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Health officials say 90-day pre-release Medicaid coverage may not be cost‑effective; state wins $5 million to link county and tribal jails to Medicaid
Summary
Department of Health and Human Services staff told the Senate Human Services Committee that federal options allow Medicaid payment for services up to 90 days before a person’s release from custody, but the department is unsure whether pursuing that option would be cost‑effective under North Dakota’s managed‑care arrangement.
Department of Health and Human Services staff told the Senate Human Services Committee that federal changes allow states to seek Medicaid payment for services provided to incarcerated individuals during a pre‑release period, but that North Dakota officials are unsure whether pursuing that option would be cost‑effective under the state’s managed‑care arrangement.
Sarah Acre, Executive Director of the Division of Medical Services, described two related federal options: a congressional authorization for up to 30 days of Medicaid payment prior to release and a Biden administration allowance up to 90 days. Acre warned that 1115‑type changes that authorize pre‑release coverage require extensive federal reporting and administrative work and that under North Dakota’s managed‑care capitation the state could pay more in capitation than it would save. She said, as a result, the department is not certain pursuing the waiver is the right option now.
Acre also told senators the department is pursuing other steps. She said the department applied for and received a federal award of $5,000,000 to build systems that exchange eligibility information with county and tribal jails, improve notifications when someone is incarcerated or discharged, and help identify people who are not on Medicaid but may qualify. Acre said the grant will be used for tribal jails as well as county jails.
Committee members raised concerns about variation in jail health care and about using suspension versus termination of Medicaid eligibility while someone is incarcerated. Acre said North Dakota already suspends Medicaid eligibility upon notification of incarceration, and that the state can reactivate coverage for services rendered outside the carceral setting (for example, hospitalization lasting more than 24 hours while the person is outside the facility).
On cost, Acre said most incarcerated people would fall under Medicaid expansion and the state pays capitation to a managed‑care organization; the department must consider whether increased covered care prior to release would increase state spending. She said the department will continue studying options and working with the Department of Corrections and Rehabilitation (DOCR) and local jails.
Ending: The department recommended further study and technical work with DOCR and county partners; no committee vote was recorded on policy or statutory change during the session.
