Since its start in 1965, Medicaid has been essential in providing health help to people with less money. But there’s a big problem when discussing jail and this health plan. A rule stops federal cash for the health care of people in jail. It makes it hard to stop their Medicaid, a significant roadblock when they return to everyday life [1][5].
Jonathan Larsen, JD, MPP, from a group that studies public health law, says the rules are strict, and getting health care again is hard for people in jail, so how quickly this happens depends on whether their coverage was stopped or ended and whether the state’s jail team works well with Medicaid. [5].
Different parts of the U.S. deal with this in many ways. Twenty-five states, including Washington, DC, cut off Medicaid if someone goes to jail. Others pause it. Some places, like California and Arkansas, pause it for up to a year, and New York for two years [1][5]. These differences mean people don’t get the same health care. It’s harder to take care of long-term health issues like drug problems, liver disease, and HIV, which happen a lot in people who’ve been to jail [5].
A new law started in April 2023 called Medicaid Reentry Section 1115. Under Social Security law, people can have Medicaid for 90 days before they leave jail. The goal is to fill the care gap they face when they leave the system [2][3]. This helps a law that wants to stop opioid abuse and help people get treatment, making getting back to life smoother and lowering death after jail [3][4].
Still, the broader reach of Medicaid under the ACA puts another twist on the story. States choose if they expand Medicaid, which changes who can get it and how easily. In states that go for expansion, people making up to 138% of the poor people’s money line can get Medicaid, helping a lot when they’re getting back to life by continuing care [6].
But in states that don’t go for the expansion, many with less money, including those just out of jail, need help finding cheap health care. This gap makes getting back harder, leading to worse health and more chances of returning to jail [6]. For those who can’t get Medicaid or market savings, health centers, given money by the health care law, offer help based on what they earn, trying to cover the lack of options [6].
Things get even trickier for those whose money is close to the poverty line. If they make enough, they might get plans with a tax credit, possibly giving them another way to get health care after jail [6].
As leaders and health workers try to fix these challenging issues, Medicaid’s role, both old and new, is proper at the heart. Working to get better health care for folks in jail not only deals with health gaps but also improves public safety and cuts costs from people returning to jail.
References
[1] Center for Public Health Law Research, “Incarceration effects on Medicaid status.” Updated June 1, 2023. Accessed February 8, 2024. [Online]. Available: https://pdaps.org/datasets/medicaid-funded-mat-for-justice-involved-persons-1565019237
[2] Centers for Medicare & Medicaid Services, “Opportunities to test transition-related strategies to support community reentry and improve care transitions for incarcerated individuals,” April 17, 2023. Accessed February 8, 2024. [Online]. Available: https://www.medicaid.gov/sites/default/files/2023-04/smd23003.pdf
[3] Centers for Medicare & Medicaid Services, “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, April 17, 2023. Accessed February 8, 2024. [Online]. Available: 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. [Online]. Available: https://www.shvs.org/cms-issues-guidance-on-section-1115-demonstration-opportunity-to-support-reentry-for-justice-involved-populations
[5] Gallagher A, Pharmacy Times, “Gap in Medicaid impacts access to services for justice-involved patients,” Accessed April 17, 2023. [Online]. Available: https://www.pharmacytimes.com/view/gap-in-medicaid-impacts-access-to-services-for-justice-involved-patients
[6] Healthcare.gov, “Medicaid expansion & what it means for you,” Accessed April 17, 2023. [Online]. Available: https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/
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