By Taylor Six
Lexington Herald-Leader
LEXINGTON, Ky. — On July 1, Louisa resident Amanda Hall celebrated 12 years in recovery from drug addiction.
The next day, coincidentally, the federal government announced that adults and children transitioning out of Kentucky state prisons and juvenile detention centers would soon have earlier access to something groundbreaking: Medicaid coverage.
The announcement was personal for Hall, who 13 years ago was a Medicaid recipient. That is, until she was imprisoned in a Kentucky jail, and eventually state prison. She lost access to Medicaid coverage and was forced into withdrawals during the limited health care coverage provided by the detention facilities.
The change would make Kentucky one of five states in the U.S. to offer state prisoners Medicaid coverage beginning 60 days before their release. The result could be “life-saving,” Hall said.
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“Medical care in (jail and prison) is beyond horrendous,” Hall, 40, said in a recent interview. Hall now works for Dream.org, a national organization that lobbies for policy reform on issues including prisons and climate change.
For now, federal rules bar jail and prison inmates from accessing Medicaid, the primary federal health insurance option for people with limited income and resources. Former prisoners can apply for Medicaid upon their release, but it can take weeks or even months for their applications to be processed.
The results can be fatal: Studies show that during the first two weeks after being released from jail or prison, people face a risk of death more than 12 times higher than that of the general U.S. population, with especially high rates of deaths from drug overdose and illness.
More than 23,000 men and women were incarcerated by the Kentucky Department of Corrections in 2020, according to a report from Medicaid services. Of those, 27% were receiving Medicaid when they were imprisoned. They all lost coverage upon incarceration.
State and federal officials hope the change, which would be granted through a waiver for Kentucky, Illinois, Oregon, Utah and Vermont, will help former prisoners adjust to life after incarceration and reduce the risk that they’ll land back in one of the facilities — or wind up sick or dead.
“We have got to work on the population that is going through the front door,” Eric Friedlander, secretary of Kentucky’s Cabinet for Health and Family Services, said in a recent interview. “These are the folks who are most vulnerable. … We are building on some of the stuff we have put in place that will continue to put people in a place where they don’t have to get back into the system.”
What has access looked like for incarcerated people?
When Medicaid was implemented in 1965 it featured an “inmate exclusion policy” that served as a federal prohibition on allocating Medicaid dollars for jail and prison inmates. The policy applies to all incarcerated people, regardless of whether they’ve been convicted.
All correctional facilities are required to provide access to health care for inmates in their custody. But the access — and quality — varies. The standard of care is determined at the state, county or facility level.
Former inmates like Hall can apply or reapply for Medicaid upon release from jail or prison. But in addition to a delay in processing times, they also face an onslaught of other essential tasks, such as getting a job, restoring family connections and securing transportation and housing. Obtaining health care can take a back seat.
But without health care, former prisoners often do not seek outpatient care, including treatment for substance use disorder or mental health conditions, leaving them with a significantly higher risk for emergency department use and hospitalization, studies show.
New waiver can serve as ‘access without delay’
The goal of the new waiver, which would apply only to prison inmates — not jail inmates, at least at first — is to provide people with services before their first day outside a detention facility. In Kentucky, services would include medical equipment, case management, medication and care coordination.
“If you don’t have insurance, how are you going to take care of those basic needs when it comes to reentry?” Hall said. “Folks who are incarcerated often suffer from mental health issues and substance use disorder, and discontinuation of medical health care can mean life or death.”
Friedlander described the services as providing inmates with a “guidance counselor on steroids.”
Emily Beauregard, executive director of Kentucky Voices for Health, which advocates for policy changes in health care, said she has been eagerly anticipating the change for years.
“This is a really critical time in their life,” Beauregard said. “If you want to make sure reentry is successful and they are able to take care of themselves and establish things they need to be successful, they need to have access without delay.”
While the Medicaid waiver and its implementation is a major step in treatment, there is still more work to do, Hall and Beauregard said.
The proposed waiver does not apply to Kentucky’s local jails, which house at least 89,000 people annually. It also does not apply to state prisoners who are housed in local jails — about 39% of the state’s prisoners, according to the Kentucky Department of Corrections.
But Friedlander and Beauregard said once the first few rounds of inmates are enrolled in Medicaid, they hope the program will expand, and local jails will participate too.
And Beauregard noted that, eventually, the suspension of Medicaid upon a person’s arrest could be lifted altogether.
“Keeping someone’s coverage active doesn’t mean you have to be spending that money,” she said. “You could still be, in a way, enrolled in coverage, but it is known to the system that you are incarcerated, and therefore, no services can be filled. A lot of people in jails would have more immediate access to care when they are released.”
When does the program begin?
Before coverage begins, the state must submit an implementation plan to the Centers for Medicaid Services. After the state gets implementation approval, Kentucky will cover a specific set of pre-release health care services, such as medication and care coordination.
The implementation plan will also outline the finer details of the state’s waiver rollout, including who will oversee the program at an individual level, be it case managers, hospital specialists or jail staff.
But it could be months before the change takes effect in Kentucky prisons.
Meanwhile, at the federal level, Medicaid officials are encouraging states to explore ways to use Medicaid money for “health-related social needs,” or economic barriers that affect a person’s ability to maintain their health and well-being.
Those types of programs, Beauregard said, can include food programs for people with dietary restrictions, installation of air conditioners for people with asthma, and providing working refrigerators.
The goal, federal and local officials say, is prevention and early intervention.
“I am really proud of Kentucky and people from different political parties coming together and formerly incarcerated people being a part of this,” Hall said. “Kentuckians deserve it — and second chances.”
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