States both blue and red are lining up to provide Medicaid coverage to people who are about to be released from jail and prison, in response to a new federal policy that aims to address high rates of emergency room admissions, overdoses and deaths among the recently incarcerated.
Seven states have won approval in the past month to extend Medicaid coverage to youth and adults up to 90 days before they are released from jail or prison, bringing the total number of states to 11. Applications are pending in at least half the remaining states.
“The bottom line is that these policies really have the potential to make the difference between life or death for people who are leaving prison or jail,” said Vikki Wachino, executive director of the Health and Reentry Project, a policy education and analysis group.
The National Conference of State Legislatures plans to highlight the trend in a featured session at its annual legislative summit, which is being held Aug. 5-7 in Louisville, Ky. Wachino will be a panelist.
The policy shift comes amid a convergence of mental health, substance abuse and homelessness crises, which are exacerbated by health disparities among America’s massive prison population.
As of 2020, there were approximately 1.8 million adults incarcerated in the United States, a population at a higher risk for health issues including HIV, substance abuse disorders and mental health conditions.
Federal law prohibits federal Medicaid money from being used to pay for health care for people who are incarcerated. States have historically either terminated or suspended Medicaid coverage for incarcerated individuals.
People leaving incarceration are typically eligible for Medicaid because they have low or no income. But state re-enrollment efforts during the re-entry process have resulted in coverage gaps and delays in accessing medical care and substance abuse treatment.
One study found that, during the two weeks immediately post-release, individuals were 129 times more likely to experience a fatal overdose than the general population.
In response to the opioid epidemic, Congress passed a bipartisan measure in 2018 that set the groundwork for states to provide Medicaid coverage to inmates prior to their release through so-called Section 1115 demonstration waivers, which allow states to deviate from federal statute to test new approaches in Medicaid.
California became the first state to gain approval for a demonstration waiver in 2023. The U.S. Department of Health and Human Services followed up later that year with a formal guidance encouraging other states to submit applications.
In addition to California, waivers have been approved in Illinois, Kentucky, Massachusetts, Montana, New Hampshire, New Mexico, Oregon, Utah, Vermont and Washington.
“States have recognized that people leaving incarceration often have poor health outcomes during the re-entry period: higher rates of overdose, higher rates of all-cause mortality, higher rates of suicide,” said Hannah Maniates, senior policy analyst at the National Association of Medicaid Directors.
“The theory that we’re seeing states test with this waiver is that, by providing coverage during this re-entry period, you can improve continuity of care in a way that improves health outcomes and other outcomes like recidivism,” Maniates said.
Wachino, a former deputy administrator for Medicaid and CHIP Services at the Centers for Medicare and Medicaid Services, said she had never seen states respond so quickly to a Medicaid waiver request and said that “speaks to a need.”
“State legislators, state executive branch officials, governors see that people are returning to communities with unmet needs, and they see the impact that that has on the people, on communities and on public safety,” Wachino said. “And then cutting across much of that is the crisis that we face as a country connecting people to mental health services, connecting people to substance use treatment.
“So all of those factors are really powering strong state interests in this moment.”
To qualify for a waiver, the state’s pre-release benefit package must include case management to assess an inmate’s health needs, medication-assisted treatment and counseling for substance abuse, and a 30-day supply of all prescription medications.
The federal guidance also encouraged states to cover services to address what Medicaid officials refer to as “health-related social needs,” including housing supports and services to address food insecurity.
Wachino said the Centers for Medicare and Medicaid Services plans to award more than $100 million in state grants in the coming months to seed state programs, and that HHS has revised its policy regarding community health centers to help them increase and strengthen re-entry services.
“The elements are really there for success,” she said.
This is part of a series of stories previewing the 2024 NCSL Legislative Summit:
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