Implementing a Prison Medicaid Enrollment Program for Inmates with a Community Inpatient Hospitalization
- 325 Downloads
In 2011, North Carolina (NC) created a program to facilitate Medicaid enrollment for state prisoners experiencing community inpatient hospitalization during their incarceration. The program, which has been described as a model for prison systems nationwide, has saved the NC prison system approximately $10 million annually in hospitalization costs and has potential to increase prisoners’ access to Medicaid benefits as they return to their communities. This study aims to describe the history of NC’s Prison-Based Medicaid Enrollment Assistance Program (PBMEAP), its structure and processes, and program personnel’s perspectives on the challenges and facilitators of program implementation. We conducted semi-structured interviews and a focus group with PBMEAP personnel including two administrative leaders, two “Medicaid Facilitators,” and ten social workers. Seven major findings emerged: 1) state legislation was required to bring the program into existence; 2) the legislation was prompted by projected cost savings; 3) program development required close collaboration between the prison system and state Medicaid office; 4) technology and data sharing played key roles in identifying inmates who previously qualified for Medicaid and would likely qualify if hospitalized; 5) a small number of new staff were sufficient to make the program scalable; 6) inmates generally cooperated in filling out Medicaid applications, and their cooperation was encouraged when social workers explained possible benefits of receiving Medicaid after release; and 7) the most prominent program challenges centered around interaction with county Departments of Social Services, which were responsible for processing applications. Our findings could be instructive to both Medicaid non-expansion and expansion states that have either implemented similar programs or are considering implementing prison Medicaid enrollment programs in the future.
KeywordsPrison Prisoners Medicaid Healthcare Access Program evaluation Social workers
We thank the NC prison system administrators and Social Work program staff who made this project possible. This project was funded by the National Institutes of Health (R01 MD008979 and R21 MH099162) and supported by the University of North Carolina at Chapel Hill Center for AIDS Research (CFAR, NIH Funded program P30 AI50410) and the UNC Criminal Justice Working Group.
Compliance with Ethical Standards
This project was funded by the National Institutes of Health (R01 MD008979 and R21 MH099162) and supported by the University of North Carolina at Chapel Hill Center for AIDS Research (CFAR, NIH Funded program P30 AI50410) and the UNC Criminal Justice Working Group.
- 1.Maruschak LM, Berzofsky M, Unangst J. Medical Problems of State and Federal Prisoners and Jail Inmates, 2011–12. Washington, DC: US Department of Justice, Bureau of Justice Statistics; February 2015. NCJ 248491.Google Scholar
- 2.Medicaid Matters: understanding Medicaid’s Role in Our Health Care System. http://www.kff.org/medicaid/8165.cfm: the Henry J. Kaiser Family Foundation; March 2011. Accessed Sept 29, 2012.
- 3.§1905(a)(A), Social Security Act.Google Scholar
- 4.Estelle vs. Gamble, 429 U.S. 97 (1976). https://www.law.cornell.edu/supremecourt/text/429/97. Accessed 17 Jan 2016.
- 5.Council of State Governments Justice Center. Policy Brief: opportunities for Criminal Justice Systems to Increase Medicaid Enrollment, Improve Outcomes, and Maximize State and Local Budget Savings. New York, NY: Council of State Governments Justice Center; 2013.Google Scholar
- 6.Hancock J. Feds Act To Help More Ex-Inmates Get Medicaid. http://www.npr.org/sections/health-shots/2016/04/29/475922382/feds-act-to-help-more-ex-inmates-get-medicaid. Accessed April 30, 2016.
- 7.Wachino V. SHO # 16–007; RE: to facilitate successful re-entry for individuals transitioning from incarceration to their communities. In: Department of Health & Human Services, ed. Centers for Medicare & Medicaid Services. from https://www.medicaid.gov/federal-policy-guidance/downloads/sho16007.pdf2016. Accessed on May 14, 2016,
- 11.Wood B. Department of Public Safety Division of Adult Correction Financial Related Audit. 2012; http://www.ncauditor.net/EPSWeb/Reports/FiscalControl/FCA-2012-4500.pdf. Accessed May 3, 2016.
- 12.Carson EA. Prisoners in 2013. Washington, DC: US Department of Justice, Bureau of Justice Statistics; 2014: NCJ 247282.Google Scholar
- 13.NC Department of Public Safety Office of Research and Planning. Automated System Query Custom Offender Reports 2016; http://webapps6.doc.state.nc.us/apps/asqExt/ASQ. Accessed May 23, 2016.
- 14.North Carolina General Assembly Session Law 2010–31. 19.6.(c). 2009 ed2009. http://www.ncleg.net/Sessions/2009/Bills/Senate/PDF/S897v8.pdf. Accessed 17 Jan 2016.
- 15.Federal Register, January 21, 2014 (Vol 79, No. 13), pp 3385–3399.Available https://www.gpo.gov/fdsys/pkg/FR-2014-01-21/pdf/2014-00931.pdf. Accessed on May 23, 2016.
- 18.Wood B. Performance Audit: department of Correction Inmate Medicaid Eligibility. 2010; http://www.ncauditor.net/epsweb/reports/performance/per-2010-7260.pdf. Accessed May 14, 2012.
- 19.Perry FL, Guice WD. Memorandum, Re: inmate Medical Cost Containment, July 1, 2014 - September 30, 2014 http://www.ncleg.net/documentsites/committees/JLOCJPS/Reports/FY%202014-15/CostContainment_Q1_Jul-Sep%202014_DOP_2014-10-22.pdf. Accessed November 10, 2016.
- 20.Perry FL, Guice WD. Memorandum, Re: inmate Medical Cost Containment, October 1, 2014 - December 31, 2015 http://www.ncleg.net/documentsites/committees/JLOCJPS/Reports/FY%202014-15/CostContainment_Q2_Oct-Dec%202014_DOP_2015-02-05.pdf. Accessed November 10, 2016.
- 21.Perry FL, Guice WD. Memorandum, Re: inmate Medical Cost Containment, January 1, 2015 - March 31, 2015 http://www.ncleg.net/documentsites/committees/JLOCJPS/Reports/FY%202014-15/DPS_Inmate_Medical_CostContainment_Q3_Jan-Mar%202015_DOP_2015-05-14.pdf. Accessed November 10, 2016.
- 22.Perry FL, Guice WD. Memorandum, Re: inmate Medical Cost Containment, April 1, 2015 - June 30, 2015 2015. http://www.ncleg.net/documentsites/committees/JointAppropriationsJPS/Reports/FY%202014-15%20Mandated%20Reports/DPS_Inmate_Medical_CostContainment_Q4_Apr-Jun%202015_DOP_2015-07-17.pdf. Accessed November 10, 2016.
- 25.Bainbridge AA. White Paper: the affordable care act and criminal justice: intersectoins and implications. 2012; https://www.bja.gov/Publications/ACA-CJ_WhitePaper.pdf. Accessed May 10, 2013.
- 27.Pew Charitable Trusts, John D. and Cathertine T. MacArthur Foundation. State Prison Health Care Spending. 2014; http://www.pewtrusts.org/~/media/assets/2014/07/stateprisonhealthcarespendingreport.pdf. Accessed May 24, 2016.