Narrowing the "Medicaid Inmate Exclusion Policy" to Improve Continuity of Care for the Reentry Population

Every year in the United States, over 600,000 people are released from prison and over 9,000,000 enter and exit jail. Many of these individuals have complex and chronic physical and mental health conditions. The Bureau of Justice Statistics found that in 2016, forty percent of incarcerated people in state prisons reported having an active chronic health condition, forty-three percent had a history of mental health issues, and fourteen percent met the threshold for serious psychological distress. Nationally, a person with serious mental illness is three times more likely to be found in a jail or prison than a hospital. Upon reentry to their communities, many individuals are left unsupported in vulnerable positions, without health insurance or transitional medical care. The consequences for those with acute medical needs and mental health disorders—particularly those with substance use disorders—can be severe. Though countless policies, practices, and dynamics underlie this concerning status quo, this Article focuses on one in particular: the “Medicaid Inmate Exclusion Policy” (MIEP).The MIEP prohibits the use of federal dollars to cover Medicaid expenses for incarcerated individuals. Scholars and legislators have argued that repealing the MIEP would improve the quality of health care provided during incarceration and continuity of care upon release. However,federal legislative efforts to repeal or amend the MIEP have failed. Recent state-based agency efforts, on the other hand, have had promising success. This Article surveys these various MIEP-related legislative and regulatory efforts and analyzes their potential to narrow the scope of the MIEP to improve quality of health care for incarcerated people and continuity of care upon reentry. Ultimately, this Article recommends leveraging state regulatory law to improve continuity of care as a potential stepping stone to repealing or amending the MIEP. This Article proceeds in four parts. Part I highlights the dismal state of correctional health care to provide context for incarcerated people’s health care needs during incarceration and upon release. Part II provides background on Medicaid and the MIEP’s impact on incarcerated and formerly incarcerated people. Part III discusses policy efforts at the federal and state levels to curb the MIEP’s effects through various legislative and regulatory mechanisms—namely, Section 1115 demonstration projects. Part IV hones in on the strengths and weaknesses of Section 1115 demonstration projects and concludes with high-level recommendations.