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Medicaid Enrollment Before Release Could Improve Health for Re-Entry

Volodymyr Herasymchuk/ Shutterstock

Two new reports, by Stateline and Kaiser’s Waiver Watch, outline the potential of a new Medicaid waiver, which allows states to provide Medicaid healthcare coverage to incarcerated people at least a month prior to release.

Last year, the Centers for Medicare and Medicaid Services released guidance about an opportunity for states to test “transition-related strategies” to support re-entry. The key part of this demonstration is that states are able to waive what’s known as the federal inmate exclusion policy, which generally prohibits Medicaid from paying for services provided during incarceration.

As of last month, federal officials had approved waiver applications from four states — California, Massachusetts, Montana and Washington. Nearly 20 other states are waiting for approval, according to health research organization KFF. Participating states must, at a minimum, provide case management, medication-assisted treatment for people with substance use disorders and a month’s supply of medication upon release.

In 2022, about 448,400 people were released from prison, according to the federal Bureau of Justice Statistics. Typically, people walking out of prison gates lack health insurance – though they are disproportionately more likely to have grave chronic conditions such as heart disease and substance use disorders. Many struggle to find healthcare providers and get needed treatment.

A study of people released from Louisiana state custody found that a “significant time gap” between prisoners’ release and when they were able to receive many important health services, particularly for behavioral health services. People often left incarceration with no medication at all and faced a mean time to fill prescriptions after release that was often 100 days or more. That was often due to the state DOC practice of hiring physicians with restricted medical licenses, which made it impossible for formerly incarcerated people to fill prescriptions written by these providers upon return to the community.

The result can be deadly, found an often-cited 2007 study of former prisoners in Washington state, which found that they were 12 times more likely to die from all causes within two weeks of release, when compared with the general population. The leading causes were drug overdoses, cardiovascular disease, homicide and suicide.

Given the grim outlook from the past, the new waivers’ potential to improve re-entry healthcare, is groundbreaking, ” said Vikki Wachino, executive director of the Health and Reentry Project and a former deputy director of the Centers for Medicare & Medicaid Services.

“What these waivers enable states to do is build a bridge to access to health care — a bridge that starts before someone’s released and continues after their release,” she said.



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