TOPEKA — The new Medicaid expansion bill, the product of a compromise
between Democratic Gov. Laura Kelly and some Republican leaders, would
change how state prisons and county jails fund health care for
By expanding the types of people who can qualify for
the program, the bill would extend Medicaid access to 80% to 90% of
state prisoners if it passes, according to the Kansas Department of
Kansas is one of only seven U.S. states
that kicks people off of Medicaid when they go to prison or jail. The
one exception is when an inmate is hospitalized for more than 24 hours.
The DOC or county jails can apply for Medicaid funding to cover part of
the cost if the inmate is eligible for the government health care plan.
now, state prison officials say, less than 1% of Kansas state prisoners
— fewer than 100 people — qualify for Medicaid based on the state’s restrictions
on age, income, disability status and family status. The department
doesn’t collect data on how many people in county jails qualify.
new bill would allow the DOC to take advantage of Medicaid funding for
more inmates. It also increases the share of state Medicaid costs that
the federal government would pay.
“It revolves around those current income requirements,” DOC spokeswoman Rebecca Witte said. “They would be eligible.”
She said the department would save $2 million in 2022 if Medicaid expansion is passed.
jails also would see savings, said Jeffrey Easter, Sedgwick County
sheriff and legislative chair for the Kansas Sheriffs’ Association.
Sedgwick County spent about $1 million in 2018 on hospitalized inmates.
He said if the bill passes, “that million dollars wouldn’t be coming out of my budget and local taxpayer money.”
collected by the Kansas Sheriffs’ Association shows most county jails —
excluding Sedgwick, Wyandotte, Johnson and Shawnee counties — spent a
total of $6 million in 2018 on outside hospitalizations for inmates.
year, Shawnee County spent $770,000 on offsite medical treatment for
jail inmates, but it didn’t have information on how much of that went to
hospitalizations. A spokesman for the county Department of Corrections
said the county does not apply for Medicaid coverage for any inmates.
and Johnson counties did not immediately respond to a request for
information on how much their jails spent on hospitalizations in 2018.
Impact on Re-entry
Medicaid expansion bill would also require the Department of
Corrections to help counties get jail inmates back on Medicaid after
Even people who go to jail for two weeks are
kicked off the program and they don’t get back on Medicaid for three or
four weeks after release, Easter said. For some people with mental
illnesses, it can turn into a cycle.
“For them to get any type of
plan or medications, they’ve got to be back on Medicaid,” Easter said.
“You see them decline, rearrested, and we (start) the process over
Currently, the Kansas Department of Health and Environment, which runs the state’s Medicaid program, contracts
with a company called Appriss to collect a daily list of people
entering and leaving county jails. The department checks the list
against its Medicaid database and terminates coverage until a person is
On the state level, the DOC sends KDHE a monthly list
of people in its prisons. The list is checked against the state Medicaid
database and KASPER, the database of state prisoners, to determine
whose Medicaid will be terminated.
Before people are released, a
special unit in the DOC processes applications for people going back on
Medicaid. The Medicaid expansion bill would require the DOC to assist
county jails with this process.
For county and state governments, the biggest effect of terminating Medicaid coverage
for incarcerated people is the time and resources needed to take people
on and off, said Maria Schiff, a criminal justice and health care
researcher for the nonprofit Pew Charitable Trusts.
“Generating a new application is more work,” she said, “than activating a suspended one.”
the most dramatic impact, Schiff said, is for the people who lose their
coverage. Once they’re released, they can struggle with navigating the
health care system, especially if they’ve been incarcerated for many
Most states that have expanded Medicaid employ re-entry
counselors in prisons and jails who help people reapply for Medicaid
before they’re released, Schiff said.
“A person in a state prison
doesn’t have the tools and internet connection and information and
access to legal forms that individuals on the outside have,” she said.
of Medicaid expansion have argued the policy will reduce recidivism.
But it’s too early for researchers to know, Schiff said. Rhode Island,
however, has seen a drop in substance abuse-related fatalities among the
“It’s not the coverage alone. Because you
don’t want these people just showing up in emergency departments,” she
said. “You really want them getting attached to a primary care system.”
Ujiyediin reports on criminal justice and social welfare for KCUR and
the Kansas News Service. You can follow her on Twitter @NominUJ.