Can Felons Get Medicaid?

Thanks to the Affordable Care Act (ACA), felons can now have a chance to get access to Medicaid. Without a shadow of a doubt, felons can really get cheaper health care, as long as they’re eligible to apply for it.

After being released from prison, felons usually hard to find a job. Even if they can earn money, their income may be limited, making access to health facilities quite difficult. With Medicaid, monthly premiums are potentially lower than other health insurance plans, especially if they don’t have any income.

If you’re the one who needs health care but your finances don’t allow it, you can try applying for Medicaid. To be approved, you may have to learn more about Medicaid, how to be eligible, and what kind of healthcare will be covered.

Okay, here’s everything you should know about Medicaid!

Medicaid: What It Is and How It Works

Medicaid is a joint federal and state health insurance program to help fund medical costs for low-income adults, the elderly, children, pregnant women, and people with disabilities. Since the ACA expanded coverage, Medicaid can now be enjoyed by incarcerated individuals upon release from prison.

Of course, the federal government has general rules that all states that participate in the Medicaid program should meet. Then, each state distributes the program based on federal standards and runs its own program by determining:

• • Which groups of individuals should be protected?
  • What health services will be provided?
  • What methodology will the healthcare provider use to obtain reimbursement?
  • What administrative activities are taking place in the state?

A Medicaid-participating state can also make changes to its program policies or operations by submitting a state plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) for review and approval.

In addition, states can also send SPAs to request permitted program changes, make corrections, or update their state Medicaid or CHIP plans with new information.

What are the Health Benefits Covered by Medicaid?

To actually run the Medicaid program, state governments establish their own rules and services covered by Medicaid. It aims to allow people and felons to get decent health care, even with affordable insurance.

In this case, every state will set the type, duration, amount, and scope of services under broad federal government guidance. In accordance with federal law, states are required to provide certain mandatory benefits and elect to cover other optional benefits.

Health services that must be covered include:

• • Inpatient and outpatient hospital services
  • Physician services
  • Laboratory and x-ray services
  • Home health services

In addition, there are some optional and beneficial services that Medicaid members should get, including case management, prescription drugs, physical therapy, and occupational therapy.

How Do Felons Become Eligible for Medicaid?

Your household income is one of the basic criteria for determining your eligibility for Medicaid. You may or may not qualify based on your income, but it depends on which state you live in.

If you’re a low-income felon and/or you’re pregnant, suffer from a disability, or have young or elderly dependents, you may qualify to receive Medicaid health care.

Whether you’re eligible or ineligible for Medicaid will depend on your state standards. And some states’ considerations that are usually taken include:

• • Does your state participate in the ACA’s Medicaid program?
  • Does your state allow you to maintain your existing Medicaid program while you’re in prison?

It’s important to note that Medicaid doesn’t cover your health care during incarceration. But if you’ve been registered for Medicaid coverage before your incarceration, it will let you stay enrolled during your time in prison. After that, you can continue that coverage as soon as you’re released.

The following are the criteria for an individual who deserves Medicaid health services:

• • Low-income families
  • Eligible pregnant women
  • Eligible children
  • Individuals with qualifying disabilities

The ACA also provides an optional eligibility group to include adults under age 65 who attain 138% of the federal poverty level or less.

Otherwise, if you are a felon with a high income and reasonable resources but you want to get medical expense relief, you can still get Medicaid services by shopping for Obamacare through the Marketplace through HealthCare.gov. However, they are also eligible for the cost savings and subsidies offered by the Affordable Care Act’s Marketplace.

When is the Best Time to Apply for Medicaid?

Actually, if you’re eligible for Medicaid, applying for insurance can be performed at any time, including while you’re still incarcerated, even if the health services cannot be used. However, it can help you get Medicaid coverage faster after you’re released from prison.

The reason is that both the Medicaid and CHIP programs are always open for enrollment throughout the year. But many people prefer to wait for the Open Enrollment Period to buy a private health plan via Marketplace.

However, if you’re newly released from prison and begin enrolling in Medicaid, you may be in a Special Enrollment Period (SEP), allowing you to enroll in a private plan outside of Open Enrollment. For more information, SEPs last for 60 days, after which you should wait until Open Enrollment to start a new plan.

HealthCare.gov announces the latest schedule for Medicaid Open Enrollment 2024, as follows:

• • November 1, 2024: Open Enrollment Period begins.
  • December 15, 2024: Deadline for coverage that will start January 1.
  • January 15, 2024: Last day to register.

To note: Medicaid coverage begins on February 1. If you sign up after January 15, you may only get a health plan if you’re eligible for a Special Enrollment Period.

To know the newest information about the Open Enrollment Period, you may have to sign up for HealthCare.gov and login. So, you can update your application if you’ve submitted, compare price plans, and renew or change for the next year.

How to Apply for Medicaid?

You can apply for Medicaid through several methods, including:

• • Via HealthCare.gov
  • Online via your state’s Marketplace website
  • By mail, by attaching a paper application
  • In person or make a phone call to your state’s Medicaid office.

Even though you’re incarcerated, you can still apply for Medicaid by following the standard process. Here’s how!

• • First, you need to sign up for a Marketplace account through HealthCare.gov.
  • After logging in, you can fill out a Marketplace application.
  • If you qualify for Medicaid, your state’s agency will contact you later.
  • Then, you have to submit an application to your state’s Medicaid office.

While you’re waiting for feedback, you can check on the status of your application via HealthCare.gov, or you can contact the state’s Medicaid office with which you applied.

You can also have an alternative to applying for Medicaid by directly visiting a local Medicaid office. The staff will then fill you in on your state’s application process.

Should You Pay for Medicaid? Or Is It Free?

It depends.

Medicaid will determine whether or not you’re charged a monthly premium based on several factors, such as your income and the type of Medicaid you’re applying for. Aside from that, some states usually allow you to pay it monthly as a copayment, coinsurance, or deductible for certain services.

In fact, many Medicaid members don’t pay anything for coverage. Your state will usually not charge you a monthly premium if you earn less than 150% of the federal policy level.

The following are some criteria for group members who are exempt from paying premiums or cost sharing for Medicaid services:

• • Children under 18
  • Pregnant women
  • People who receive hospice care
  • People who receive long-term care in healthcare facilities
  • Native Americans who receive services through an Indian Health Service provider
  • Beneficiaries are eligible for Medicaid under the Breast and Cervical Cancer Act.

In addition, some health services, such as emergency services, preventive services for children, and services related to pregnancy and family planning, are also excluded from out-of-pocket costs.

Even if you are a member of Medicaid, which is charged monthly, the costs you have to pay will vary depending on your state and your household income level. Typically, your total out-of-pocket costs for Medicaid, including cost sharing and premiums, should not exceed 5% of the member’s household income.

Why Should Felons Get Medicaid Services?

Providing ex-offenders with proper health insurance makes sense. Why?

The long period of detention causes a number of felons to develop quite serious health problems, such as hepatitis C, tuberculosis, HIV, etc. So guessing, if they’re released, the diseases have the potential to spread to people around them, including their families and relatives.

The fact that it is difficult for people with criminal records to find work after incarceration means that getting adequate medical care will also be difficult, right?

If this situation continues, it’s possible that felons will be forced to earn money illegally, leading them to return to criminal activities. So, the recidivism rate in a state will continue to increase, especially for drug addicts who do not receive rehabilitation facilities.

With the Medicaid service approach, this can be called an effort by the federal and state governments to provide support and care to formerly incarcerated people at no cost and/or at an affordable cost so that they can access health care easily, including both mental and physical treatment.

Last but not least, having easy access to other types of health programs, including Medicaid after incarceration, can help smooth the process of felons reintegrating into society.

List of States That Don’t Participate in the Medicaid Program

Keep in mind that not all states accept and run Medicaid programs; some may decline it due to a few reasons. When the ACA expanded Medicaid coverage to all states, the Supreme Court of the United States allowed states to opt out of the expansion.

As such, felons in states that do not participate in this program may not have access to Medicaid unless they meet other eligibility requirements in their respective states. So, if you live in one of the following states, you cannot get Medicaid services:

• Alabama
• Alaska
• Florida
• Georgia
• Idaho
• Indiana
• Kansas
• Louisiana
• Maine
• Mississippi
• Missouri
• Montana
• Nebraska
• New Hampshire
• North Carolina
• Oklahoma
• Pennsylvania
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Virginia
• Wisconsin
• Wyoming