Obamacare moves to cover more criminals

New Obamacare Rule Gives People on Parole and Probation Medicaid
New Obamacare Rule Gives People on Parole and Probation Medicaid

White House officials on Thursday announced a new rule that would extend government-funded health care to most people living in halfway houses, providing coverage to nearly 100,000 additional people.

They also clarified for states that people on probation, parole or in home confinement were not considered inmates of a public institution and could also receive the government-funded coverage. Medicaid, the program they will be covered under, extends to the poorest Americans under Obamacare and comes at little or no cost to patients.

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"What this guidance does is remind states of some of the tools they have available to them," said Victoria Wachino, director of the Center for Medicaid and CHIP Services, said in a call with reporters Thursday.

The model is likely to fit into the bipartisan emphasis on prison reform that is reshaping criminal justice policy and that has been endorsed by presidential candidates. When prisoners are incarcerated, the state or federal government is required to provide them with medical care. When they are released, however, for the most part they become uninsured. This population also has disproportionately high rates of chronic conditions and infectious disease.

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Government officials emphasized the impact the program could have on people with mental health and substance abuse disorders, who are believed to make up about half of the incarcerated population. People with these conditions often cycle through the criminal justice system, whether while causing disruption during a state of psychosis or breaking the law to access drugs. Michael Botticelli, the White House's director of national drug control policy, said enrolling this group in Medicaid was one of the "best ways to protect public safety" because it could help provide care for those who might otherwise relapse or die from a drug overdose.

Some county jail officials have already helped former inmates enroll in Medicaid and have said they have seen a dramatic reduction in the number of people who cycle in and out of the justice system.

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The Obama administration has repeatedly stressed the impact that Medicaid coverage can have on social issues, including on curbing gun violence, and has encouraged states to expand Medicaid as a way to manage chronic mental health conditions.

Enrolling in Medicaid would allow prisoners could begin to "seamlessly access services upon release," Wachino said.

But when pressed during the call with reporters about other barriers people face to health care access – including a dearth of medical providers and the fact that some applicants find the process of enrollment difficult – Wachino replied only that the Centers for Medicare and Medicaid Services was excited about the potential of Medicaid expansion and that it was helping states provide stronger eligibility.

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Officials said the impact of Medicaid coverage would be paticularly pronounced in states that had expanded Medicaid through Obamacare. The law initially provides full federal funding to states who cover those making less than 138 percent of the federal poverty level, or $16,243 a year. Though the law orginally intended for all states to participate, a Supreme Court decision made expansion optional. So far, 30 states and the District of Columbia have expanded Medicaid, and Louisiana will expand its program beginning in June. Obamacare has already far surpassed projections for Medicaid enrollment.

State lawmakers have resisted expanding Medicaid on political grounds, but have also said they are concerned about the cost of expansion, given that the federal government gradually dwindles funding support to 90 percent after three years.

According to a report published Thursday by the Department of Health and Human Services, 2.2 million people are incarcerated in the U.S., and 4.7 million are on probation or parole. Officials in the call with reporters Thursday did not have an estimate on how much it would cost to cover people who had been incarcerated with Medicaid but pointed out that medical care provided when people were in prison or jail was already expensive. Both Medicaid and justice programs have overwhelmed state budgets.