When jails do mental health: Medicaid, local politics and public safety

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Rick Perry may have said "no" to Medicaid expansion, but given the economics of the situation, I'll bet Republican legislators all over the state have faced local meetings like the one described in the Waco Tribune-Herald evincing the Legislature's "division with local government leaders" on whether to expand Medicaid. "Top officials with the city of Waco and McLennan County support the Medicaid expansion envisioned as part of national health care reform, saying it would cut the area’s uninsured rate by more than half and bring $58 million a year in new federal funding to the area." Local officials in every county with taxpayers on the hook for a hospital are thinking the same thing.

Grits' particular interest in possible Medicaid expansion lies in the expanded access to mental health care for probationers and parolees and possibly federal cost sharing for inpatient hospital care at TDCJ. The Harris County Jail ain't for nothing the largest mental health institution in the state. Medicaid expansion would allow a continuum of care for folks jails currently treat, stabilize and let go. Not only are there costs to local government from uncompensated care at the emergency room, IMO there's a not-negligible public safety cost from limiting access to mental-health services in an era when we use local jails as front-end mental health providers.