People returning from prison to the community have historically been uninsured, despite having physical and behavioral health problems that may perpetuate a cycle of relapse and reoffending. We describe Oregon's pre-Affordable Care Act (ACA) process to enroll released prisoners into its state-financed Medicaid program for childless adults. Sizeable numbers participated, including many with mental health and substance abuse problems. Persons leaving prison were as likely as the general population to submit Medicaid applications and less likely to be denied. Challenges arose when the application process straddled prison release, but the ACA simplifies the process and may increase enrollment efficiency.
Once inmates are released from prison, untreated health issues such as mental illness and substance abuse can contribute to a cycle of reoffending. Released inmates are typically low income and have high health care needs, but have been ineligible for Medicaid until its recent expansion under the Affordable Care Act (ACA).
In Oregon, a Medicaid program that existed before the ACA allowed otherwise ineligible inmates to apply for coverage after their release. National efforts to increase enrollment after inmates are released could lead to greater coverage and improved public health and safety. But did Medicaid eligibility effectively increase coverage in Oregon?
- A sizeable share of inmates were interested in Medicaid coverage. Those who registered for the application process were more likely to need mental health or substance abuse treatment than those who did not register. Registrants were also more likely to be female and white.
- Inmates who were invited to apply submitted applications at a rate similar to the general population. Whether or not they chose to apply depended heavily on the timing of their invitation. Those who were invited after release were less likely to apply.
- Inmates were significantly less likely to be denied coverage than the general population. Inmates are more likely to be poor and to meet the income and resource limits. Those who were denied were usually denied for missing the deadline or because they were still in prison when their application was reviewed.
- Eighteen percent of inmates registered for the state’s Medicaid lottery during their final six months in prison. Sixteen percent registered during the six months after release.
- Fifty-eight percent of prerelease and 55 percent of postrelease registrants needed mental health or substance abuse treatment.
- Thirty-three percent of invited inmates obtained coverage compared with 25 percent of the general population.
- Forty-one percent of invited inmates applied for Medicaid; 79 percent of them were found eligible and granted coverage.