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.
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.
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:
Compared to the general population, individuals in jails and prisons suffer:
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.
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:
Over $60 billion in improper Medicaid payments are remitted annually.***
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