HHS Guidance Increases Care Access for Incarcerated Medicaid Beneficiaries

The US Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), has released guidance to help states boost access to healthcare for incarcerated Medicaid beneficiaries before their release.

The Medicaid Reentry Section 1115 Demonstration Opportunity would allow state Medicaid programs to cover healthcare services for up to 90 days before an incarcerated individual’s expected release date. These services, including substance use disorder treatment and chronic condition care, would otherwise not be covered by Medicaid due to statutory exclusion that prevents Medicaid payment for most services provided to people in the care of a state or county carceral facility.

“Today, we reach a significant milestone in expanding access to health care in the Medicaid program. This guidance outlines a pathway to implement historic changes for individuals who are incarcerated and eligible for Medicaid,” CMS Administrator Chiquita Brooks-LaSure said in the announcement. “By improving care and coordination prior to release from the justice system, we can help build a bridge back to the community and enhance individual and collective public health and public safety outcomes.”

Incarcerated individuals who are eligible for Medicaid and have upcoming release dates have been historically underserved and adversely impacted by poverty and inequality. The demonstration opportunity aims to improve care access and address social determinants of health for this population by covering services ranging from case management to medication-assisted treatment.

The demonstration can help Medicare beneficiaries connect with healthcare providers before their release to ease their transition back into the community and maintain care access following incarceration.

Access to substance use disorder treatment, mental healthcare, and other healthcare services can help reduce emergency department visits, inpatient hospital admissions, and overdoses, the press release said. In addition, adequate access to healthcare can improve overall health outcomes and lower the risk of returning to a carceral setting.

From 2011 to 2012, around 37 percent of people in state or federal prisons and 44 percent of incarcerated people overall had a history of mental illness, according to data from the US Department of Justice.

What’s more, as high as 65 percent of incarcerated people have a substance use disorder, the National Institute on Drug Abuse (NIDA) estimated. Without treatment, formerly incarcerated people have a higher risk of overdose within the first few weeks of returning to their community.

“The Biden-Harris Administration has made expanding access to high-quality, affordable health care a top priority. We are committed to ensuring all Americans have the peace of mind they deserve knowing they have access to life-saving health care, whether it is medication-assisted treatment for substance use disorders or prescription medication to treat other chronic health conditions,” HHS Secretary Xavier Becerra said.

“Through this historic new effort, we are working to ensure that people who were formerly incarcerated can transition successfully back into the community with the health care supports and services they need. This is an essential step for advancing health equity in our nation, and we encourage all states to take advantage of this new opportunity.”

The demonstration also aims to improve coordination and communication between correctional systems, Medicaid systems, community-based providers, and managed care plans, HHS and CMS said.

The guidance builds on the policies included in the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act. Additionally, the demonstration opportunity supports the Biden Administration’s Safer America Plan and Unity Agenda.

As of September 2022, eleven states had submitted section 1115 demonstration waivers to boost access to care for incarcerated Medicaid beneficiaries. California became the first state to cover care for these beneficiaries in January 2023 after HHS approved its demonstration.