Affordable Care Act brings crucial health coverage to jail population

March 3, 2014, George Washington University

Under the Affordable Care Act, an estimated 4 million people who have spent time in jail will have better access to health coverage for conditions that might—if left untreated—result in higher health care costs and an increased risk of recidivism. That's the conclusion of an analysis by researchers at the George Washington University School of Public Health and Health Services (SPHHS).

"Health reform gives people with a history of jail time access to continuous care for the first time ever," says lead author Marsha Regenstein, PhD, who is a professor of health policy at SPHHS. "The hope is that such coverage will help keep individuals and entire communities healthier and reduce the nation's ." The report appears in the March issue of the journal Health Affairs.

Jails, unlike prisons, typically house offenders who have been detained or arrested by the police—often for misdemeanors or nonviolent crimes. In many cases, people who are mentally ill, have substance use problems or are homeless and picked up and sent to jail for a short period and then quickly released back into the community. Without follow-up care or treatment they are at risk of another arrest and the cycle repeats, according to the authors of the new report.

Counties, cities and other localities operate more than 3200 jails across the nation and they are responsible for providing some level of health care to inmates while they are incarcerated. "The Affordable Care Act doesn't change that responsibility but it does mean that many in the jail population will be able to get before and after time spent in the local jail," said co-author Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at SPHHS.

Medicaid does not provide coverage for people serving time in jail. The Affordable Care Act does nothing to change that situation. However, under the ACA people with a history of a jail stay may be eligible for Medicaid coverage upon release—particularly if they live in a state that has opted to expand its Medicaid program.

According to the analysis an estimated one out of six people expected to enroll in Medicaid under the new state expansion programs will have spent some time in jail during the past year. To date, 25 states and the District of Columbia have expanded Medicaid programs to cover more of the low-income population.

And this report says another one out of ten people enrolling in health plans under the insurance Marketplaces will have a history of a recent jail stay. Under the ACA, people who are poor but still do not qualify for Medicaid can often purchase an affordable by going to the online insurance Marketplaces.

The promise of continuous coverage would mean that people with serious mental illness or substance abuse might get medication and treatment that would help them stay off the streets—and possibly out of situations leading to an arrest in the future. About 64 percent of people incarcerated in jails meet the criteria for mental illness at the time of their booking and the same high number have problems related to alcohol or drug abuse, the authors note.

But such positive outcomes can be expected only if community jails, insurers, and health care providers work together to coordinate services so that people coming out of jails can sign up for Medicaid or a qualified health plan and then get an appointment quickly at the local clinic or health care provider, Regenstein said.

In some cases, jails identify chronic health problems and provide for inmates. But they rarely connect with or have ties to providers in the community, Regenstein says. Without those ties and the resulting treatment inmates can be released with an infectious disease or health problem that goes unaddressed and then worsens or even spreads to others.

While most jails still rely on paper records, the use of electronic information exchanges could help ensure a healthy and smooth transition to the community, the authors contend. Such electronic health records could follow the patient once they are released or vice versa. Providers in jail or in the community could then follow-up on a patient's chronic condition such as diabetes or asthma and ensure that medications or treatments are available before, during or after a jail stay.

Finally, jails are realizing they must work closely with Medicaid offices and health insurance navigators in order to identify and enroll people who qualify for health plans. The challenge is that jails have limited staff or resources for this kind of outreach, the authors said. There are also many logistical barriers that make it hard for jail inmates to produce the kind of documentation they need to qualify for and enroll in a new health plan.

The authors conclude that the opportunities offered by the ACA for this population outweigh any barriers and could benefit not just individuals but entire communities. "Enrolling people who are to be released from jail will require substantial effort and resources," says Rosenbaum. "However, this investment will pay off in terms of better health, reduced costs and possibly the reduced risk of additional time."

Explore further: CWRU researcher finds released inmates need reentry programs to meet basic and mental health needs

More information: The report, "What the Affordable Care Act Means for People with Jail Stays," appears in the March issue of Health Affairs: … nt/33/3/448.abstract

Related Stories

CWRU researcher finds released inmates need reentry programs to meet basic and mental health needs

January 6, 2014
When inmates with severe mental illness are released from jail, their priority is finding shelter, food, money and clothes. Even needs as basic as soap and a place to bathe can be hard to come by for people leaving jail, ...

ACA brings legal immigrants opportunities as well as responsibilities

December 16, 2013
The Affordable Care Act (ACA) does not expand access to health insurance for undocumented immigrants but may pave the way for many legal immigrants who have trouble obtaining this crucial coverage, concludes a report released ...

Over one million community health center patients will remain uninsured and left out of health reform

October 16, 2013
A new report by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University School of Public Health and Health Services (SPHHS) examines the impact of health reform on community ...

HIV-infected women experience worse treatment outcomes after release from jail

January 22, 2014
(Medical Xpress)—A Yale study has uncovered significant gender differences in the treatment outcomes of HIV-infected jail detainees who are transitioning to life outside jail, with women faring much worse than men. The ...

After committing a crime, guilt and shame predict re-offense

February 11, 2014
Within three years of being released from jail, two out of every three inmates in the US wind up behind bars again—a problem that contributes to the highest incarceration rate of any country in the world. New research suggests ...

New report looks at how states' restrictions on ACA implementation are affecting access

January 14, 2014
The first study to gauge the impact of state restrictions on the roll-out of the Affordable Care Act (ACA) indicates that community health centers across the country are engaged in an intensive effort to find and enroll eligible ...

Recommended for you

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

Can muesli help against arthritis?

January 15, 2018
It is well known that healthy eating increases a general sense of wellbeing. Researchers at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) have now discovered that a fibre-rich diet can have a positive influence ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.