Gap in Medicaid Impacts Access to Services for Justice-Involved Patients

When Medicaid was authorized in 1965, it included the Medicaid Inmate Exclusion Policy, which prevents federal matching funds from paying for health care for those who are justice involved, making the criminal justice system responsible for the individual’s health care. As a result, enrollment in Medicaid may be suspended or terminated.¹

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“This has major implications for what happens when they reenter the community. If their coverage was terminated, it will be much more difficult to activate coverage. If their coverage was suspended, it will be easier to reactivate coverage, but it all depends on coordination between the Department of Corrections and Medicaid in the state,” Jonathan Larsen, JD, MPP, legal program manager at the Center for Public Health Law Research at Temple University, said in an interview with Pharmacy Times.

According to the Center for Public Health Law Research, 25 states and Washington, DC, terminate Medicaid upon confinement in jail, while 25 states suspend Medicaid. Of those latter 25, 22 suspend Medicaid for the full term. California and Arkansas suspend Medicaid for a maximum of 12 months and New York for a maximum of 24 months. Twenty-one states suspend Medicaid for the full period, according to the dataset.¹

Larsen added that often, those who are involved in the justice system could experience substance use disorder and other chronic conditions such as tuberculosis, hepatitis C, and sexually transmitted diseases including hepatitis B and HIV. By experiencing disrupted care and reentering the community without health care coverage, patients could experience a lapse in treatment.

For individuals involved in the justice system, Larsen said there is a significantly higher risk of death when reentering the community. Other factors such as poverty, unemployment, and homelessness can further complicate access to health care.

With health care coverage maintained rather than terminated, 1 burden is taken away upon reentry, Larsen said.

In April 2023, states had the opportunity to apply to the Medicaid Reentry Section 1115 Demonstration Opportunity under the Social Security Act (42 USC § 1315), which would allow for up to 90 days of Medicaid coverage as part of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act.² The aim of the waiver is to help increase care for justice involved individuals immediately prior to release to help them with reentry, according to a news release from the Centers for Medicare & Medicaid Services.³

“There’s all this additional coordination that could be happening to assist individuals with reentering the community. States that do receive this approval would have to have an actual suspension policy in place vs a termination policy,” Larsen said.

According to an article in State Health and Value Strategies, additional services were designed to increase continuity of coverage and services by Medicaid; improve communication among the justice system, Medicaid, managed care systems, and community providers; and increase quality of care for enrollees to facilitate successful reentry.⁴ Minimum covered services include case management, medication-assisted treatment, and a 30-day supply of all medications. Additional services address physical and behavioral health, as well. Policy makers hope the waiver reduces the number of emergency department visits and inpatient hospitalizations as well as allcause deaths close to the release date.⁴

“We’re talking about literally tens of millions of [individuals] potentially impacted by this policy, so any efforts to better coordinate care [and] establish auto-enrollment in Medicaid when returning to the community would have some positive impact,” Larsen said.

References

1. Incarceration effects on Medicaid status. Center for Public Health Law Research. Updated June 1, 2023. Accessed February 8, 2024. https://pdaps.org/datasets/medicaid-funded-mat-for-justice-involved-persons-1565019237

2. Opportunities to test transition-related strategies to support community reentry and improve care transitions for individuals who are incarcerated. Centers for Medicare & Medicaid Services. April 17, 2023. Accessed February 8, 2024. https://www.medicaid.gov/sites/default/files/2023-04/smd23003.pdf

3. HHS releases new guidance to encourage states to apply for new Medicaid Reentry Section 1115 Demonstration Opportunity to increase health care for people leaving carceral facilities. News release. Centers for Medicare & Medicaid Services. April 17, 2023. Accessed February 8, 2024. https://www.cms.gov/newsroom/press-releases/hhs-releases-new-guidance-encourage-states-apply-new-medicaid-reentry-section-1115-demonstration

4. Serafi K, Boozang P, Morgan G. CMS issues guidance on Section 1115 Demonstration Opportunity to support reentry for justice-involved Populations. State Health and Value Strategies. April 19, 2023. Accessed February 8, 2024. https://www.shvs.org/cms-issues-guidance-on-section-1115-demonstration-opportunity-to-support-reentry-for-justice-involved-populations/#_ftnref10