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GAO-14-752R 1 (2014-09-05)

handle is hein.gao/gaobaaifs0001 and id is 1 raw text is: cAO U.S. GOVERNMENT ACCOUNTABILITY OFFICE 441 G St. N.W. Washington, DC 20548 September 5, 2014 The Honorable Fred Upton Chairman Committee on Energy and Commerce House of Representatives The Honorable Joseph Pitts Chairman Subcommittee on Health Committee on Energy and Commerce House of Representatives Medicaid: Information on Inmate Eligibility and Federal Costs for Allowable Services Medicaid, a joint federal and state health care program, covered health care services for more than 72 million individuals at a cost to the federal government of $262 billion in 2013.1 In 2014, Medicaid is expected to cover as many as 7 million more individuals as a result of the Patient Protection and Affordable Care Act (PPACA),2 most of whom will be low-income adults, a population that may include inmates in state prisons and local jails.3 Federal law prohibits states from obtaining federal Medicaid matching funds for health care services provided to inmates with the exception of when inmates are patients in medical institutions.4 Under this exception, inmates who are eligible for Medicaid are admitted to hospitals or other qualifying facilities for at least 24 hours. In these cases, inpatient services qualify for federal Medicaid matching funds and are therefore allowable (hereafter referred to as allowable services). The intent of the federal prohibition is to ensure that federal Medicaid funds are not used to finance care that is the responsibility of state and local authorities.5 1The federal government matches state Medicaid service expenditures based on a statutory formula known as the Federal Medical Assistance Percentage (FMAP). The FMAP depends on each state's per capita income and may range from 50 to 83 percent. 2pub. L. No. 111-148, 124 Stat 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010 (HCERA), Pub. L. No. 111-152, 124 Stat. 1029 (2010). For purposes of this report, references to PPACA include the amendments made by HCERA. 3For purposes of this report, we define inmates as individuals incarcerated in state prisons, local jails, or facilities under contract with states or local authorities, such as counties. Inmates in state prisons are typically individuals sentenced for more than one year. Inmates in local jails are typically individuals with a sentence of less than one year or awaiting adjudication. We did not include federal prisoners in the scope of our work, because officials from the Federal Bureau of Prisons, which oversees federal prisons, told us that the Bureau is not enrolling prisoners in Medicaid for purposes of obtaining federal Medicaid funds for inpatient services that qualify for such funds. 442 U.S.C. § 1396d(a)(29)(A). 5The U.S. Supreme Court has determined that state and local correctional facilities are required to provide health care services to inmates in accordance with the Eighth Amendment of the Constitution. See, e.g., Estelle, et al. v. Gamble, 429 U.S. 97 (1976), Brown, etal. v. Plata, et al., 131 S. Ct. 1910 (2011). GAO-14-752R Medicaid and Inmates Page 1

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