Medicaid Agencies

Help improve continuity of care, efficiency, and savings throughout the incarceration lifecycle

Solve Program Integrity Problems with Timely Data

As a Medicaid professional, you are pulled in many directions and challenged with ensuring compliance with fiscal controls, leveraging fraud prevention, and improving national Medicaid data to support program integrity. Yet, your agency may lack the people, time, and timely, reliable data needed to help you determine changes to beneficiary eligibility status due to incarceration.

Our value proposition to Medicaid agencies is two-fold: we offer Medicaid agencies access to near real-time, nationwide incarceration data and a team of experts to implement the solution and support our clients.
A man sitting at a desk taking notes from his laptop
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Update Beneficiary Status 

Medicaid payments can be suspended or terminated when beneficiaries become incarcerated and reinstated once they are released, preventing overpayments and eliminating lapses in care. We provide the internal tools necessary for you to take steps to solve these issues.
 
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 Improve Continuity of Care 

Seamless continuity of care supports and informs beneficiaries’ healthcare providers and helps beneficiaries suffering from behavioral health issues avoid future incarceration.
 
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Save Taxpayer Dollars

Beneficiaries who are released from incarceration, and whose coverage has been reinstated, are less likely to rely on costly emergency care, easing the financial burden on taxpayers.

Reduce Medicaid Fraud by Effectively Updating Beneficiary Status with Our Support

With data access limited to your state’s Department of Corrections database, you can’t search other states’ incarceration databases to locate individuals who may no longer be eligible for Medicaid benefits.

Your agency’s integrity could be compromised and overpayments to healthcare providers may be a serious problem.

Our Incarceration Intelligence™ solution for Medicaid gives agencies access to timely data. Agencies are able to place “watches” on their provided beneficiary lists, and receive alerts when relevant matches are:

  • Booked into custody
  • Released from custody
  • Incarcerated for a certain “length of stay”
Diagram showing incarceration monitoring of non-custodial parents

Improve Continuity of Care for Incarcerated Medicaid Beneficiaries You Provide

Compared to the general population, individuals in jails and prisons suffer:

  • 3x the rate of serious mental illness
  • 4x the rate of substance abuse disorders
  • 4-9x the rate of active tuberculosis (TB), HIV infection, and Hepatitis C

Many incarcerated individuals require a variety of ongoing behavioral and physical health services, creating a critical need to facilitate the appropriate treatment program, funded by the appropriate authority. Strengthening continuity of care for incarcerated Medicaid beneficiaries is critical to improving healthcare quality and reducing recidivism.

A man in a prison cell leaning on the bars looking directly into the camera

Save Taxpayer Dollars Through Greater Program Efficiency

Approximately $60 billion in improper Medicaid payments were made in 2017, according to the Centers for Medicare and Medicaid Services.* Access to near real-time incarceration data empowers you to directly decrease the cost of Medicaid fraud to your agency.

Additionally, continuity of care mitigates many potential costs for communities:

  • Individuals without a primary healthcare source are far more likely to use expensive services like ambulance rides and emergency room visits.
  • Untreated illnesses become increasingly expensive the longer that care is delayed.
  • Behavioral health issues and recidivism cycles costs lead to increased need for taxpayer-funded law enforcement services, legal services, and re-incarceration services.

60%

60% of incarcerated individuals in the U.S. fall below the Medicaid income threshold.**

$60B

Over $60 billion in improper Medicaid payments are remitted annually.***

2/3

Two out of three inmates meet the medical criteria for substance abuse disorder.****

*https://www.medicaid.gov/state-resource-center/downloads/mac-learning-collaboratives/justice-involved-populations.pdf ; ** https://www.ojp.gov/ncjrs/virtual-library/abstracts/behind-bars-ii-substance-abuse-and-americas-prison-population; ***https://www.cms.gov/newsroom/press-releases/cms-office-actuary-releases-2017-national-health-expenditures; ****https://www.prisonpolicy.org/factsheets/pie2018_allimages.pdf

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Learn More About Incarceration Intelligence for Medicaid

Strengthening continuity of care for incarcerated Medicaid beneficiaries is critical to improving healthcare quality and reducing recidivism.