Nevada one of few Medicaid expansion states to terminate inmate benefits

A measure before state lawmakers could help connect individuals released from Nevada’s jails and prisons with the health care and other services they need to succeed on the outside. 

The National Sheriffs’ Association says more than half of the individuals taken into custody each year have a substance abuse disorder. Mental health issues are also prevalent. But a state policy that terminates Medicaid coverage of the incarcerated delays access to medication and other essential services upon release.   

“It’s a very vulnerable time,” state Sen. Joe Hardy, a medical doctor, testified Tuesday before the Senate Health and Human Services Committee. “They are at risk for recidivism.”

The Medicaid Inmate Exclusion Policy is a federal law that prohibits states from using Medicaid matching funds for incarcerated adults and juveniles, except those hospitalized off-site for more than 24 hours.  

But some states, primarily those that expanded Medicaid under the Affordable Care Act, have adopted policies that suspend, rather than terminate coverage, resulting in quicker resumption of benefits for individuals released from custody.  

Nevada is not one of those states. In fact, it’s one of only five with expanded Medicaid coverage to terminate, rather than suspend benefits for the incarcerated.

Senate Bill 93 would allow the state to suspend coverage and lift the suspension immediately upon an inmate’s release from jail or prison.  A similar measure in 2019 died after passing out of committee. 

“It’s good for the prisoner who gets out and it’s good for the state because we save money,” Hardy testified. 

The Advisory Commission for Nevada’s 2019 Justice Reinvestment Initiative recommended “requiring pre-release enrollment for eligible offenders for Medicaid and Medicare to assist
individuals released from custody with medical and mental health conditions.”

Connecting individuals with the services they need is crucial to avoiding recidivism, say local government officials involved in a legislatively-mandated study of homelessness.  

“Access to medication, to supports, to housing — just essentially linking people to a system of care as quickly as possible as they are discharged from the correctional setting is very important in trying to address those factors driving recidivism,” Clark County Director of Government Affairs Joanna Jacob testified before lawmakers. 

“Often times what we’ve seen is when they’re released from our facility and have not been able to have their Medicaid reinstated, they turn to those other illegal substances trying to medicate themselves,” Washoe County Sheriff Darin Ballaam testified. “Suspending, as opposed to terminating, will greatly improve continuity of care and outcomes for inmates.” 

Ballaam said the Washoe County jail currently processes six to 15 applications a day for Medicaid or SNAP benefits for inmates about to be released.  

“By the time they’re released from our facility, their Medicaid has been reinstated,” he said. “We truly believe its incumbent upon us in an effort to reduce recidivism and get back on the road to recovery.” 

Incarcerated adults have higher rates of HIV/AIDS, sexually transmitted diseases, hepatitis B and C, and tuberculosis, according to the National Commission on Correctional Health Care, but eligibility for Medicaid among the formerly incarcerated varies by state, depending largely on the status of expanded coverage.  

The Government Accounting Office estimated in 2014 that 80 to 90 percent of inmates in Colorado and New York, which expanded Medicaid, were eligible for coverage, compared with two percent in North Carolina, which had not. 

Terminating Medicaid coverage is especially problematic for those temporarily held in jail. 

A number of states impose limited suspensions, which prevent individuals held in jail pending charges or trial, from losing coverage pre-conviction. The bill before legislators contains no such provision.  

Medicaid enrollment sometimes requires forms of identification not available to the incarcerated.  Some states allow temporary enrollment until ID can be obtained and a full application completed, according to a 2018 report on Medicaid and prisons.