By Craig Acorn and Harris Silver, MD
— Gov. Susana Martinez can support her commitment to fiscal responsibility and health care and to reduce crime and overdose with one stroke of her pen.
Senate Bill 65 passed the Legislature with strong bipartisan support and enables inmates held in jails, prisons, and Children, Youth and Families Department facilities for 30 days or more to apply for Medicaid so they can be covered when discharged. It also suspends rather than terminates enrollment for those already on Medicaid when incarcerated. The law would take effect in January to coincide with the date when more than 90 percent of inmates would become eligible for Medicaid under the expansion Gov. Martinez announced recently.
Through its course in the Legislature, the bill was called a no-brainer given strong evidence that ensuring access to health care is critical to reduce recidivism and save state and local dollars. Newly eligible discharged inmates’ health care costs will be covered 100 percent by federal funds for the first three years and no less than 90 percent after 2019. At least 80 percent of those incarcerated—adults and youth—have mental health and substance use disorders.
Treatment interventions made possible through this bill can greatly reduce criminal behavior that accompanies these disorders, reducing crime and creating savings. Indeed, the federal Substance Abuse and Mental Health Services Agency estimates a $12 return in criminal justice and health care savings for every dollar spent on treatment. During Senate floor discussion, one former prosecutor senator called SB 65 the most important crime-reduction bill introduced this session.
Also, with enrollment suspended, Medicaid can now easily be billed for the cost of hospitalizing inmates outside corrections facilities. With that substantial cost now borne almost entirely by state and county indigent funds, New Mexico should see the multi-million dollar savings other states realize.
Given the high rate of substance use and mental health disorders in inmates, linking immediately to health care is also essential to reduce the risk of overdose and suicide. In the two weeks after release, overdose risk to former inmates spikes 130 times and suicide increases eight-fold. With our state ranking as the nation’s highest in overdoses, the Legislature should be applauded for taking this great step.
Yet Gov. Martinez may be considering vetoing the bill. Why? It may be she is misinformed from within her administration.
The Human Services Department estimated a high cost for implementing the bill, but legislators saw through it. They understood the cost of enrolling discharged inmates under expanded Medicaid was already included in the Human Services Department’s budget request. With the department’s new online system, applications from anywhere require only an Internet connection. The department also estimated a high cost of “interfacing” with corrections facilities, even though officials knew—but failed to mention—that 90 percent of that cost will be covered by Medicaid. Finally, the Human Services Department said suspending Medicaid for inmates was very complex, though other states do not report such issues.
The governor’s office has said it supports the bill’s concept but doesn’t think legislation is required. It says it could proceed administratively just helping state prison inmates apply. The Legislature rejected that plan for several good reasons.
First, there’s no mandate to ensure this and successor administrations follow through. The governor’s approach excludes county jails where many more inmates are housed and for whom counties bear all the costs of outside hospitalization and post-release uninsured health care. It also leaves out our vulnerable confined young people. Finally, without suspended enrollment, inpatient Medicaid reimbursement continues to be lost.
We encourage Gov. Martinez not to pass up this unique opportunity to accomplish many of the goals she has spoken out for so forcefully. By signing SB 65 into law, she can reduce crime and health care costs and save many lives. Now that’s a real no-brainer.
Craig Acorn is a senior attorney at the New Mexico Center for Law and Poverty. Harris Silver is a drug policy analyst at the University of New Mexico.