- The Washington Times - Monday, October 6, 2014

Obamacare has made most prison and jail inmates eligible for Medicaid in states that expanded the federal-state health program, according to a new study Monday from the Government Accountability Office — but few inmates are actually getting the kinds of services that can be reimbursed by federal taxpayers.

In California, which is one of 27 states to have expanded Medicaid under Obamacare, 72 percent of prison and jail inmates are now eligible for the health program, the GAO said. By contrast, in North Carolina, which didn’t expand its program, just 2 percent are eligible.

But even in California, only a little more than 2 percent of inmates got the kind of care that the federal government will reimburse — meaning that despite many inmates being eligible for the program, few of them were actually drawing extra money from federal taxpayers.

“While the majority of inmates in states with Medicaid expansion are likely eligible for Medicaid, just a small proportion of inmates are likely to receive services eligible for federal Medicaid funds,” the GAO said.

Under Obamacare, states had the choice of leaving their Medicaid program untouched or expanding it to raise the income threshold for those who qualify for coverage. If they increased the threshold, the government promised to cover 100 percent of the new costs through 2016, then pare it down to 90 percent by 2020. More than half of the states have chosen the expansion.

But federal law limits what medical services can be reimbursed with federal money, and federal officials have deemed most inmate medical care out of bounds, concluding that states should be responsible for the health care of their inmates. The chief exceptions are when inmates are admitted to a hospital for a stay of 24 hours or more.

The GAO found that expansion would make 80 percent of inmates in New York, and 90 percent of inmates in Colorado, eligible for Medicaid. In California, it’s 72 percent — with the rest not qualifying because they are in the country illegally. Obamacare generally prohibits illegal immigrants from getting benefits.

With those restrictions, the government ended up paying $1.3 million for inmates’ care in Washington state in 2013 and $38.5 million for care in California, investigators said.

Colorado and New York — two other states that GAO investigators looked at that expanded Medicaid — couldn’t provide a dollar amount for federal reimbursement for inmates’ care.

Expansion of Medicaid was one of the most controversial parts of Obamacare. Congress had tried to make it mandatory, saying that states either had to expand or else drop all of their Medicaid program.

But a 2012 Supreme Court ruling said that was an unconstitutional imposition on states. The justices’ decision said states instead had an option of whether to expand or not.

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