However, the decision on funding remains in the hands of each individual state. Sheila Hagar of the Union-Bulletin in Walla Walla, Wash., recently ran a four-part series that examines health care for prisoners in her coverage area and touches on some problems that are common in most of the nation.
Hagar, citing the National Alliance on Mental Illness training manual, told the Rural Blog that NAMI says: "Medicaid is a joint federal and state program. However, federal Medicaid funds cannot be used to pay for services to people incarcerated in jails or prisons. Individual states, however, are not required to terminate Medicaid while residents are incarcerated. Instead states have the option of keeping individuals on the Medicaid rolls while jailed, even though federal Medicaid funds cannot be used. The advantage of keeping individuals on the Medicaid rolls is eligibility for services can be restored immediately upon release."
Washington, for example, "terminates Medicaid eligibility immediately upon incarceration in jail or prison," Hagar said. “'This forces individuals to reapply for these benefits when they are released from jail or prison, often resulting in long delays in obtaining vital treatment and services,' NAMI said, significantly increasing the risk of recidivism and re-incarceration. When Medicaid coverage is linked to Social Security benefits, that forces people to reapply for coverage, even when incarceration is for a brief period."
In Kentucky, "the state picks up on federal Medicaid funding for inmates, which will expand when health reform takes full effect," reports Molly Burchett for Kentucky Health News, which is published by the Institute for Rural Journalism and Community Issues, which also publishes the Rural Blog. Earlier this year Louisville jails signed inmates up for health coverage to save the state money, reports Kentucky Health News.
Davidson sites a report from the Government Accountability Office that says “The combination of expanded Medicaid eligibility and enhanced funding for those newly eligible as allowed under PPACA gives states additional incentives to enroll inmates in Medicaid and obtain federal matching funds and increases the federal responsibility for financing allowable services for inmates.”
"By expanding Medicaid to everyone who earns less than 138 percent of the federal poverty level, or about $15,000 a year for an individual, almost every state prison inmate in the country—about 1.5 million people—would qualify for Medicaid if they needed treatment outside prison," Davidson writes. "If every state expanded Medicaid, millions of inmates, probationers and parolees nationwide could be placed on the Medicaid rolls as a result of Obamacare."
Hagar touches on these issues in her series. "When people are processed into the Walla Walla County Jail, many arrive with mental health problems on top of their legal ones," Hagar writes. "Most lose their Medicaid benefits, meaning their health care must be covered with local taxpayer dollars when inmates’ families cannot pick up what can be a hefty tab." The jail spent $102,310 on medical costs in 2013, down from $203,682 in 2011, and one main reason is poor funding.
Another problem Hagar uncovered is that prisoners are not receiving necessary care. "Corrections facilities across the country are tasked by law to provide inmates minimal civil rights," Hagar writes. "But that mandate is muddied by a lack of guidance, no state statues and no definition of minimum requirements in setting such a standard, said Jim Bloss, who serves on the policy board of the National Alliance for Mental Illness in Washington state." In another story Hagar examines the plight of a woman to receive mental health care for her son.
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