A simple change to state law could keep released inmates from returning to jail, overdosing on drugs or experiencing a relapse of mental illness, say advocates for two bills introduced in the Legislature.
Unlike most states, Missouri terminates Medicaid health care coverage when someone is incarcerated in jail or prison. In at least 35 other states, including Illinois, Medicaid enrollment is instead suspended and reactivated upon release from a correctional facility.
In general, jails and prisons pay the costs of medical care for inmates. Private insurance generally covers medical care during pretrial detention and post-release, and prisons can bill the insurance companies for eligible charges during incarceration.
The termination of Medicaid eligibility means Missouri youth or adults with disabilities can experience delays in medical treatments and prescription drugs when trying to reapply for coverage. States that only suspend Medicaid coverage during incarceration can reactivate the coverage more quickly, and with less paperwork and administrative oversight, advocates said.
“Because we know that the first few days and weeks after getting out of jail or prison are the most important in terms of access to health care, this time gap between application and approval of Medicaid is a key reason we are hoping to make the change to suspension (of coverage),” said Nicole Wemhoff, a law student at St. Louis University who works with the nonprofit Missouri Appleseed on the issue.
People who are incarcerated are more likely to experience mental health disorders, substance abuse, addiction and chronic illnesses, including asthma and diabetes, that may make them eligible for Medicaid, according to the federal Medicaid and CHIP Payment and Access Commission.
In Missouri, an estimated 14 percent of incarcerated men and 31 percent of incarcerated women have mental illness. A majority are believed to have substance use disorders including opioid addiction, according to the state Department of Corrections.
The percentage of inmates eligible for Medicaid government insurance is not known, but believed to be significant, said Dr. Jacqueline Landess, assistant professor of psychiatry at St. Louis University.
“Someone with schizophrenia, who may need monthly injections, those are the folks we worry about the most,” said Landess, who has treated inmates in the St. Louis County jail.
The problem is exacerbated in Missouri, which is one of 14 states that have not expanded Medicaid for impoverished people through the Affordable Care Act. In states that expanded Medicaid, many released inmates would be eligible for the government benefits based on income.
“You would see people released (in St. Louis County) … and I assume unless they had family members that were really involved in their care, they most likely went back out to the streets, with many of them ending up again if not in the jail, then in the emergency room,” said Landess.
Missouri is already one of the slowest states at processing Medicaid applications, with nearly half taking 45 days or longer. Only Georgia and Virginia are slower, according to a January report from the Kaiser Family Foundation.
The issue is gaining attention as Missouri health officials face questions about a large drop of more than 70,000 residents — including 56,000 children — from Medicaid enrollment in the last year.
“It is so hard to get approved for Medicaid,” said Mikel Whittier of the St. Louis Integrated Health Network. “Without that continuous care we see higher risks of people overdosing and other adverse health outcomes.”
The issue should be resolved this year at least for youth offenders in Missouri. Under the federal Support for Patients and Communities Act, signed by President Donald Trump in October, states must suspend rather than terminate Medicaid eligibility for anyone under age 21 and restore coverage upon release from jail as of October 2019.
The laws have the support of law enforcement, advocates said.
Rep. Lane Roberts, R-Joplin, a former police chief, introduced a bill in the Missouri House Wednesday that would suspend rather than terminate Medicaid eligibility for offenders in correctional facilities. Sen. Lincoln Hough, R-Springfield, introduced a similar bill in the state Senate earlier in February.
Christine Patterson, executive director of the National Alliance on Mental Illness-St. Louis called Missouri’s policy “an unnecessary hurdle” for the inmate population.
“It would certainly help to not have as much time to get back on their medication,” she said. “If 35 other states have done it, why aren’t we doing it?”