The 44 million Americans expected to get health insurance under the Affordable Care Act this year could include those cycling in and out of the nation’s prison system.

Under the ACA, Medicaid will pay for inmates’ hospital stays longer than 24 hours and will also allow for greater access to insurance coverage later.

This could mean getting health care access to pregnant inmates, which two University of Minnesota professors say are one of the most vulnerable populations in the country.

In last month’s issue of the leading journal Health Affairs, assistant health policy professor Katy Kozhimannil and assistant pediatrics professor Rebecca Shlafer said the ACA may impact inmates by expanding their Medicaid coverage on temporary medical leave and provide better access to health insurance when they’re released from prison.

“Prior to ACA, incarcerated individuals were not eligible for Medicaid reimbursement, period,” said Shlafer, who is the research director for the Isis Rising project, which provides resources and support to pregnant inmates in Minnesota.

On average, inmates have higher rates of complex health risks, she said, like higher incidence rates of HIV, substance abuse and mental health issues. They’re also costly to correctional facilities, she said, and can lack sufficient access to health insurance after they’re released.

Previously, state and federal prisons paid the entire cost of inmates’ hospital stays, Shlafer said. But under the ACA, inmates staying in hospitals are temporarily eligible for Medicaid coverage beyond 24 hours.

This is important for pregnant inmates, she said, because typical hospital stays for labor and delivery are between 48 and 72 hours. And for women who undergo Caesarean sections, that third day of hospital care is particularly crucial, she said.

Shlafer said the Medicaid expansion may also help prevent correctional facilities or county jails from temporarily releasing inmates, or “furloughing” them, to avoid paying for costly medical expenses.

Last fall, the Star Tribune reported that the Beltrami County jail temporarily furloughed an inmate after he had been beaten so badly that he required reconstructive surgery.

Minnesota Department of Corrections spokesman John Schadl said medical furloughs are only granted a couple of times per year when certain conditions are met.

He said inmates qualify for temporary medical release only if they require extended treatment for a “grave” medical illness where their needs would be met better elsewhere or if they’re terminally ill and not considered dangerous to the public.

But he said the Department of Corrections doesn’t release inmates to avoid incurring medical costs, including for child deliveries.

“We have never offered conditional medical release to a woman because she was pregnant,” Schadl said. “We try to provide excellent prenatal, OBGYN and doula [services] on-site.”

He said the biggest impact the ACA will have on state or federal prisons is providing affordable health insurance for inmates after their release.

“It’s going to be a lot easier for an offender upon release to obtain health insurance. That’s a big deal,” Schadl said. “That’s a big deal for anyone, really. It doesn’t matter if you’re a recently released offender or someone recently released from college.”

Kozhimannil said taxpayer dollars pay for almost half of all births in the United States, including those of incarcerated women.

There are roughly 14,000 women in federal prisons nationwide. When they enter jail or prison, 6 to 10 percent of female inmates are pregnant, and more than 1,400 give birth every year in prison. The cost of an average delivery is about $9,000, Kozhimannil said, and that price goes up to about $13,000 for a C-section.

“If you’re a prison system or a county jail that’s strapped for cash … it’s really a problem,” she said. “It’s something that they’re worried about — taking care of pregnant inmates.”

Isis Rising project director Erica Gerrity has been working with pregnant inmates at the women’s correctional facility in Shakopee, Minn., for 10 years. She said she hopes the Medicaid expansion will help free up the facility’s budget for other inmate resources.

Right now, Gerrity said the correctional facility pays for an inmate’s child delivery, but under the expansion, the facility could split the cost with the U.S. Department of Health and Human Services.

Isis Rising provides inmates with nonmedical pregnancy support — also known as doula services, she said. This can include educating women on what to eat during pregnancy, what to expect during childbirth, how to properly breastfeed and parenting lessons.

There’s a high need for these services at Shakopee, Gerrity said. But the facility doesn’t have the funding to support them, she said, so their program relies on volunteers and private donors in order to operate.

More than 51,000 women were arrested in 2010 in Minnesota. If Medicaid can help free up funding for Isis Rising, Gerrity said she thinks they could help more inmates while saving taxpayers money.

“We’re talking about [thousands of] pregnancies,” she said. “So, it’s not just this small, nuanced issue. It really affects a lot of people.”