The Health Care Crisis in America’s Jails

Hyland: A 1965 U.S. law prohibits the use of Medicaid for care provided to prison inmates, including those booked into local jails. Hello, and welcome to Comcast Newsmakers. I'm Sheila Hyland. The Medicaid Inmate Exclusion Policy impacts not only those who are convicted, but those who are incarcerated prior to conviction, putting financial strain on county governments. Brian Namey, Chief Public Affairs Officer of the National Association of Counties, joins me to talk about this issue. And, Brian, thank you for being our guest.

Namey: Thank you, Sheila, for having me.

Hyland: This is a topic that many Americans may not be aware of. If you are jailed and not convicted, you automatically lose your federal health-care benefits. Why should every American be concerned about that?

Namey: That's right. When you are arrested, before you're convicted of any crime, you lose access to things like Medicaid, Medicare, children's health insurance if you're a juvenile, and even veteran's benefits. This is an issue because 90% of the people in those jails are gonna be going back into the communities, and if there is a disruption in their health-care coverage, they might end up worse than when they started because they're not receiving treatment for things like serious mental illnesses and co-occurring substance-use disorders.

Hyland: And as I understand it, there are a lot of jail inmates that do have a lot of needs. They may have addictions. They have a lot of mental health issues, other chronic illnesses. And how are the jails at treating them?

Namey: Jails were never designed to treat mental illnesses. That's why we're advocating for a change in this federal policy, because most people who are in those jails are gonna be leaving those jails. 95% percent of people in jails are leaving those jails at some point and going back into the community. And if their care is disrupted, when they go back into the community, they're likely to be end up back where they started to contribute to that revolving door of incarceration.

Hyland: And we should make a differentiation between jail and prisons, as well.

Namey: That's right. That's probably the root of the confusion when this federal policy was enacted back in the '60s. Prisons are primarily for people who have been convicted of a crime and serving sentences. We're talking about people who were arrested and go to jails. 90% of people in local jails, primarily owned by county governments, have not been convicted of any crime. And so we see this as a constitutional issue. We're stripping away federal benefits of people who have not gone through due process.

Hyland: And I, as I understand it, the majority of them are nonviolent offenders.

Namey: That's right. You know, somebody who has a serious mental illness might be pushing a shopping cart down the street and screaming at the top of his or her lungs. And because there have been a reduction of mental-health facilities in this country, in many cases, jails have become the largest behavioral-health centers in America.

Hyland: And you sort of touched on this earlier, but how does this contribute to the recidivism rate among jail inmates?

Namey: When people leave those jail facilities and they don't have the coverage they need, whether through Medicaid, Medicare, their veterans benefits, when those benefits are suspended, it can take weeks or months for them to have those benefits reinstated. And in that time period, they could end up worse than before they went into jail in the first place.

Hyland: And what's important to remember, too, is that all of this is putting financial burden on local counties across the U.S.

Namey: That's true. It's a huge financial burden to local taxpayers. It's a terribly inefficient use of taxpayer resources. But what's more than that, it produces poor outcomes for those individuals and their families.

Hyland: And so you have teamed up with the National Association of Sheriffs to try to tackle this problem and get the laws changed.

Namey: That's right.

Hyland: What do you hope to do?

Namey: About a year ago, we launched a task force with the National Sheriffs Association, and we hope to examine the direct impacts of this policy on communities across the country and county governments and advocate for a change in federal law that would allow Medicaid and other federal benefits to continue during incarceration pre-conviction.

Hyland: What kind of financial burden are we talking about exactly?

Namey: It's billions of dollars. I mean, county governments spend close to $180 billion a year on things like health care and the justice system. Billions of that is providing health care for those individuals who need those services.

Hyland: And is there a call to action for the general public?

Namey: Sure. We encourage every member of the general public to call their senators, call their members of Congress, and ask them to change this policy.

Hyland: Alright, Brian Namey, thank you so much for being our guest today. Appreciate it.

Namey: Thank you.

Hyland: And thank you for joining us. For more great conversations with leaders from your community and across the nation, visit comcastnewsmakers.com. I'm Sheila Hyland.