1/19/2014

Look who the few people getting health insurance through Obamacare are!: Obamacare picking up the tab for prison inmates

This last week has shown real errors in Obamacare enrollment numbers.  The Obama administration claims that 1.9 million people enrolled in October or November in states due to expanded Medicaid coverage, but actual Medicaid enrollment due directly to the ACA’s expansion of Medicaid was probably only about 190,000.  The difference is that the Obama administration claimed people who were normally enrolling in Medicaid were counted in the Obama total.  Even Glenn Kessler at the Washington Post has this headline: "Warning: Ignore claims that 3.9 million people signed up for Medicaid because of Obamacare."

From OregonLive:

Multnomah County officials expect national health care reform to cut the county's medical bills, too. 
By enrolling jail inmates in nationally subsidized healthcare -- best known as "Obamacare" to both the President and his critics -- the county could bill the federal government for the cost of providing some of them medical care. 
County health department officials briefed Multnomah County commissioners on the issue this week. . . .
The National Association of Counties is pushing other counties to adopt this policy as a way to shift their costs onto the federal government.

The ACA’s significant expansion of health insurancecoverage has many important implications for counties, as county governmentsprovide the local health care safety net infrastructure, public health functionsand other health care services, as well as often govern, finance and operate localcoverage and enrollment programs.  Counties also run and finance local jails, which are responsible for providing health care coverage for the approximately 13 million individuals who are booked into these facilities each year. . . .
There is a specific ACA provision related to the exchanges that could significantly impact county jails, which states that “an individual shall not be treated as a qualified individual, if at the time of enrollment; the individual is incarcerated, other than incarceration pending disposition of charges.”  This provision will likely allow eligible individuals in custody pending disposition of charges to enroll in a health insurance plan offered through an exchange prior to conviction, or maintain coverage if they are already enrolled. . . .  Additionally, as counties are responsible for providing health care services for county jail inmates and the overwhelming majority of individuals in jails lack any type of health insurance coverage, this provision could potentially reduce county jail health costs. . . . 
While federal law does not allow for the reimbursement of  inmate medical care under Medicaid, there is an important exception to this rule.  Specifically, the exception states that federal financial participation (FFP) is permitted “during that part of the month in which the individual is not an inmate of  a public institution.” 1 The Centers for Medicare and Medicaid Services has verified through guidance letters issued in 1997 and 1998 that this exception applies to incarcerated individuals once they are admitted as an inpatient in a hospital, nursing facility, juvenile psychiatric facility or intermediate care facility that is not part of the state or local correctional system.   Therefore, if an inmate is eligible for Medicaid and is  transported out of a correctional facility to receive inpatient  hospital services, Medicaid can be billed to cover the cost of these services. . . . 
Thus counties are not just being advised on how to get the federal government to pick up the tab for their healthcare costs, but they are also being encouraged to handle any health care costs in what in many ways could be more costly than if the county jail took care of them itself.

Here is a note from the Association of County Commissions in Alabama.

. . . Some national groups would like to see local county jails be enrollment centers for a new population that will become eligible for Medicaid benefits.  While some county jails across the country have enrolled individuals leaving custody of the county jail as part of a re-entry program, it is not a requirement. 
Also, for these individuals to be eligible for enrollment for Medicaid benefits while they are incarcerated, they cannot be convicted of a crime or sentenced and awaiting transfer to state prison.  They must be pre-trial inmates. 
These questions arise because the ACA will expand eligibility Medicaid benefits to individuals that are up to 65 years of age and are living at 133 percent of the federal poverty level.  Individuals in this group of people may find themselves entering into the criminal justice system through the local county jail.  While this group of people may be eligible for or enrolled in Medicaid, Medicaid will not pay for any medical treatment while the individual is incarcerated. . . .
Total enrollments may be some place about 200,000 to 300,000 versus the 3.9 million.  If the national number of people in jail over the course of a year is 13 million and a quarter of the year is 3.25 million (October, November, and December), you need just a trivial percentage of them (between 6.2 and 9.2 percent) to sign up to cover the entire 200,000 to 300,000.

So how big are the enrollment changes from prison and jail in the past de-enrolling people from Medicaid.
The survey, published online today in the American Journal of Public Health, evaluated Medicaid policies from December 2011 to August 2012 at 42 state prison systems. According to the results, 66.7% of the prisons terminated enrollment and 21.4% suspended inmates from Medicaid when they were incarcerated. However, two-thirds of these prisons also helped prisoners reenroll when they were discharged. . . . 
Rich and his colleagues questioned the policies to terminate coverage during incarceration as ACA provisions roll out. States with expanded Medicaid programs will cover all adults, regardless of whether they’re disabled or have dependents, up to 138% of the federal poverty level. Broader eligibility means more prisoners likely will be covered. But if their coverage is terminated, prisons can’t benefit from a 1997 federal law that allows Medicaid to cover inpatient care that inmates receive outside of the prison system, as long as they’re Medicaid eligible. . . .
So what happens if other prisons and jails across the country have done the same thing?  In 2012, there were 745,000 people in county jails and 1,484,000 in prisons.  If just 13 percent of people in jail or prison get enrolled in Obamacare, that would give you 300,000.  Even if just 5 percent are enrolled, would be 111,420 or more than a third of the top 300,000 estimate.

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