Table 4 Considerations for implementation of Medicaid suspension and enrollment in Jails

Short stays and unpredictable release dates create challenges

“The biggest operational challenge with jails is just that people are in and out all the time. And the length of stay– the average stay is 25 days, but half of the population turns over every week.” –National Expert

Differences in priority

“[Medicaid enrollment is] basically the last thing they’re really thinking about. So, they’re not really addressing their medical because they’re anticipating a short term stay. So it’s not really a first priority.” –Medicaid Official

Statewide coordination difficult across jails

“The ability to partner and coordinate, and at times, have things really driven by the governor’s office, makes prisons an easier lift because you’re accountable to the same entity.” –National Expert

Jails need relationship with local Medicaid office

“We actually have a pretty good working relationship with our county assistance office so we can submit [Medicaid] applications up to 30 days before an individual is released. And most if not– I would say the majority of cases, the inmate will be activated the day the individual is released. So we’re really fortunate in that respect.” –Carceral Official

Need to rely on low-tech solutions

“On the jail side is all manual. We have to be told when they go in, and we have to be told when they leave. And if anything breaks down in terms of the communication on the back end, then we’ve got incorrect information.” –Medicaid Official

Rural jails face particular challenges

“In some of the more rural counties, they just don’t have the population to do the enrollment suspension and to do the pre-release inmate applications. It requires the data agreements. It requires manpower. And so some of the more rural counties just don’t have the population to– at least from the county sheriff’s perspective, they may not appreciate the benefits to justify the expenditures.” –Medicaid Official