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The Boston Globe

Health & wellness

Change proposed in inmates’ health coverage

Massachusetts is poised to join a dozen states that are reaping millions in federal dollars for prisoners’ health care and possibly also reducing the risk that released inmates will reoffend.

All that is required is a change in state law governing the Medicaid program. The proposed change, now before the Legislature, would permit the state to suspend Medicaid coverage of inmates in jails and prisons, instead of terminating it after arraignment, as is now required.

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It sounds like a minor tweak, but the implications are large. If coverage is suspended, when an inmate needs to be hospitalized for more than 24 hours, Medicaid pays the bill instead of the jails and prisons and the state gets at least half the money reimbursed by the federal government.

Equally important for proponents of the change, inmates’ health coverage would immediately be reinstated upon release, removing an obstacle to services such as mental health and substance abuse treatment, which can help them adjust and stay out of trouble.

“When you talk about controlling costs, providing better health care, and reducing recidivism, this is a winner on every level,” said Middlesex Sheriff Peter J. Koutoujian, who has championed the proposal.

The US Centers for Medicare & Medicaid Services has allowed states to suspend inmates’ Medicaid coverage since 1997, but only 12 did so. One, North Carolina, reported reaping $10 million in 2011, the first year of the program.

Now, in states choosing to expand Medicaid under the Affordable Care Act, many inmates have access to coverage for the first time, making the potential for federal reimbursementthat much greater. The Medicaid expansion encompasses low-income childless adults, and the federal government will pay 100 percent for those who are newly eligible.

In Massachusetts, with barely 3 percent of the population uninsured, the change is still expected to make a big difference, because a high proportion of the uninsured are believed to be people involved with the criminal justice system.

State Auditor Suzanne M. Bump advised legislators in a June 12 letter that Massachusetts could “realize significant annual cost savings” if it adopted the change and enrolled inmates in Medicaid.

Koutoujian estimates that 25 percent of inmates in the Middlesex House of Correction are uninsured and that the vast majority are eligible for Medicaid. If the bill passes, he plans to enroll eligible inmates in Medicaid upon arrival and immediately suspend their coverage.

Koutoujian, a former state representative who had chaired committees focused on health care, said that asking inmates to fill out a form upon release and wait for eligibility determination is unrealistic for people already overwhelmed looking for work and a place to live.

“When you’re reentering society from a period of incarceration, every speed bump is a major hurdle,” he said.

Forty percent of inmates in Koutoujian’s charge suffer from a mental illness, and 80 to 90 percent report drug or alcohol addiction, he said, making it urgent for them to connect with caregivers shortly after release.

The proposed change is being considered by the legislative conference committee now working to reconcile the House and Senate versions of the fiscal 2015 budget.

The committee, expected to complete its work in the next few days, has two versions before it: a Senate bill that would require suspension of inmates’ Medicaid coverage and require that uninsured inmates eligible for Medicaid be enrolled; and a House bill that only calls for a study of the issue.

Koutoujian noted that the sponsors of the legislation — Senator Patricia D. Jehlen, a Somerville Democrat; and Representative David T. Vieira, an East Falmouth Republican — come from opposite ends of the ideological spectrum.

MassHealth, as the Medicaid program is called in Massachusetts, does not comment publicly on bills before the Legislature. But Jehlen said the agency has no objection.

“I’m optimistic; there’s significant possible savings and no known opponent,” Jehlen said. “It’s not just saving money, although I expect significant savings. It’s good public health, and it’s good for people who are trying to get over substance abuse or mental health problems. And there are a lot of those in our correctional facilities.”

The bill has the support of the Massachusetts Sheriffs’ Association. The 14 sheriffs run the jails, housing about 4,300 people awaiting trial, and the county houses of correction, with about 5,300 men serving sentences averaging about two and a half years.

Inpatient health care is a major and unpredictable cost for the system. In Middlesex County alone, inmate medical care totaled $7.4 million in the 2013 fiscal year. Less than $2 million of that could have been billed to Medicaid if coverage suspensions were allowed, Koutoujian’s staff said.

The Department of Correction, which runs the state prisons housing just over 10,000 inmates serving longer sentences, spent $98.6 million on inmate health care in 2013, and annual hospital costs vary from $5 million to $10 million.

Felice J. Freyer can be reached at felice.freyer@globe.com . Follow her on Twitter @felicejfreyer.
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