Inmate Medicaid waivers draw interest

A new policy that allows states to provide Medicaid health care coverage to incarcerated people at least a month prior to their release has drawn bipartisan interest and a slew of state applications.

Federal policy has long prohibited Medicaid spending on people who are incarcerated in jails or prisons, except for hospitalization. As a result, when people are released, they typically don't have health insurance and many struggle to find health care providers and get needed treatment. In a population that is disproportionately likely to have chronic conditions such as heart disease and substance use disorders, that can be deadly.

Some states terminate residents' Medicaid coverage when they're incarcerated, while others just suspend it. Either approach can cause delays in seeking health care for people recently released from incarceration, with sometimes disastrous outcomes: A seminal 2007 study found that former prisoners in Washington state were 12 times more likely to die from all causes within two weeks of release, compared with the general population. The leading causes were drug overdoses, cardiovascular disease, homicide and suicide.

Because a disproportionate number of Black, Native and Hispanic people are incarcerated, lowering their death risk after release might reduce racial health disparities in the overall population.

In 2022, about 448,400 people were released from prison, according to the federal Bureau of Justice Statistics.

Under federal guidance released a year ago, states can connect prisoners with case managers 30-90 days before they are released to develop plans based on their health needs. The case manager can help the person make post-release appointments with primary care doctors, mental health counselors, substance use programs, and housing and food assistance.

States that want to extend Medicaid coverage to people in prison or jail must request a federal waiver to do so. At a minimum, participating states must provide case management, medication-assisted treatment for people with substance use disorders and a month's supply of medication upon release, though states are free to do more.

The Health and Reentry Project, a policy analysis organization focused on health care for former prisoners, called the new policy "groundbreaking."

"What these waivers enable states to do is build a bridge to access to health care — a bridge that starts before someone's released and continues after their release," said Vikki Wachino, executive director of the Health and Reentry Project and a former deputy director of the Centers for Medicare & Medicaid Services.

"It's about starting the process before they leave prisons and jails, so that they can have stronger connections to health care providers and treatment providers after they leave prison and jail."

As of last month, federal officials had approved waiver applications from four states — California, Massachusetts, Montana and Washington. Nearly 20 other states are waiting for approval, according to health research organization KFF.

Jack Rollins, director of federal policy at the National Association of Medicaid Directors, said states that want to participate are focusing on different incarcerated populations and medical conditions. Some would start with jails, others with state prisons or youth detention facilities. Some states would provide coverage to all inmates, others just to those with a substance use disorder.