) research fellow who lead a recent PPIC event in Sacramento to discuss the importance of ensuring that inmates are covered both before and after their prison stays.
“So despite the difficulties of reaching this group because they don’t have access to standard ways of getting coverage, it remains extremely important,” said Bird.
In California, there are roughly 200,000 people incarcerated in the prisons and jails across the state. Because that number has constantly been increasing, it’s become important to monitor the effectiveness of the benefits reaching the population. It has been said of some California counties that jails submit more medical claims that hospitals.
Under the current standards, inmates receive health care services from county jail systems while incarcerated. However, it's been shown that few inmates have access to coverage after they are released from custody. The expansion of the California’s Medicaid program (Medi-Cal) under the ACA has extended insurance eligibility to much of the historically uninsured jail population. Particularly, single men without children (a chronically underserved sub-demographic under pre-ACA Medi-Cal) are now eligible for an expanded roster of health services and counseling.
To help with ACA enrollment for inmates who aren’t insured, California recently signed into law Assembly Bill 720 (AB 720). The bill facilitates the use of jails as sites for health insurance enrollment. By doing so, this will inevitably increase enrollment levels for the jail population and could potentially reduce corrections costs, while giving inmates direct pathways to coverage.
Additionally, the bill allows those who were previously covered under Medi-Cal to avoid termination, which was the previous regulation. Under AB720, inmates would simply undergo suspension until they’re released from custody, at which time they’d be allowed to reenroll for benefits.
“Across these jail systems, one thing that’s required is for them screen all inmates for health issues,“ Bird said. “However, the institutions aren’t reimbursed for treatment unless the inmate is hospitalized for over 24 hours, so the burden of providing this care really does fall at the local level.”
According to the most recent data from 2012, there were almost 2.3 million encounters in which an inmate required medical attention throughout the California prison system. That number equates to nearly 200,000 medical visits each month in county jails alone. However, by Bird’s estimation if inmates are taking advantage of ACA benefits while not incarcerated, institutions will save money because they will in turn see less “sick calls” while these individuals are in prison.
“Such a large population of inmates have conditions that need to be managed on a continuous basis,” Bird said. “So if someone has a well-managed disease when they come in, that condition may be much cheaper to treat while they’re in custody.”
Currently, members of PPIC have been working directly with counties throughout the state to assess how they are working to put the AB109 changes into effect in their institutions. The goal is to not only reiterate the importance of integrating AB720 and the ACA, but also ensure that California’s prison population, on an individual basis, understands the changes.
“We’re at the very early stages, but right now we want to know how [the policy changes] are being approached from a strategic standpoint,” Bird said. “However, the overall goal is to pick up the enrollment of ACA so that it’s truly benefitting those who don’t realize all there is to offer.”