HIV exists in the nation’s prisons and jails just as it does in surrounding communities. People living in prisons/jails are also more likely to be poor, non-white, and have higher rates of mental illness and substance abuse compared to people who aren’t incarcerated. Coverage through Medicaid or Marketplace qualified health plans (QHPs) can help meet complex medical needs. In addition, for people living with HIV (PLWH) the Ryan White HIV/AIDS Program remains available to fill in gaps in HIV care and medication access, and can often provide financial help with premiums and out-of-pocket costs, as well as case management and other services.
Coverage eligibility for people involved with the criminal justice system
Coverage eligibility rules for incarcerated persons can be complicated. Here are important facts to keep in mind.
Medicaid: Individuals can enroll in Medicaid anytime during the year, but Medicaid can-not pay for services while they are incarcerated. CMS encourages states to suspend rather than terminate coverage during incarceration.
Marketplace: PLWH can maintain Marketplace coverage while incarcerated if they are classified as ‘pending disposition of charges’ (in other words, being held without a conviction before sentencing or other final settlement of a case). However, this information must be re-ported to the Marketplace, and individuals must continue paying health insurance premiums. This FAQ document from the Federal marketplace provides more information, including eligibility for pro-bationers and parolees.
Special enrollment period (SEP): All released individuals have access to a SEP that allows them to enroll in a QHP within 60 days of release. If they do not enroll within this time period, they must wait until the next open enrollment period.
Strategies to improve enrollment
There are many strategies that states, RWHAP agencies, and case managers can employ to improve enrollment and link-age to care for recently incarcerated PLWH. States can ensure that a short-term supply of ART is made available to PLWH up-on release through ADAP, and strive to cultivate a statewide network of agencies to support recently released PLWH.
Service providers can collaborate with the criminal justice system to institute dis-charge planning for inmates that includes: making an appointment with a health care provider, assisting with enrollment in health coverage, and providing a supply of HIV medications. Service providers can also work to ensure that the same case manager stays with the client pre and post release, and that all case managers are trained in substance use and mental health issues. Case man-agers should work to build trust with clients, help with enrollment paperwork, and support linkage to care and services up-on release. It is particularly crucial to connect clients to stable housing, employment, and com-munity support systems.
For more information: From ACE TA Center: This webinar for RWHAP providers working with PLWH involved in the criminal justice system provides strategies and lessons learned for connecting recently incarcerated PLWH to coverage and care. From CMS: This Q&A document describes how states can facilitate access to Medicaid for individuals transitioning from incarceration. From HHS: This blog post gives highlights of recent guidance on how states can improve access to Medicaid coverage for newly released individuals. From NASHP: This 2015 toolkit reviews state strategies to enroll justice-involved populations in health coverage.
The ACE TA Center works with the Ryan White HIV/AIDS Program to help diverse clients get enrolled in health coverage. targethiv.org/ace.