Medicaid health coverage for those nearing prison release

Kentucky is one of five additional states that will soon provide Medicaid health coverage for people nearing release from prison or juvenile detention, according to the U.S. Department of Health and Human Services.

"We've been eagerly anticipating CMS's approval of Kentucky's healthy re-entry demonstration for years now," said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of health advocacy groups.

The program started as a demonstration focused on treatment for substance-use disorder during incarceration and "has expanded to focus on putting in place all of the physical and behavioral health treatment, care coordination, and wrap-around supports justice-involved Kentuckians need to successfully return to their communities and thrive," Beauregard said in an email.

This demonstration program is operated under a partial waiver of the Medicaid program's inmate-exclusion policy, which prohibits paying for services to inmates unless they are admitted to a hospital.

"Providing avenues for greater health outcomes is always the right thing to do, and this program does just that," state Cabinet for Health and Family Services spokesman Brice Mitchell said in an email.

Before the state can start the coverage, it must submit an implementation plan to the Centers for Medicare and Medicaid Services, Mitchell said: "Upon receiving implementation approval from CMS, Kentucky will cover a select set of pre-release health-care services through Medicaid and the Kentucky Children's Health Insurance Program for up to 60 days before an individual's expected date of release."

Kentucky didn't take full advantage of the waiver, which allows states to provide coverage up to 90 days before the expected release date. Eligibility is based on income; the limit is 138 percent of the federal poverty level.

Mitchell added, "The individual must be eligible for Medicaid or KCHIP to qualify and must be a state inmate housed in one of Kentucky's 14 prisons or a post-adjudicated juvenile in the custody of the Department for Juvenile Justice."

Mitchell provided data from the state Department of Corrections, which said "There are 19,220 individuals serving felony convictions in state prisons or jails, as well as an additional 49,700 on active supervision with the Division of Probation and Parole. At least 95% of the state inmate population will be released from incarceration at some point."

Kentucky's waiver doesn't allow inmates in jails to participate, because its jails are operated by counties, not the state. Beauregard said, "We've advocated for allowing jails to opt in, if they are willing to meet requirements and participate fully." She said the state Department for Medcaid Services "has said they will consider [jails] as a future phase of this project."

Coverage will be available not only to adult prisoners, but incarcerrated youth, under the Children's Health Insurance Program, called KCHIP in Kentucky. Beauregard praised the inclusion of youth in the coverage, which was not part of the original demonstration program for substance-use-disorder treatment and not part of the orignal application for its expansion.

"Another important expansion from the original waiver is that youth who are in detention facilities will also get these services and wrap-around supports, which has the potential to reduce recidivism," Beauregard said.

A July 2 news release from HHS noted that incarcerated people often report higher levels of substance-use disorders, chronic health conditions and other health concerns, and that people transitioning out of jail or prison can experience delays in obtaining access to Medicaid or CHIP.

HHS Secretary Xavier Becerra said in the release, "For people involved in the justice system, ensuring a successful transition back into the community includes having the health-care supports and services they need."

Kentucky is the first Southern state in the program. The other newly approved states are Illinois, Oregon, Utah and Vermont; California, Massachusetts, Montana and Washington had already been approved.