Policy solutions to end gaps in Medicaid coverage during reentry after incarceration in the United States: experts’ recommendations

Abstract

Aims

We sought to gather experts’ perspectives on Medicaid coverage gaps during reentry to identify high-yield policy solutions to improve the health of justice-involved individuals in the United States.

Subject and methods

We interviewed 28 experts at the intersection of Medicaid and criminal justice via telephone between November 2018 and April 2019. Interviewees included Medicaid administrators, health and justice officials, policy makers, and health policy researchers. We performed thematic analysis of semi-structured interview transcripts to identify emergent themes and distill policy recommendations.

Results

Three themes emerged: 1) Medicaid coverage gaps during reentry contribute to poor health outcomes and recidivism, 2) excessive burden on justice-involved people to re-activate Medicaid leads to coverage gaps, and 3) scalable policy solutions exist to eliminate Medicaid coverage gaps during reentry. Policy recommendations centered on ending the federal “inmate exclusion,” delaying Medicaid de-activation at intake, and promoting re-activation by reentry. Experts viewed coverage gaps as problematic, viewed current approaches as inefficient and burdensome, and recommended several policy solutions.

Conclusion

By pursuing strategies to eliminate Medicaid gaps during reentry, policymakers can improve health outcomes and efficiency of government spending on healthcare, and may reduce cycles of incarceration.

Semi-structured interview guide

Greetings, thank you for taking the time to speak with me today. As I mentioned in my email invitation, researchers from UCLA are conducting a research study to identify policy solutions to eliminate gaps in Medicaid when youth are exiting juvenile detention facilities.

I will now read you a consent script, at the end, can you please answer yes or no if you are willing to participate? This consent will be recorded along with the interview (read script).

• 1. Would you please tell me a bit about your current occupation?

  • a. What are your additional experiences relevant to Medicaid and/or juvenile justice?

• 2. Please tell me about how Medicaid re-enrollment is handled in your county/state

  • a. What are problems you see with how Medicaid re-enrollment is handled?

  • b. What is working well with how Medicaid re-enrollment is handled?

  • c. To what extent do you see reducing gaps in Medicaid coverage as a priority?

  • d. What happens with CHIP (if different)?

• 3. What do you think of the following proposed solutions (feasibility [cost, infrastructure, legal barriers]/ logistics/ policy window/ unintended consequences/ priority/ level):

  • a. Medicaid off switch:

    • a) End inmate exclusion

    • b) Suspension only (federal, state, or CHIP suspension for California)

    • c) Continuous eligibility

    • d) Wait longer to turn off

  • b. Pre-release:

    • a) Assist re-enroll prior to release

    • b) Make re-enrollment pre-release easier

    • c) Leave with Medicaid card

    • d) Reduced sentences for completing Medicaid application

    • e) Care coordination and health navigation education

  • c. Post-release:

    • a) Prescription for covered medication or medication supply at release

    • b) Assist families with re-enrollment post-release (or new enrollment)

    • c) Presumptive eligibility (one month)

    • d) Faster reinstatement [faster eligibility determination, short form application]

    • e) Acceptance of alternate forms of ID for Medicaid re-enrollment

    • f) Care coordination post-release

  • d. Other:

    • a) Integrative data system/ computerized re-activation

    • b) State task force

    • c) Other suggestions

• 4. Focusing on state level solutions:

  • a. Which of these solutions can be best addressed through state legislation?

  • b. What state legislative policy solution would you prioritize for California?

  • c. To what extent are solutions the same across states?

  • d. Are there other legislative priorities regarding Medicaid or CHIP coverage for youth post-incarceration? [federal, other states, county]

• 5. Any other thoughts?

• 6. Are there any other resources you suggest?

• 7. Who do you recommend we speak to next from (POSITION or PLACE)?

• 8. Is it okay if we contact you again if we have questions?

Thank you!