The Affordable Care Act: Implications for Public Safety and Corrections Populations

Many people in correctional institutions have faced barriers obtaining needed health and behavioral health care services in the community either prior to their incarceration or upon reentry following
incarceration. One-third to three-quarters of men booked into jails in ten major cities in 2010 were not covered by any type of health insurance.1 This is largely because of high rates of unemployment and narrow Medicaid eligibility criteria. Unemployment limits access to employer-based health plans and the ability to purchase private insurance or pay health costs out-of-pocket. Additionally, people who have been incarcerated face enduring barriers to employment both because of legal barriers and
the stigma associated with having a felony conviction. Consequently, they also face enduring challenges obtaining employer-based health insurance.2, 3 Medicaid is an alternative for some individuals, but only for those who meet income requirements and who are also either pregnant, have dependent children, or are severely disabled.4

The Affordable Care Act

The Affordable Care Act (ACA) signed into law by the President in 2011 potentially can aid individuals who are at risk for incarceration and those who have been incarcerated through provisions that allow states to expand eligibility for Medicaid. The ACA creates new mechanisms for uninsured people to obtain coverage for physical and behavioral health care. First, by 2014 each state must have a health insurance exchange that will act as a regulated health insurance marketplace whereby
uninsured individuals with incomes between 133% and 400% of the federal poverty limit can purchase coverage. Individuals will receive tax credits on a sliding scale to offset the cost of this coverage.5

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