State Division of Corrections officials project having inmates on Medicaid has saved the division more than $1 million in medical treatment for inmates this year so far.
The Division has been signing up eligible inmates for Medicaid since January 2014, when West Virginia expanded its program to cover those who make up to 138 percent of the federal poverty line, a provision of the Affordable Care Act. Medicaid will pay for treatment of inmates only after they have been admitted to a hospital for more than 24 hours.
So far, 367 inmates have signed up for Medicaid once they've been in the hospital for more than 24 hours, Debbie Hissom, health services administrator for the Division of Corrections, said earlier this month.
Hissom said the division has saved a projected $1.15 million from January until July.
“We use the approximate cost of inpatient hospitalization, which is $1,600 per day, to arrive at our projected savings,” she wrote in an email to the Gazette-Mail. “These are only projected, as the billing process takes quite a while, and Medicaid can always come back and deny certain claims, causing DOC to have to pay them.”
Once a person is enrolled in Medicaid, the program will pay retroactively for their last three months of care.
The Division has also saved money on its medical contract with Wexford Health Services, which previously paid for all inmate hospitalizations up to $5,000 per inmate per year, Hissom said. Quantifying how much the Division saved on the contract is difficult, Hissom said.
“The inpatient hospitalization portion of our contract was $2.3 million,” she said. “So technically, I guess the most correct answer would be that we saved $2.3 million on that portion of our contract: however, our contract actually increased due to other things.”
The Division of Corrections also has been helping inmates sign up for Medicaid ahead of their release or parole, Hissom said. As of earlier this month, 670 parolees or released inmates had signed up for the program.
“When they leave, the case manager and supervisor meets with them about 30 to 60 days out from discharge and they will help the inmate sign-up online with [the state's benefit sign up website] wvinroads.org,” Hissom told the Gazette-Mail in June. “That way when they get home they have their Medicaid card waiting for them.”
Because they don't have an income while in prison, all of the inmates are generally eligible for Medicaid.
“All the inmates are eligible as far as we know, until they're circumstances change,” Hissom said. Some of the inmates are on work release but most still qualify for the program, she said.
“Most work-release status, paroling, or discharging inmates are eligible,” she said. “If they are not, it is typically due to either their employer offering insurance, or having insurance through a spouse, not meeting income requirements, etc.”
Inmates can and often do refuse the service, though, Hissom said.
Correction officials and health policy analysts have said Medicaid might be a help in driving down recidivism rates. They reason that with more access to mental and substance abuse treatment, former inmates may not commit crimes that land them back in prison.
“One of the drivers behind a criminal history, directly or indirectly, is a substance abuse problem,” Jim Rubenstein, commissioner of the state Division of Corrections told the Gazette-Mail in 2014. “[Medicaid coverage] could make a critical difference, by having some kind of coverage that would gain these individuals access to needed treatment or counseling. And while we know that substance abuse is a big issue, to have coverage for basic medical care could also make a difference in their lives as well.”
In Michigan, recidivism rates fell after an program was implemented that links newly released prisoners to a medical home that helps them get medication and care, according to the Kaiser Family Foundation.
It's too soon to say whether West Virginia's recidivism rates are going down, though. The state calculates recidivism rates by tracking the percentage of inmates who return to prison within the first three years of release. In recent years the recidivism has been varied slightly between 26 and 28 percent from year to year. The latest recidivism rate is 26 percent, and that number reflects the number of inmates released in 2012, before Medicaid was expanded.
For more reports about the effects of the Affordable Care Act in West Virginia, see this story on those whose income is too high to receive insurance subsidies, this one about how Medicaid acts as a “bridge” for some, and this story regarding state political leaders and their thoughts on Medicaid expansion in the future.