A New Era for Healthcare Access: Medicaid Expands to Incarcerated Populations
A Milestone for Equitable Healthcare
In a groundbreaking move, Medicaid is expanding into carceral settings, marking a significant shift in healthcare access for incarcerated people. Beginning in January 2025, new federal requirements will mandate comprehensive health services for young people who are incarcerated, with the potential for expansion to include adults. This policy represents a long-awaited step toward addressing the pressing health disparities faced by this vulnerable population.
Historically, Medicaid’s inmate exclusion policy has limited access to healthcare within correctional facilities, typically covering only emergency or inpatient hospital care. As a result, incarcerated individuals often receive inadequate preventative care, mental health support, and treatment for chronic illnesses, contributing to a cycle of health problems upon reentry into society.
Bridging the Gap in Healthcare for Youth
The new policy prioritizes young people under 21 who are eligible for Medicaid and CHIP, as well as former foster youth who qualify for Medicaid until age 26. This age group faces unique challenges, often experiencing high rates of adverse childhood experiences, such as abuse and neglect, which can have a lasting impact on their physical and mental health. They are also at increased risk for substance use disorders and other chronic illnesses.
Under these changes, Medicaid and CHIP will be required to provide a comprehensive range of services within 30 days before release. This includes medical, dental, and behavioral health screenings, as well as diagnostic services and case management. Crucially, case management will continue for 30 days post-release, including referrals to community-based providers and needs assessments.
“These policy changes aim to ensure smoother transitions at reentry, establish connections to community providers, and promote ongoing access to care and support,” says Elizabeth Hinton, a Medicaid policy expert at KFF.
The scope of this transformation goes beyond simply extending coverage; it necessitates forging new relationships between Medicaid and correctional institutions. These partnerships will require unprecedented coordination and collaboration, including data-sharing agreements and robust case management systems.
Expanding Care for Adults: Waiver Opportunities
Recognizing the significant health needs of the broader incarcerated population, federal policy has also opened the door for Medicaid waivers to extend pre-release coverage to adults. Under Section 1115 waivers, states can seek approval to provide coverage for essential services, including case management, medication-assisted treatment (MAT) for substance use disorders, and a 30-day supply of prescription medications at release.
CMS has already approved waivers in 11 states, with 15 more applications pending. Meanwhile, Louisiana is the only state in the Gulf South to submit a waiver. While CMS establishes minimum requirements, states have flexibility in tailoring their waiver programs, with pre-release coverage periods ranging from 30 to 90 days.
“We’ve seen states go beyond minimum requirements to target specific populations and extend coverage,” Hinton notes, adding that the Affordable Care Act’s Medicaid expansion has played a critical role, allowing states to cover childless adults and broaden the pool of eligible individuals.
Addressing Racial Disparities: A Path Forward
The expansion of Medicaid into correctional settings holds immense promise for addressing long-standing racial disparities in health outcomes. Incarceration rates are disproportionately high among Black and Hispanic individuals, who already face systemic barriers to healthcare access. By ensuring access to comprehensive pre-release services, Medicaid coverage can help mitigate these inequities and pave the way for a more equitable healthcare system.
“We know there are racial disparities in incarceration that further exacerbate health disparities,” says Hinton