Assessing the Impact of the Affordable Care Act on the Previously Incarcerated Population
A Research Brief by: Tiffany Loh
The previously incarcerated population in the United States is not only disproportionately male, minority, and low income, but also much more likely to have physical and mental diseases compared to the rest of the population (Heiss, Somers, & Larson, 2016). They have the highest need for primary care but are historically the least likely to receive primary care due to their underserved status (Howard et al., 2016)
The Affordable Care Act brought the previously incarcerated an opportunity to achieve better health outcomes. Before the ACA, the majority of the previously incarcerated population was uninsured and typically received gaps in care. Most states terminated an individual's Medicaid coverage upon incarceration, putting a stop to many individuals' prescriptions and treatment as they re-entered society (Heiss et al., 2016). ⅔ of individuals who had previously been treated with psychiatric medication during incarceration had not taken medication since incarceration (Howard et al., 2016). Individuals were at greatest risk of overdose the first week after release, and overdose was the leading cause of death for individuals post-incarceration (Heiss et al., 2016).
Insurance Coverage and Health Care Utilization Post-ACA
With ACA Medicaid expansion in 32 states, a large portion of the post-incarcerated population became Medicaid eligible. Medicaid enrollment for post-incarcerated individuals jumped from 20% in 2010 to 63% in 2014 (Heiss et al., 2016). Since the expansion, many states pushed to suspend enrollment instead of cutting off Medicaid enrollment, making it easier for many incarcerated individuals to receive care upon release. However, coverage did not translate to better health care utilization outcomes. Data focused on young, previously incarcerated men (ages 18-44) showed that these individuals increased emergency department utilization and did not increase primary care utilization despite increasing coverage of primary care services (Winkelman et al., 2016).
Why did Medicaid expansion increase primary care utilization and decrease ED use for the general population, but not for the previously incarcerated (Sommers, Blendon, Orav, & Epstein, 2016)?
How can this change?
Even though the ACA intended to provide more stable care for this population, the previously incarcerated population is still not not receiving primary care services 7 years after enactment. However, the mandatory interaction between the previously incarcerated population and systems opens up an opportunity to change the tradition of emergency departments as regular sources of care.
Parole and probation officers need to engage in a health coach role (Medicaid.gov, 2015). When routinely checking up on the status of patients, they should promote the usage of primary care services and connect them with community health centers.
Applying Connecticut's model nationally, corrections systems should hire discharge planners that coordinate appointments for inmates with providers and provide prescriptions immediately post release (Ryan et al., 2016).
Coordination between Medicaid agencies and correctional facilities is the key to health for the previously incarcerated population. If correctional facilities work to improve education towards its inmates on the importance of primary care utilization vs. emergency department regular use, the narrative can be changed.