Like inmates throughout the country, most people entering the Louisville Metro Jail lack health insurance and many suffer from long-untreated chronic conditions.
At least partly as a result, some people, particularly those with serious mental illness and drug or alcohol addiction, keep getting re-arrested and returning to jail, increasing costs to taxpayers.
Louisville Metro Corrections Director Mark Bolton saw an opportunity when Kentucky expanded Medicaid in 2014 to cover low-income adults. With support from Mayor Greg Fischer, Bolton hired a full-time Medicaid enrollment staffer in December 2014 to sign up people during the jail intake process. That way, they could more readily access needed care, including behavioral care and medication-assisted addiction treatment, after release.
Then last year, Bolton launched a related program for “familiar faces”—those who are homeless, suffer from mental illness and/or addiction, and repeatedly are picked up on public nuisance-type charges. On release, they are given a backpack containing medications, basic clothing items, hygiene supplies and bus tickets, and staffers transport them to shelters or clinics. It's based on a program begun at Cook County Jail in Chicago.
Nationally, 42% of state prison inmates report both mental health and substance-abuse disorders, research shows. Other studies have found that providing good services to released inmates charged with minor crimes can reduce re-arrest and re-incarceration rates by 90%.
Nevertheless, thousands of people eligible for Medicaid are leaving jails and prisons without being signed up for coverage, increasing the chances of poor health outcomes and a return to incarceration, experts say.
Some local jails, including those in Chicago, Tucson, Ariz., and Albuquerque, have launched initiatives to increase the number of inmates who have Medicaid when they are released. But there are tough challenges, including poor coordination between local jail authorities and state Medicaid agencies, lack of funding to hire enrollment assisters, and chaotic conditions during jail intake, said Maureen McDonnell of the Chicago-based not-for-profit Treatment Alternatives for Safe Communities. In addition, there is sometimes political opposition to offering public health insurance to accused lawbreakers.