New requirements for how Medicaid and Children’s Health Insurance Program (CHIP) agencies provide services to incarcerated youth are scheduled to go into effect in January 2025.
This change is based on new requirements in the Consolidated Appropriations Act of 2023. Federal policy also opens the door to expanded pre-release coverage for incarcerated adults.
For decades, Medicaid inmate exclusion policies have denied many prisoners access to comprehensive health care services while incarcerated, except for limited inpatient care.
Incarcerated people often face significant health disparities compared to the general population. They are disproportionately affected by infectious diseases such as hepatitis C, tuberculosis and HIV, as well as chronic diseases such as diabetes, hypertension and heart disease. In addition, mental health conditions and substance use disorders are highly prevalent.
These disparities are further exacerbated by socio-economic factors such as poverty, limited access to preventive care, and systemic inequalities. Blacks and Hispanics, who face higher rates of incarceration, often face these challenges more acutely, further exacerbating disparities in health outcomes.
Expanding Medicaid to incarcerated people will address these disparities by ensuring consistent and comprehensive access to health care.
“This is the first time that Medicaid has been used to cover some health care services for incarcerated people,” said Elizabeth Hinton, a Medicaid policy expert at KFF, a nonpartisan health policy research group. ” he said.
States have continued to eliminate Medicaid enrollment since pandemic coverage protections expired last year. But more than a dozen states are also expanding access to low-income people, including children.
begins with youth
The new policy applies to youth under age 21 who are eligible for Medicaid and CHIP, and to former foster youth who are eligible for Medicaid up to age 26.
It aims to address the significant health disparities faced by this population. They often report higher rates of adverse childhood experiences, such as abuse and neglect, which lead to poor health outcomes such as substance use disorders and early death.
Under the new policy, Medicaid and CHIP must provide medical, dental, behavioral health and diagnostic services within 30 days before termination. Case management is also covered for 30 days before and after release, including community introductions and needs assessments.
Hinton notes that these systemic challenges require “new relationships between Medicaid and correctional institutions” and require operational coordination on an unprecedented scale. .
“The goal of these policy changes is to ensure a smooth transition upon re-entry, establish connections with community health care providers, and facilitate access to care and support,” Hinton says.
Extending care to adults
Federal policy has also been expanded to allow Medicaid exemptions for pre-release services for adults.
Under Section 1115 waivers, states can now seek approval to provide coverage for case management, medication therapy (MAT) for substance use disorders, and a 30-day supply of prescription drugs upon discharge .
To date, the Centers for Medicare and Medicaid Services (CMS) has approved waivers in 11 states, with applications pending in 15 more states. Louisiana is the only state in the Gulf South to have submitted a waiver, which is currently pending.
Hinton noted that while CMS sets minimum requirements, states have flexibility in adjusting their waivers with a 30- to 90-day pre-release period.
“We’ve seen states go beyond the minimum requirements to target specific populations and expand coverage,” he said, adding that the ACA’s Medicaid expansion would allow states to cover childless adults. He added that it played a vital role in making this possible and further expanding the reach of the target audience.
Only 10 states are not participating in the federal program that expands Medicaid to people who remain in the health insurance “coverage gap.”
Addressing racial disparities
This policy update has the potential to address longstanding racial health disparities exacerbated by incarceration.
Medicaid coverage can help alleviate these inequities by improving access to pre-release services and serve as a model for addressing the needs of other underserved populations. It is possible.
“We know there are racial disparities in incarceration, which exacerbate health disparities,” Hinton said.
Future challenges
However, there are significant hurdles to implementing these programs.
Hinton said implementing pre-release services will require new partnerships between systems like CMS and state corrections departments to provide technical assistance and ensure systems are in place to share data. He said there is.
CMS has stated that it will prioritize community-based providers over medical providers to facilitate a “warm handoff” in the transition to post-release care, but building this infrastructure requires a history of requires cooperation between siled systems.
And while these policies have bipartisan support, their implementation could change under the incoming Trump administration. Hinton said the demonstration waiver, which allows states to test innovative or experimental projects within the Medicaid program to improve health care delivery, increase access and reduce costs, is a priority for the administration. He said that this is an area in which he can make a statement.
For example, the Biden administration’s guidance emphasizes health-related social needs and expedited waiver approvals, but future administrations may change these priorities.
why is this important
At the heart of this expansion is an emphasis on the importance of access to health care for justice-involved people.
Hinton said that expanding Medicaid to include cancer care settings will open the door to a more equitable health care system and strengthen the safety net for some of society’s most vulnerable populations.
“It’s really at the heart of the fact that people who are incarcerated have very high physical and behavioral health needs and are at a very vulnerable time for reintegration into the community,” Hinton said. .
Mississippi lawmakers failed to come together to pass a bill that could expand Medicaid to thousands of residents.
This story was created by Gulf Newsroomcollaboration with. Mississippi Public Broadcasting, WBHM In Alabama, WWNO and WRKF Louisiana and NPR. Health equity coverage supports: commonwealth fund.
