In 2021, more than 440,000 people returned home to communities from prisons. Roughly 7 million people entered jails that year, many of whom returned to communities within a month. People who are returning to their communities from prison or jail often fall into gaps between the health care and criminal justice systems, due in part to loss of insurance coverage during incarceration, leaving them to navigate a fragmented patchwork of services on their own. Since 2018, through a series of policy changes, Congress, state leaders, and federal policymakers have worked to use Medicaid to improve access to health care at reentry, and by extension, to improve both health and safety outcomes for people and communities.1
Earlier this month, Congress passed bipartisan legislation, the Consolidated Appropriations Act of 2024 (CAA), that includes several changes to Medicaid policy for justice-involved populations. These provisions, summarized below, could help to improve care transitions at reentry, promoting access to needed care and support.
Suspending, Rather Than Terminating, Medicaid Enrollment for Incarcerated People
Medicaid’s longstanding inmate exclusion prohibits coverage when a person is incarcerated, other than in certain narrow circumstances. Therefore, when a person with Medicaid coverage is incarcerated, states typically either terminate their enrollment, requiring that the individual apply after release, or suspend that enrollment, which facilitates faster reinstatement when the person returns to the community. Under the new law, beginning in 2026, all states are required to suspend, rather than terminate, Medicaid coverage when people are incarcerated. Setting a national standard of suspension is an important step toward facilitating continuity of care and access to needed services for the millions of people who return to communities each year from incarceration.
Using State Grants to Build Operational Capacity
To implement these and other recent Medicaid reentry changes effectively, states need support to address existing operational and systems gaps to ensure improved access to care at reentry. For example, fewer than half of states use automated systems to transmit enrollment and release information between prisons and jails or state and county agencies that review Medicaid eligibility. Under the CAA, $113.5 million in planning grants will be awarded to states by March 2025 to build the operational capacity to support continuity of care for people leaving incarceration. These funds can be used to support efforts by state agencies, community-based organizations, state and local correctional institutions, Medicaid managed care plans, and other stakeholders. Grants can be used to identify and address operational gaps, create standardized processes and build the systems and technology infrastructure necessary to support care transitions, and establish oversight processes to monitor compliance with state requirements.
Guidance to Support State Implementation and Operations
There is growing state interest in these Medicaid policy changes. Twenty states have proposed Medicaid reentry waivers and more states are developing proposals. But bridging these systems is complex and requires sustained collaboration between state, federal, and local actors. For example, creating automated processes to suspend and reinstate coverage is challenging and requires overcoming technology hurdles and often involves addressing variations in systems and processes across agencies and individual corrections facilities. The CAA requires that the Centers for Medicare and Medicaid Services issue guidance to states within 18 months, laying out strategies and best practices states can use to overcome common implementation and operational challenges. The guidance will focus on:
- eligibility and enrollment process modifications
- screening, application assistance, and coordination of reinstatement of coverage
- data sharing and exchange
- ensuring the timely provision of services, and
- establishing community-based provider networks.
It also will describe ways that states can use Medicaid information technology and administrative funding to support their efforts to build continuity of care.
Connections to Community Providers
The CAA also extended and increased needed funding for community health centers (CHCs) until the end of the calendar year. As community-based health providers serving underserved areas and communities, CHCs have a major part to play in supporting successful transitions for people returning to communities. Work previously published by the Commonwealth Fund examines the role of CHCs in providing care to people who experience incarceration.
Policy Implications
The CAA policy changes build on recent bipartisan activity at both the state and federal levels focused on advancing public health and public safety by building bridges between corrections and health care. Ensuring that individuals have Medicaid coverage and connections to care upon reentry has the potential to improve a range of health and public safety outcomes, including reducing mortality, unnecessary emergency room visits and hospitalizations, and rates of recidivism and reincarceration.
