Provide Guidance on Closing Medicaid Reentry Gaps

Formerly incarcerated people face multiple challenges as they reenter society, from the need to find stable housing to the search for steady employment. Poor health—and the struggle to obtain health care—compounds the obstacles. Compared with the general population, people in prison have disproportionately high rates of chronic conditions and infectious diseases. In addition, more than one in four incarcerated individuals have been diagnosed with a mental health condition at one point in their life, and nearly two-thirds of those behind bars in the U.S. suffer from a substance use disorder. Connecting people leaving prison with health care and preventive services immediately upon their return to society can save lives. One study of formerly incarcerated people in Washington State found that in the two-week period following release, their risk of death was nearly 13 times that of the state’s resident population. While locating care providers is one key challenge, formerly incarcerated people eligible for Medicaid also can face a lengthy wait for benefits, leaving them unable to pay for services or prescriptions. Strategies that enable people to overcome these and other service barriers can limit unnecessary and costly hospitalizations, institutionalizations, and emergency room visits. The Task Force recommends strengthening care transitions for those individuals who are eligible for Medicaid. Ensuring the availability of community-based health care for reentering citizens—as quickly as possible—can improve health outcomes and, in turn, reduce recidivism, enhance public safety, and cut the costs of incarceration.


The Department of Health and Human Services should issue guidance on demonstration projects under Section 1115 of the Social Security Act to improve care transitions for soon-to-be formerly incarcerated persons who are otherwise eligible for Medicaid.

Implementation Steps

  1. The Department of Health and Human Services should immediately convene the stakeholder group as required by law (SUPPORT Act) and, using best practices identified by that group, develop and issue guidance for states on innovative service delivery system demonstration project opportunities for care transitions for soon-to-be formerly incarcerated persons.

Annotated Citations

The Pew Charitable Trusts. “Prison Health Care: Costs and Quality.” October 2017. “If treatment is not continued outside prison gates, the recidivism-reduction and public health effects of even well-designed and -executed health programs delivered in facilities can be undermined. For example, being uninsured upon release—true of nearly 80 percent of individuals in past years, according to some estimates— can serve as a major barrier to further care and is predictive of recidivism and associated with shorter times to re-incarceration. Similarly, in-prison treatments for substance use disorders and mental illness deliver better and more durable results when patients are handed off to community providers.”

Guyer, Jocelyn, et al. “State Strategies for Establishing Connections to Health Care for Justice-Involved Populations: The Central Role of Medicaid.” The Commonwealth Fund. 11 January 2019. “Medicaid expansion has provided states with a powerful tool to address the health care needs of justice-involved individuals — a population that suffers with especially high rates of physical and behavioral health problems, as well as barriers to housing, jobs, and other social needs that can affect health. Medicaid expansion makes most individuals coming out of prison or jail eligible for coverage. States are taking full advantage, putting in place policies and processes to ensure that coverage is effective prior to release. Of course, coverage is necessary but not sufficient. With coverage as a foundation, states have developed a range of promising models — often as part of larger initiatives aimed at high-risk, high-cost populations — that tend to include key elements that can be identified and potentially replicated by other states. These elements can be included as requirements in Medicaid managed care plans, provided as part of health homes, or disseminated in other ways. The challenge going forward is to solidify coverage upon discharge, maintain it, and connect people leaving the prison system with the comprehensive health care, social supports, and care management they need.”

Jannetta, Jesse, et al. “Strategies for Connecting Justice-Involved Populations to Health Coverage and Care.” Urban Institute. 16 March 2018. This Urban Institute project, funded by a Bureau of Justice Assistance grant, serves as a national policy guide and provides a roadmap for state and local justice and healthcare officials and other stakeholders who want to increase coverage and improve health outcomes for justice-involved people. The authors contend that the best practices they outline will enhance public safety, reduce recidivism, and more efficiently use public resources. The guide’s solutions are aimed at tackling three goals: (1) efficiently enrolling justice-involved people into Medicaid and other health coverage, (2) helping justice-involved people who have returned to the community obtain coordinated physical and behavioral healthcare that meets this population’s distinctive needs, and (3) supporting efforts to increase enrollment and the provision of appropriate coordinated care. Focusing on the first goal (enrolling individuals into Medicaid), the authors offer strategies in three areas: (1) bolstering the eligibility and enrollment workforce for justice-involved people, (2) setting enrollment priorities, and (3) improving suspension and renewal processes. Throughout the project, the authors determine a particular action’s potential impact. They find that a strategy that leverages navigators, application assisters, and eligibility workers has “high” potential impact. Also, they find that improving the suspension and renewal process will have a moderate to high impact for justice-involved individuals. To accomplish this, the authors favor establishing effective processes for suspension or reclassification and renewing eligibility for incarcerated beneficiaries using available data sources.

Howard, Jhamirah, et al. The Importance of Medicaid Coverage for Criminal Justice Involved Individuals Reentering Their Communities. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. April 2016. This issue brief explains why Medicaid and access to health benefits play a key role in improving the health of justice-involved individuals as they try to reenter society. Justice-involved individuals have disproportionately high rates of chronic conditions, infectious diseases, and behavioral health problems, thus making them particularly vulnerable when reentering society without health coverage. Largely, justice-involved individuals become responsible for their own health care after release from jail or prison, including under probation, parole, or home confinement. The authors highlight studies that show that untreated or undertreated behavioral health disorders contribute to higher risk for poor health outcomes and recidivism. The issue brief concludes by reiterating the importance of unfettered access to Medicaid coverage for justice-involved persons, noting that access “may improve health outcomes, reduce recidivism, improve public safety, and lower the costs of incarceration.”