By Katie Horneffer, Intern, Care4Carolina
Each year, North Carolina spends over $1.5 billion to keep nearly 52,000 people incarcerated in its prisons and jails. Corrections costs also make a significant dent in counties’ budgets; for example, Haywood County spends about $3.4 million per year in jail costs, Macon County spends about $2.6 million, and Jackson County spends about $2.1 million. Closing the health insurance coverage gap would increase access to affordable mental health and substance use treatment—reducing crime, incarceration rates, and public safety costs.
Substance use and mental health issues are common in the justice-involved population. About 70% of incarcerated individuals have a substance use disorder, and 65% report symptoms of mental illness. In North Carolina, 33% of federal prison sentences are drug-related. Recognizing the important role behavioral health plays in our justice system, advocates from both political parties have pushed for treatment programs as an alternative to incarceration for minor crimes.
By helping individuals manage their mental health and substance use, closing the coverage gap can reduce crime and incarceration rates. One study found that states that have closed their coverage gap saw a 5.3% reduction in annual violent crime rates, which translates to a total annual cost savings of $4 billion.
Improved access to behavioral health treatment can also reduce reentry rates among formerly incarcerated individuals. Right now, only about 2% of justice-involved individuals in North Carolina have access to Medicaid upon release from prison, making it difficult to get needed services to manage their behavioral health. When substance use or mental health goes untreated and unmanaged, it easily can lead an individual back to prison or jail.
By increasing access to affordable health insurance, formerly incarcerated people have a better change of successfully reintegrating into the community. Studies show that justice-involved individuals with Medicaid coverage have 16% fewer detentions in the year following release, compared to those without coverage. People with Medicaid coverage are also 14 percentage points more likely to receive treatment for an opioid use disorder, and access to medication treatment for substance use can lead to a 17-33% decline in arrests.
Reducing our prison population wouldn’t just be good for our community—it comes with financial savings, too. The NC Department of Public Safety spends nearly $38,000 per year on each individual incarcerated in our state’s prisons. It’s far less expensive to pay for an individual’s behavioral health treatment than it is to pay for their incarceration. And because the federal government covers 90% of the cost of closing the coverage gap—with even higher federal funding under the American Rescue Plan—most of the cost of behavioral health treatment for this population would be covered by federal dollars, not state dollars.
Closing the coverage gap would also save public safety dollars by covering some healthcare costs for incarcerated individuals. Although Medicaid doesn’t cover health services provided in prisons, it covers inpatient care that incarcerated people receive outside the prison. But because North Carolina has not closed its coverage gap, most incarcerated individuals aren’t eligible for Medicaid—so the Department of Public Safety has to pick up those costs. Closing the coverage gap would save the NC Department of Public Safety an estimated $10 million each year in justice-involved inpatient health expenses. It would also offset county-level spending on prisoner health expenses, which can cost counties hundreds of thousands of dollars per year. This would free up our public safety system to spend these dollars on other pressing safety issues in our communities, like fire protection or emergency response.
Closing the coverage gap would expand alternatives to incarceration while reducing public safety expenses. Urge your representatives to act now to provide access to affordable health insurance for all North Carolinians. A healthy community is a safer community.