Mass Incarceration: Implications for Post-Incarceration Exchange Purchase of Insurance

Just in case it crossed your mind while reading my two previous posts, it is probably important to know up front that the incarcerated may not use the exchanges to purchase health insurance. For this purpose, however,"incarcerated" has a fairly narrow meaning: excluding probation, parole, or home confinement. In addition, you are not incarcerated if you are in jail or prison pending disposition of charges. Still, the interpretation of ACA Section 1312's language stating that a prisoner "shall not be treated as a  qualified individual, if at the time of enrollment, the individual is incarcerated, other than incarceration pending disposition of charges" has generated a fair amount of confusion.

Many of the imprisoned, on the county jail level, are essentially transitory in that status. The relatively long fuse on applying for health insurance through the exchanges or Medicaid, for that matter,  and then the wait for actual enrollment, probably made this seem mostly a theoretical concern from the perspective of an entity seeking to lower its own correctional health care costs  Of course, if the emphasis were on preparing the incarcerated individual for re-entry, jails would be a clear point of contact for newly eligible individuals for both exchange purchased and government funded health insurance.

As the National Association of Counties points out,  it might be difficult to identify a population more in need of behavioral health services, for example, than the currently imprisoned. For that reason alone, county jails and all correctional authorities ought to be priority locations for assistance in applying for health insurance coverage, whatever the source.  An estimated fifty percent of prison or jail inmates have a mental health problem. Not surprisingly, an untreated mental health problem marks a prison or jail inmate as more likely to have been involved in a fight inside the facility since incarceration. As one group of authors so poignantly asked: When Did Prisons Become Acceptable Mental Healthcare Facilities?  Or, for that matter, when did prisons become unacceptable mental healthcare facilities?  Are they really healthcare facilities at all?

Post-incarceration, the same individuals may be eligible for subsidized exchange purchase. The recently released have a sixty day special enrollment period. After that, it is necessary to wait for the next exchange open enrollment. 

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