A new Medicaid program could dramatically improve health care for incarcerated people if states use it

States can now use federal funds to ensure that people leaving prison have access to health care. But states must first apply to join the program.

The Centers for Medicare and Medicaid Services (CMS) has created an exciting new way for states and localities to use federal Medicaid funds to pay for health care in prisons and jails. This January, CMS approved California’s application for the first-ever waiver of Medicaid’s Prisoner Exclusion Policy, which since 1965 has prohibited the use of federal dollars for inmate medical care. In April, CMS issued instructions on how each state can apply for the same eligibility. In June, Washington state became the second state approved for the program. Called Medicaid Reentry, the strategy promises to dramatically improve health outcomes for incarcerated people, reduce recidivism rates for the hundreds of thousands of Americans who are released from prison each year, and increase public safety across the country.

Waiver of the so-called federal “prisoner exclusion” clause

Without a CMS-approved waiver, the Prisoner Exclusion prohibits the use of federal Medicaid funds to fund non-inpatient health services for people involuntarily held in public facilities, including prisons, youth correctional facilities, and prisons. As a result, inadequate health care has been the norm for incarcerated individuals, who suffer from disproportionately higher rates of substance use disorder (SUD), mental illness, infectious diseases, and other chronic health conditions than the general public. No wonder so many people are in poor health when they are released. Research shows that people released from prison have a higher risk of dying soon after their return. One study found that individuals had a 13-fold higher risk of death and a 130-fold higher rate of fatal overdose in the first two weeks after release compared to the general population.

States that grant waivers can turn things around by ensuring that individuals are connected to health coverage, assessed for health needs, provided with care, including substance use disorder and mental health care, and placed in community-based care before leaving prison. : or prison. While each state’s waiver application is unique, California’s approved application, for example, allows federal Medicaid funding to cover essential health care services and supports; medications such as mental and substance use disorders; laboratory and radiological services; case management; and using community health navigators up to 90 days before someone is discharged.

According to CMS state section 1115 waiver data, six states — Illinois, Kentucky, Massachusetts, Rhode Island, Utah, and West Virginia — had demonstrable Medicaid reimbursement waivers as of Nov. 9. Several other states, including Arizona, Montana, New Hampshire, New Jersey, New Mexico, New York, Oregon, and Vermont, have developed or are currently developing Medicaid Reentry waiver proposals in line with the new CMS guidance and the huge Medicaid Reentry wide recognition of benefits.

Based on the Sheriff’s Model Health Plan in Fairfax County, Virginia

In Fairfax County, Virginia, the Sheriff’s Office has already established high-quality health care, screening and recovery services without federal funding. In 2022, the office recorded more than 700,000 health contacts; of that number, approximately 80 percent of the prison population received medication, and nearly 40 percent received medication specifically for mental and/or substance use disorders (SUDs). The Department’s Medication for Addiction Treatment (MAT) program has treated more than 1,500 people with buprenorphine and other FDA-approved SUD medications. The Fairfax County Sheriff’s Office (FCSO) also operates an intensive addiction treatment program led by peer recovery specialists called Striving for Recovery (STAR). More than half of previous STAR participants have successfully returned to the community without returning to jail or prison.

FCSO also works to provide returnees with direct links to outpatient clinics, residential treatment centers and community resources; bridge medications for opioid use disorder and tools, including Narcan and fentanyl test strips; rehabilitation housing scholarships; transportation assistance to access care; Mobile phones; and backpacks with transitional essentials. FCSO’s medical and reentry staff work to establish early connections with outside health care providers and clinics to ensure continuity of care and ease people’s transition back into the community. Finally, they help eligible individuals nearing release apply for Medicaid or regain coverage.

Additional funding from CMS through the state’s approved Medicaid Reentry waiver will only help to further expand and improve the services and supports that FCSO and other Virginia jails and prisons can offer to those in their care.

A win for all of us

The reality is that 95 percent of incarcerated individuals will eventually return to our general communities. As such, we must ensure that the hundreds of thousands of people leaving prisons and jails across the country can access the care they need. We all win when formerly incarcerated people become healthy, productive members of the community. All states should immediately take advantage of this opportunity.

Tracy M. Gardner is the Senior Vice President of Policy Advocacy at the Legal Action Center, a legal and policy organization working to combat discrimination, build health equity, and improve opportunities for individuals and families affected by the criminal justice system, substance use disorders, and substance use disorders. towards creation. HIV/AIDS.

Sheriff Stacey Ann Kincaid manages the Fairfax County Sheriff’s Office in the state of Virginia, serving an area of ​​more than 1.1 million residents. One of his top priorities is how our criminal justice and behavioral health systems interact, leading to better outcomes for individuals and the community.

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