By Melissa Santos
Prisons and jails in Washington are not only using the federal Affordable Care Act to cut their own health care costs, they're also signing up soon-to-be released inmates so their health care coverage begins as soon as they walk out the door.
The state Department of Corrections has an agreement with the state Health Care Authority that allows prisons to pre-enroll inmates in Medicaid 30 days before their release.
So does the Thurston County Jail, along with a community organization serving the jail in Spokane County, said Jim Stevenson, spokesman for the Health Care Authority.
Federal rules prohibit inmates from receiving Medicaid coverage while they are incarcerated, except for extended hospital stays. But by signing an agreement with the Health Care Authority, agencies can submit health insurance applications on behalf of inmates early, as long as Medicaid coverage doesn't actually begin until after the inmates are out.
Besides Thurston and Spokane, four jails in Clallam, Skagit, Stevens and Clark counties have agreements pending with the Health Care Authority that would allow them to pre-enroll inmates in Medicaid, Stevenson said.
The advantage of signing up inmates for Medicaid while they are still incarcerated is that prison or jail officials can help inmates complete the application, as well as ensure their health care coverage begins as soon as they're released, said Kevin Bovenkamp, the Department of Corrections' assistant secretary of health services.
"It really helps with re-entering the community," Bovenkamp said. "The more people can access health care, we're hoping that's going to drive down the criminal behavior out there and the recidivism." The Department of Corrections hired three new people -- whose combined salaries total $100,404 -- to process inmates' Medicaid applications. The agency submits Medicaid applications only for inmates who want the coverage, Bovenkamp said.
As of April 16, the DOC had enrolled 745 inmates in Medicaid pending their release, according to data provided by the agency. Of those applications, 582 had already been approved, a DOC spokeswoman said.
"Right now we're getting about 100 applications a week, and I think that will continue to grow," Bovenkamp said in an interview earlier this month.
Thurston County jail officials are focusing on enrolling inmates who have mental health problems or have chronic health issues, said Todd Thoma, chief deputy of corrections with the Thurston County Sheriff's Office. The Thurston County Jail had enrolled 25 inmates in Medicaid as of last week, Thoma said.
"Especially with the mentally ill, we want to enroll them because the likelihood that they're going to go outside the jail and enroll themselves is pretty limited," Thoma said.
Under the Affordable Care Act, many prison inmates are newly eligible for Medicaid. The federal health care reform law now extends Medicaid coverage to single, childless adults whose income is up to 138 percent of the federal poverty level.
Before Jan. 1, Medicaid coverage mainly applied to pregnant women, people with children, and the blind, disabled or elderly.
Ed Troyer, a spokesman for the Pierce County Sheriff's Department, said that the Pierce County Jail hasn't enrolled inmates in Medicaid yet, but is looking at ways to do so.
"We have asked Conmed (our new contract medical provider) to come up with a process to sign inmates up during the booking process," Troyer wrote in an email last week. "We will have a process in place soon. ... It's still being developed."
Mary Wood, section manager with the Health Care Authority's office of Medicaid and Medicare eligibility, said a written agreement--called a memorandum of understanding-- is necessary to set ground rules for the inmate pre-enrollment process.
Mainly, the Health Care Authority wants jails and prisons to promise they'll stop an inmate's Medicaid application if something delays his or her release, Wood said.
That way, an inmate who is still incarcerated doesn't end up getting enrolled in Medicaid or subsidized private insurance in violation of federal law, Wood said.
King County has been working to set up such an agreement, but doesn't have one in place yet, said James Apa, a spokesman for Public Health -- Seattle & King County.
Because of that, the King County Jail must wait until inmates are discharged to submit their Medicaid applications.
Through March, King County had enrolled 110 people in Medicaid through the jail, and had assisted an additional 91 people in determining their eligibility and starting applications, Apa wrote in an email.
Beginning the process earlier would help jail officials catch errors in inmates' applications, as well as help the jail direct inmates to places in the community where they can go for treatment, Apa said.
"We can connect with their established primary care provider, which provides continuity of care," Apa said.
Keith Seinfield, another spokesman for Public Health -- Seattle & King County, said that even if released inmates end up returning to jail after being enrolled in Medicaid, jails will still save money by helping them get treatment while they're on the outside.
"If they've been off their medication that whole time, it can be a lot more expensive to treat them those initial days in the jail," Seinfeld said.
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