Why Expanding Medicaid Coverage To Prison Inmates Will Save States Money


New enrollment data suggests Obamacare’s optional expansion of Medicaid could actually lower costs for states by helping a population in great need of health care: prison inmates.

Under the expansion, 21 million low-income Americans are now eligible for health insurance — and 35 percent of those people are either current inmates, or currently on parole or probation. For instance, the Cook County Jail in Chicago has submitted more than 4,000 applications for its inmates since the start of this year. In the Portland area, over 1,200 inmates are now enrolled. If all states followed suit, over 7.3 million current or former prisoners would have health insurance.

Not everyone is excited about the idea of inmates gaining coverage. In April, a Fox News contributor characterized giving inmates Medicaid as “ridiculous and unfair to every taxpayer,” saying it’s a “loophole of Obamacare” that makes “absolutely no sense.” However, ensuring that inmates have access to health care when they leave jail will ultimately be a financial benefit to states that implement expansion.

In California, where prisons are some of the most expensive in the country, it costs around $47,102 a year to house an inmate, and over a quarter of these costs are for health care alone. It costs the state a far lower sum — just $3,558 — to provide an individual with Medicaid. Even in states with lower prison costs, keeping an inmate in jail usually costs tens of thousands of dollars, while the national average cost for states to provide one person with Medicaid is just $5,352.

And that Medicaid cost can be offset even further by lowered emergency room costs. Emergency room visits, which previously-uninsured Americans often use in the place of regularly seeing a health care provider, are extremely expensive. But when low-income inmates have access to insurance, they may go to emergency rooms less. Reports coming out of the Transitions Clinic, a program that started in 2006 to help newly released prisoners access health services, show that people who went to the clinic had 50 percent fewer visits to the ER than people who didn’t go to the clinic.

Providing health care to inmates could also help lower the rate at which previously released prisoners are rearrested, called the “recidivism rate.” The national recidivism rate has remained around 40 percent for years. If states reduce their recidivism rates by just 10 percent, they could save a combined $635 million each year in averted prison costs, according to a Pew Research study — and Medicaid expansion could help them get there. In Maryland, the amount of inmates who return to prison has dropped 11 percent since the state’s prison system implemented an initiative to increase access to medical and mental health services.

Access to health care after prison is especially important because prisoners are much more likely to suffer from chronic health conditions and mental health issues. According to the Bureau of Justice Statistics, 64 percent of state and federal inmates meet the criteria for mental illness, compared to just 25 percent of the general population. Though provided health care in prison, inmates with mental health problems are often subjugated to extended stays in solitary confinement, which often leaves prisoners worse off when they leave.

Before health reform, some released inmates found they actually had better access to health services while in prison (where the Supreme Court says lack of adequate health care constitutes cruel and unusual punishment) than in the outside world. Some have gone as far as to commit crimes in order to go back to prison to benefit from health services, because, without Medicaid expansion, they didn’t have the money or employment opportunities necessary to access insurance for treatments.

Only 26 states and the District of Columbia have implemented the Medicaid expansion, while the rest currently refuse. The states that have chosen not to expand are limiting millions of low-income people from accessing health insurance, and are actually costing themselves millions in federal funds by doing so.

Shannon Greenwood and Abigail Bessler are interns at ThinkProgress.