Rebuilding Lives. Strengthening Communities.

Medicaid does not pay for services while an individual is
in jail or prison. Federal law does not require states to
terminate eligibility, but most do. The state removes the
prisoner’s name from the Medicaid list immediately when
it is informed of the person’s incarceration. Medicaid
benefits are supposed to be reinstated upon release; a state
may not drop someone from the rolls unless it has been
determined that the individual is no longer eligible. But
jails and prisons must notify the Illinois Medicaid Office of
the prisoners’ release. If this does not happen, released
prisoners have to submit an entirely new application, and
may lack any means of paying for and receiving
medications and health care they need to stabilize their
mental health condition. A 2004 Urban Institute study
found that 16 months after release, 85 percent of former
prisoners were uninsured. 61
Under the current system, most individuals with serious
mental illness will spend their first months out of prison
living on the streets and sliding into more and more
dangerous mental states. Many will be rearrested and
returned to jail or prison before their SSI and Medicaid
benefits are reinstated.
Solution
IDOC should enhance its efforts to encourage all prisoners
to apply for SSI or SSDI if they are eligible. For prisoners
who are interested, IDOC should do what it can to help
facilitate and expedite the process.
The Social Security Administration (SSA) has a
“pre-release procedure” designed to “promote deinstitutionalization
by assuring eligible individuals timely SSI
payments when they reenter the community.” 62 IDOC
should take advantage of this pre-release procedure to
assure speedy restoration of SSI and SSDI benefits upon a
prisoner’s release. 63 As part of this procedure, a
“pre-release agreement” should be established between
IDOC and SSA. The local Social Security offices would
help correctional staff learn the rules for pre-release processing
of applications and reapplications for benefits.
Correctional staff would help the prisoner initiate his or
her benefits applications in anticipation of release, gather
supporting documents, and notify SSA when the prisoner
is officially released. With such an agreement, SSA can
process claims more quickly and prisoners can begin
receiving payments within days, not months, of their
release. This agreement and process currently exists and
is being implemented at Dixon Correctional Center. 64 This
arrangement should be expanded to and used at all IDOC
institutions statewide.
Illinois should further move to suspend, rather than terminate,
Medicaid eligibility during incarceration. This is
possible under federal law, but requires state legislative
approval. In May 2004, the Centers for Medicare &
Medicaid Services encouraged all state Medicaid directors
to “ ‘suspend’ and not ‘terminate’ Medicaid benefits while
a person is in a public institution” as part of a larger effort
to end chronic homelessness. 65 The prisoner would
remain enrolled but placed on suspended status. Then,
immediately upon release, the prisoner would be entitled
to receive benefits from an approved provider. The
Bazelon Center has a model law that Illinois could use as
a guide. 66
IDOC should consider extending its post-release housing
subsidies beyond the typical two months for former
prisoners with mental health issues who have initiated the
process but are still awaiting reinstatement of benefits.
IDOC also should facilitate scheduling post-release health
care appointments and obtaining an adequate supply of
medications for prisoners to cover any delay in benefit
coverage that may occur.
Other states are grappling with these same issues and have
developed innovative strategies to address them. 67 For
example, the Texas legislature created a specific agency—
the Texas Correctional Office on Offenders with Medical
or Mental Impairments (TCOOMMI)—to meet the needs
of prisoners with mental illnesses. TCOOMMI has a formal
agreement with SSA for processing applications for
prisoners awaiting release. The New York State Office of
Mental Health (OMH) operates a Medication Grant
Program for prisoners with mental illness whose Medicaid
applications are being processed. OMH provides coverage
for psychiatric medications in the community until an
applicant’s Medicaid eligibility is determined.
MAYORAL POLICY CAUCUS ON PRISONER REENTRY
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