Boston, MA – Individuals who have experienced incarceration often face higher rates of mental illness, substance use disorder, and chronic diseases compared to the general population. Despite these challenges, federal policies like the “inmate exclusion” rule restrict Medicaid coverage for those who are incarcerated, except for limited inpatient hospital services. This limitation can lead to difficulties in accessing necessary healthcare upon reentry into society, putting individuals at a higher risk of overdose death, suicide, hospitalization, and emergency department visits.
Recently, there has been a new initiative that allows states to request a waiver of the inmate exclusion policy from the Centers for Medicare and Medicaid Services (CMS). This initiative aims to provide “reentry services” to help individuals transition back into the community smoothly. These services focus on improving health care transitions, ensuring continuity of health coverage, minimizing disruptions in care, enhancing health outcomes, and reducing rates of repeat incarceration.
According to a recent analysis, approximately 1.2 million individuals were in federal and state prisons by the end of 2022, with an additional 660,000 people held in local jails as of mid-year 2022. The report highlights that individuals who are incarcerated often have higher rates of chronic diseases such as hypertension, tuberculosis, hepatitis, and HIV/AIDS compared to the general population. Additionally, many of them have significant behavioral health needs, with an estimated 65% of people in prisons nationwide having an active substance use disorder.
Several states, including California, Montana, and Washington, have already received approval to offer pre-release services to certain Medicaid-eligible individuals who are incarcerated. California anticipates around 200,000 people per year will be eligible for these services, while Washington estimates 4,000 individuals annually. Furthermore, nineteen more states have pending waiver requests with CMS to implement similar programs.
Pre-release services vary by state but typically include case management to assess health and social needs, assist with service connections pre and post-release, medication-assisted treatment, counseling for substance use disorders, and a 30-day supply of prescription medications upon release. These initiatives aim to address the complex healthcare needs of individuals reentering society after experiencing incarceration, providing support to improve their overall well-being and reduce the likelihood of recidivism.