![]() ![]() How are states coordinating care for incarcerated individuals upon release?.What are state proposals to provide pre-release Medicaid coverage to incarcerated individuals?. ![]() Using information from KFF’s 21 st annual Medicaid budget survey and ongoing analysis of Section 1115 waivers and other initiatives, this brief answers three key questions about state efforts to connect individuals to care before, upon, and following release from incarceration: This provision would impact coverage options for justice-involved individuals in non-expansion states, who may have new coverage options through the Marketplace upon release from incarceration.Īt the state level, states may expand access to Medicaid coverage and care for justice-involved populations through a variety of mechanisms, including existing authorities as well as Section 1115 demonstration waivers. The BBBA would also temporarily close the coverage gap for individuals with incomes below poverty living in states that have not adopted Medicaid expansion by allowing these individuals to purchase federally subsidized coverage on the ACA Marketplace through 2025. This provision would be effective on the first day of the first fiscal year calendar quarter that begins two years after date of enactment (as soon as January 1, 2024). Both the version of the proposed Build Back Better Act (BBBA) passed by the House of Representatives on Novemand the version revised by the Senate Finance Committee on Decemwould partially lift the inmate exclusion policy by allowing federal Medicaid money to be used to pay for Medicaid-covered services 30 days prior to release for people who are incarcerated. ![]() The Biden Administration has also identified investments in justice-involved populations as a key Medicaid priority. The 2018 SUPPORT Act included provisions to promote continuity of care for justice-involved individuals, including prohibiting states from terminating Medicaid eligibility for incarcerated individuals under age 21 or former foster care youth up to age 26 and requiring eligibility redeterminations prior to release. In the 39 states (including DC) that have adopted Medicaid expansion under the Affordable Care Act, nearly all adults with incomes up to 138% of the federal poverty level (FPL) ($17,774 for an individual in 2021) are eligible for Medicaid however, eligibility for adults remains very limited in the remaining 12 states. One analysis of inmates incarcerated between 20 found that in the first full year after release from incarceration, only 55% of individuals had any reported earnings and among those with jobs, median earnings were only $10,090. In states that have adopted Medicaid expansion under the Affordable Care Act (ACA), many justice-involved individuals could be eligible for Medicaid coverage. Although the statutory inmate exclusion policy prohibits Medicaid from covering services provided during incarceration (except for inpatient services), states may take other steps to leverage Medicaid to improve continuity of care for justice-involved individuals. Justice-involved individuals are disproportionately low-income and often have complex and/or chronic conditions, including behavioral health needs. The COVID-19 pandemic has magnified pre-existing health disparities for justice-involved populations, with coronavirus infection rates among incarcerated populations higher than overall infection rates in nearly all states. ![]()
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