Dear Chairwoman Cooper, Rep. Frye, Rep. Schofield and Chairman Werkheiser,
In recent years, Georgia has seen several bipartisan efforts to reform our state’s criminal legal system, reduce recidivism and support justice-involved Georgians. These reforms are a strong start to better supporting Georgians who are incarcerated, on parole and more, and we know you have supported many of them. It is for this reason that we, the undersigned, write to you today about another commonsense opportunity to support Georgians who were previously incarcerated: Medicaid expansion.
While federal law, unfortunately, severely limits Medicaid reimbursement for eligible Georgians who are currently incarcerated, those who have been released can access Medicaid as long as they meet other eligibility requirements. When reentering, justice-involved Georgians become responsible for their own health care—but because they face challenges to gaining meaningful employment, let alone employment that provides health benefits, health care coverage is too often out of reach. Nationwide, approximately 60 percent of formerly incarcerated people face unemployment.
Justice-involved Georgians would benefit greatly from improved access to health care. People in jail and prison have worse health outcomes before, during and after incarceration and are more impacted by chronic diseases like diabetes, infectious diseases like hepatitis and mental illness and substance use disorders than the rest of the population. The risk of death from heart disease, drug overdose and suicide is almost 13 times higher within the first two weeks after release from prison than among the general population. Due to over-incarceration and underinvestment in mental health and substance abuse supports, uninsured or under-insured Georgians in need of behavioral health treatment often end up incarcerated instead. The National Institute on Drug Abuse has found that 85 percent of people in prison have an active substance use disorder or was incarcerated for a crime involving drugs or drug use. According to the Department of Justice, 37 percent of people in prison had been told in the past by a mental health professional that they had a mental disorder. compared to only 5 percent of the entire population. COVID-19 and the related economic volatility have increased rates of mental health and substance abuse concerns in recent years, and Georgians who are justice-involved and already face issues finding employment that pays a living wage would benefit greatly from access to treatment. Medicaid expansion helps: in states that expanded Medicaid, the uninsured rate among those with opioid-related hospitalizations fell from 13.4 percent in 2013 (before expansion) to 2.9 percent two years later. And after Kentucky expanded Medicaid, the number of people seeking substance abuse treatment jumped 700 percent. The benefits extend beyond just health—one county in Florida experienced a 16 percent recidivism reduction among formerly incarcerated individuals with severe mental illness after enrolling in Medicaid after release.
Justice-involved people also experience chronic illness at higher rates than the general population. Access to food, stable housing and other social and economic factors contribute to health outcomes, so those in poverty are more likely to experience health concerns. At the same time, poverty is in many ways criminalized in Georgia, and therefore people in poverty are more likely to be incarcerated. Medicaid expansion would help reentering Georgians who are still seeking employment, unable to work or working in a job that does not provide coverage by helping provide access to continuous care. Continuity of care is critical in helping address these illnesses, as well as lowering health care costs and decreasing hospitalizations and mortality rates. This is particularly important because, in the two weeks following reentry, the mortality rate for justice-involved people is 12 times higher than that of the general public.
Nationally, it is estimated that 1 in 6 people eligible for coverage under Medicaid expansion would be justice-involved, and 25-30 percent of those in jail would benefit. The General Assembly has shown an interest in reducing recidivism and supporting reentry. Full Medicaid expansion in Georgia would help advance those goals while also giving nearly 500,000 Georgians access to coverage and helping Georgia’s rural hospitals stay open. It’s also fiscally responsible: while the state has in recent years pursued health care waivers through the Georgia Pathways program that would partially expand Medicaid, the plans would cost the state $2,420 per enrollee and cover fewer people, while full Medicaid expansion would cost only $496 per enrollee and cover more people.
The answer is clear: lawmakers interested in supporting Georgians as they successfully reenter society should expand Medicaid in Georgia. Though Crossover Day is over, legislators could include Medicaid expansion in bills that have passed out of their original chamber.
Bell Primary Care, LLC
Covid Survivors for Change
Stephen R. Scarborough, Criminal Defense Attorney
End Mass Incarceration Georgia Network
Feminist Women’s Health Center
Georgia Budget and Policy Institute
Georgia Coalition for the Peoples Agenda
Georgia Interfaith Public Policy Center
Georgians for a Healthy Future
HIV Dental Alliance
Jewish Community Relations Council
Legal Action Center
Motherhood Beyond Bars
National Incarceration Association
Partners for HOME
Partnership for Southern Equity
Planned Parenthood Southeast
Positive Impact Health Centers
Progressive Gospel Ministries
Ryan White HIV Health Services Planning Council
Step Up Savannah
Women on the Rise