National Policy Update! Federal Funding for Re-Entry Health Services
Davey, aged 62, uses Medicaid to pay for medication to manage his heart condition. He is arrested and cannot afford his bail, so he is booked into jail and loses Medicaid coverage. Medicaid will not cover him as long as he is incarcerated, but the jail cannot deny him the medication. The county jail is now paying for a medication that was covered under Medicaid just weeks ago.
This is the unfortunate reality happening in many jails across the country.¹ The Medicaid Inmate Exclusion Policy (MIEP) has historically made incarcerated individuals ineligible for Medicaid coverage and terminates a person’s coverage upon incarceration. When people covered under Medicaid come into jail and lose their coverage, it becomes the county jail’s responsibility to pay for necessary medical care. This means counties are providing treatment without payment, going into debt, and running health care services at a deficit.
Take advantage of Section 1115 waivers
More and more states are using Section 1115 waivers to get health care approved and funded on the federal level. These initiatives waive the MIEP and authorize states to make changes to Medicaid programs. For example, many states are adding re-entry programs and allowing detainees to register for Medicaid prior to release, so they can be covered once in the community. Currently, 11 states have approved waivers for incarcerated individuals, and even more states are pending approval.²
If Section 1115 waivers are not available in your state, reach out to your state Medicaid director. Consider sending a copy of the CMS guidance letter on the issue. If a waiver is currently pending in your state, you can leave a public comment encouraging CMS to pass the application. Take advantage of Section 1115 waivers.
Contact Congress
Another initiative, supported by the National Sheriff's Association, would propose legislation to change the wording of Medicare law to allow incarcerated people to remain covered for the entirety of their incarceration. Since this national push requires an act of Congress, the progress has been slow going.
While Section 1115 waivers seem to be much easier to get, they are state-based initiatives and a short-term solution. The waivers are re-evaluated and re-applied for, much like grants. States without strong support from a Sheriff’s Association, DOC, or governor, may not be getting waivers any time soon. While amending the MIEP would be a more permanent solution to the problem, it is vastly harder to achieve. Consider partnering with your Sheriff’s Association to contact Congress and encourage national legislation.
Not sure where to start?
Apply for grant funding in 2025
Looking ahead, more funding options will become available in 2025. Recent policy developments have started to open the door for federal funding to support re-entry health services in jails.
Starting in 2025, Medicaid will begin to cover certain health services for incarcerated people prior to release, including:
· Case management for juveniles
· Diagnostic and screening services
· Behavioral health screening
The Centers for Medicare and Medicaid Services (CMS) is expected to issue grants to help with this transition beginning in 2025.³ Right now, these grants are not open. Keep an eye out for more information from Spark Training on how to apply for funding in 2025 when it becomes available.
For more information, please contact training@sparktraining.us.
1. Albertson, Elaine. (2020). Eliminating Gaps in Medicaid Coverage During Reentry After Incarceration, American Journal of Public Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002937/.
2. Centers for Medicaid & Medicare Services (2024). HHS Authorizes Five States to Provide Historic Health Care Coverage for People Transitioning out of Incarceration, CMS. https://www.cms.gov/newsroom/press-releases/hhs-authorizes-five-states-provide-historic-health-care-coverage-people-transitioning-out.
3. Congressional Research Service. (2024). Consolidated Appropriations Act (P.L. 118-42): Medicaid and Medicare provisions (R48075), CRS. https://crsreports.congress.gov/product/pdf/R/R48075.
Disclaimer
All materials have been prepared for general information purposes only. The information presented should be treated as guidelines, not rules. The information presented is not intended to establish a standard of medical care and is not a substitute for common sense. The information presented is not legal advice, is not to be acted on as such, may not be current, and is subject to change without notice. Each situation should be addressed on a case-by-case basis. When in doubt, send them out!®