Background
The gap in access to healthcare for those being held in federal and state prisons and jails - nearly 2.3 million people in 2020 - arises from the lack of access to insurance coverage. The Medicaid Inmate Exclusion Policy, written into law in 1965, prevents justice-involved people from receiving Medicaid benefits and purchasing a plan through the Marketplace. This is despite the fact that justice-involved people are disproportionately low-income and uninsured - in the 30 days before entering the justice system, nearly 32% of people in state prisons were insured by Medicaid and almost 50% were uninsured. This lack of coverage contributes to the 19% of justice-involved people who do not see a healthcare provider or have a health-related visit for the duration of their stay.
Need for Health Coverage
Justice-involved people experience disproportionately higher rates of infectious and chronic disease, and disability. Due to the congregate settings of correctional facilities, infectious diseases spread quickly, with higher rates of tuberculosis, Hepatitis B and C, and HIV/AIDS than that of the general population. Despite having significantly higher rates of hypertension, diabetes, heart disease, and other chronic diseases than the general US population, justice-involved people often do not receive proper screenings to identify these issues. These conditions may then be exacerbated by the environment of the criminal justice system which results in a lack of exercise, poor diet, and barriers to effectively manage a disease.
Rates of mental health disorders are extremely high amongst justice-involved people - approximately 44% of people in jails and 37% in prisons have a history of mental health conditions. In the first two weeks following release, justice-involved people are at a risk nearly 13 times higher than the general population of death, with the leading cause being drug overdose followed by cardiovascular disease. Medicaid is the largest payer for mental health services, yet for a population where mental health conditions are experienced at such high rates, its services are unreachable.
Current Legislative Actions
Federal and state governments have attempted to bridge these healthcare coverage gaps. Most efforts have focused on providing a seamless transition in coverage as people exit the criminal justice system. The Reentry Act of 2023, recently reintroduced in the U.S. Senate, would allow Medicaid to offer coverage for eligible individuals 30 days prior to release. Furthermore, earlier this year the Department of Human and Health Services approved a California section 1115 waiver which allows Medi-Cal to cover select pre-release health concerns, including substance use disorders and chronic health conditions, for up to 90 days before release. Since then, the Centers for Medicaid and Medicare Services released a statement encouraging states to apply for their own Medicaid Reentry Section 1115 waiver. Similarly, a measure was passed in the 2022 omnibus appropriations bill that will give states the option to provide Medicaid and CHIP coverage to justice-involved youth, pending disposition of charges. The Humane Correctional Health Care Act, reintroduced for the third time in 2023 in the current Congress, is the most comprehensive policy recommendation and would repeal the Medicaid Inmate Exclusion Policy, ensuring important access to treatments and services. Efforts to smooth reentry transitions are vital components of addressing the gaps in coverage and could lead to life saving services for this unique population. Addressing these silos of care by allowing continued Medicaid coverage during an individual’s stay is essential in saving lives and improving the health of our population overall.