Federal officials allow Oregon to offer Medicaid services to those behind bars

Certain Medicaid services will be offered to people 90 days before they are released from jail or prison. (Getty Images)

UPDATED at 3:05 p.m., July 3, 2024 with additional information from the Oregon Health Authority.

Federal officials have approved Oregon’s request to offer free Medicaid services for addiction and some other services to people who are on the verge of being released from jail or prison, something that’s prohibited by federal law.

The U.S. Department of Health and Human Services said Oregon will offer the new program, along with Illinois, Kentucky, Utah and Vermont. They’re joining California, Massachusetts, Montana and Washington state which first piloted programs offering some Medicaid services to people about to be released.

Inmates who meet Medicaid’s low-income limits will qualify for the program 90 days before their release from jail or state or tribal prison. They’ll be eligible for lab and radiology services along with mental health assessments and medications to treat opioid addiction and mental illness.

When people are jailed or imprisoned, they lose their Medicaid coverage, and they have to reapply once they’re out. That leads to health care gaps. Studies show that people who end up in prison or jail have higher rates than the general public of physical and mental illness, including hypertension, asthma, tuberculosis, hepatitis B and C and HIV, and higher rates of premature death from infectious and chronic diseases, drug use and suicide.

“For people involved in the justice system, ensuring a successful transition back into the community includes having the health care supports and services they need,” Health and Human Services Secretary Xavier Becerra said in a statement.

The program aims to provide a seamless health care transition as people try to rebuild their lives in the community. Being screened for mental health issues while still behind bars is expected to help them get counseling or other treatment more quickly when they’re out.

“Fifty percent of all people in Oregon prisons have been diagnosed with a disability or mental illness, which makes uninterrupted care really important,” Amy Bacher, an Oregon Health Authority spokeswoman, said in a statement.

The people who participate will benefit from case management, which means they’ll be assessed before their release and monitored once they’re out. State officials hope to get people enrolled with a regionally based Medicaid insurer, a coordinated care organization, as soon as they’re released, something that has been a challenge in the past.

Captain Lee Eby, jail commander at Clackamas County Sheriff’s Office, said the program marks a “gigantic step” toward rehabilitating people into the community.

“I have seen the effects of our current system where the gap experienced hinders desperately needed access to care and services for those leaving incarceration to continue down their path of recovery,” Eby said. “This funding will be a huge tool for jail and prisons in helping those incarcerated receive proper discharge planning for successful reentry into the community, ensuring the continuation of care for one of our most vulnerable populations.”

Lawmakers tackle issue

Approval of the program follows passage of House Bill 4002 by the Oregon Legislature. The law directs $211 million toward tackling addiction, including building new diversion programs for those who are charged with possessing a small amount of illegal substances. It also includes $10 million to screen people in jail for opioid addiction and to treat them with medication so that they can stabilize their lives and continue their recovery when they’re released.

About 65% of people behind bars have an addiction problem, according to the Centers for Medicare and Medicaid Services, but they’re often not screened or treated. This $10 million allocation – and the just-approved Medicaid program – aims to address that issue. Democratic Rep. Pam Marsh of Ashland, who was behind the push in the Legislature to offer medication treatment for opioid use in jail, welcomed approval of the program.

“I’m thrilled with the approval of the Medicaid waiver, which will provide long-term sustainability to continue and expand opioid medication treatment in our jails,” Marsh told the Capital Chronicle. “These services are critical if we want to break the cycle of addiction, criminality, and incarceration — and to save lives in that process.”

Opioid overdoses have skyrocketed in Oregon in recent years with the spread of fentanyl, which can be fatal in tiny doses and is mixed into counterfeit opioid pills that sell on the streets for as little as a dollar. According to the Oregon Health Authority, 280 people died in Oregon from fatal opioid overdoses in 2019. That soared to about 1,050 in 2023.

The Medicaid program marks an attempt by the Biden administration to address the nationwide addiction crisis.

“Expanding access to life-saving treatment and recovery supports for incarcerated people is a critical part of our bipartisan efforts to beat the overdose epidemic and save lives,” Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy, said in a statement.

The Centers for Medicare and Medicaid Services said thousands of people would benefit across the newly approved programs in the five states, but it’s unclear how many will qualify in Oregon. Bacher of the Oregon Health Authority said that 60 institutions with more than 20,000 beds will qualify for the program but they have to opt in.

“We will be working closely with correctional partners to assess their readiness and support their ability to implement if the facility and their local partners choose to do so,” Bacher said.

The cost is unclear, but the majority will come from federal coffers. The federal government pays for about 60% of Medicaid, while the state pays the rest.

The health authority aims to launch the program in 2026

“ We’ll be working on timeframes for implementation and will have a lot of work with carceral settings to be ready for this, ” Bacher said in the statement.

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