ments (Rich, Dumont, and Allen, 2012). Some systems provide waivers for copayments, at least for some types of care such as communicable diseases and true emergency and follow-up care; copayments can also be waived for incarcerated people who are medically indigent. A 2003 Centers for Disease Control and Prevention report on a multistate outbreak of antibiotic-resistant staph infections in correctional facilities listed copays along with staff shortages as hindering access to timely care, contributing to the spread of the infection. Further, in most states, individuals entering incarceration already enrolled in Medicaid face disenrollment from the program, despite federal guidance that Medicaid coverage only be suspended, not terminated, as a result of incarceration (Phillips, 2012). With this pattern of disenrollment, almost 80 percent of those previously covered are without private or public insurance when released, exactly during the high-risk re-entry period when access to health services can be critical.

The ACA presents a major opportunity for millions of poor people to obtain insurance coverage. When fully enacted in 2014, ACA will raise Medicaid eligibility levels to 133 percent of the poverty line for all adults. States will receive a 100 percent federal subsidy to cover the expansion of Medicaid enrollment for the first three years and a tapering subsidy thereafter. A substantial percentage of those newly eligible for Medicaid will have some involvement with prisons or jails. The potential of the ACA to reach these individuals is great but also has limits. Some of these limits are formal, including legal restrictions on accessing benefits. Other possible barriers may include limits to the ability to facilitate the Medicaid enrollment process within correctional facilities.

As delineated in the paper by Regenstein and Christie-Maples (2012), jail inmates who are held pending disposition (estimated at from one-half to two-thirds of the jail population) may face formal restrictions to accessing benefits. The authors make the following distinctions among inmates pending disposition:

•    Incarcerated individuals pending disposition are qualified to enroll in and receive services from health plans participating in state health insurance exchanges if they otherwise qualify for such coverage.

•    Individuals pending dispositions who satisfy bail requirements and are released into the community will be eligible to enroll in Medicaid and receive services so long as they meet the program requirements.

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