For the past several years, Maine has been grappling with the issue of Medicaid expansion. Many Mainers, including our governor, have expressed concern that accepting the expansion will cost the state too much money. But opponents of expansion have focused on the potential cost to our state without adequately considering the immediate economic benefits that other states enjoy. Only a year and a half after expansion, eight of the 32 states that have expanded Medicaid have seen more than $1.8 billion in increased savings and revenue.
The incarcerated population — many of whom are childless, non-disabled adults — warrants further attention in the expansion debate. The cost of providing health care to this population is astronomical, and it will continue to rise as our prison population ages. Although federal law prohibits the use of Medicaid dollars for treatment provided to inmates within correctional facilities, there are some avenues of treatment that are reimbursable. Under Medicaid expansion, inpatient treatment at hospitals and other health care facilities for eligible prisoners would be funded by federal rather than state dollars.
Maine spent $17 million on health care for its inmate population in 2011, a 16 percent increase from 2007, according to a 2014 Pew Charitable Trusts study. Without expansion, these costs are solely on the shoulders of Maine taxpayers. Kentucky and Michigan, which have expanded Medicaid, saw inpatient treatment savings of $16.4 million and $19.2 million, respectively, for fiscal years 2014 and 2015. Ohio also realized $10.3 million in savings in fiscal year 2014 because of Medicaid expansion.
Eighty percent of the people released from jails and prisons are discharged into the community without insurance, yet the majority of them would be eligible under the expansion. If this population was enrolled in Medicaid prior to being released, there would be no interruption in care, as the access to treatment that was provided during incarceration would continue in a community setting. This is particularly important because of that rates of untreated chronic and sometimes communicable conditions — including HIV/AIDs, hepatitis C, diabetes, hypertension and asthma as well as substance use and mental health disorders — are disproportionately high in the prison population. Access to effective and ongoing treatment is not simply a matter of individual physical and mental health, it is a matter of public health and safety as well.
It is no secret that a distressingly large percentage of incarcerated individuals struggle with addiction, mental illness, or both, and that many of them are arrested for nonviolent crimes in which untreated mental illness or substance use played a significant role. Access to treatment lowers arrest and recidivism rates, results in fewer new people entering the criminal justice system, decreases use of emergency services and inpatient psychiatric facilities, and increases public safety and fiscal savings. In Washington state, a state-funded program to provide drug and alcohol treatment to low-income adults resulted in a significant reduction in arrests among treatment participants, resulting in $275 million in savings for law enforcement, correctional facilities, the court system and would-be victims.
Closer to home, Maine’s drug courts have demonstrated that participation in treatment effectively lowers incarceration and recidivism rates while also decreasing health care costs as individuals recover from their addictions. Every $1 spent on drug courts conservatively saves an estimated $1.87 for Maine’s criminal justice system. Other states have achieved significant savings through drug and mental health treatment courts as well, but, unlike Maine, states that have expanded Medicaid are able to take advantage of federal funds to help defray the costs of providing these services.
Access to ongoing treatment is the most cost-effective way for Maine to combat its drug problem, decrease its prison and jail population, reduce state expenditures and increase the health and safety of Maine residents. Funding for this is available through Medicaid expansion, and it would provide us with the opportunity to prevent some of our most at-risk individuals from becoming casualties of addiction, mental illness and incarceration — if only we reach out and take it.
Victoria Townley worked for more than 10 years in the mental health field, and she is pursuing a Masters of Social Work at the University of Southern Maine in Portland. She lives in Readfield.