10
except as inpatients in a medical institution.
30
This is otherwise known as the “Medicaid inmate
exclusion.” Although there appears to be interest amongst prisons, jails, and their partner agencies to
identify and enroll eligible people in public health care benefits prior to release, many facilities do not
have processes or staffing in place to do so. One study found that only 28% of jails screen for Medicaid
eligibility at release.
31
As a result, those returning from incarceration may face obstacles when seeking
to find, understand, and use information to inform their health-related decisions and take appropriate
health-related actions for themselves.
Efforts to provide health care for individuals while incarcerated, including mental health and substance
use disorder treatment, have a high risk of failure without continuity of care upon release. Access to
Medicaid coverage for returning community members can provide continuity of care that may improve
health outcomes, reduce recidivism, and improve public safety.
32
However, depending on a person’s
state of residence, Medicaid benefits may not be easily accessible, or may not be available at all to
adults released from a correctional facility. Some states have opted to implement policies and
procedures to facilitate the eligibility process, to ensure services are available as promptly as possible
upon reentry into the community.
33
However, that eligibility is only valid in the state of residence,
typically the state in which the correctional facility is located, with few exceptions. Often, when
individuals reenter the community, their families, social supports, housing, and employment
opportunities may not be in the same state. In the event the individual moves to another state to resume
community life, the Medicaid benefits established in the state where the individual was formerly
incarcerated do not transfer to the new state. Medicaid eligibility must then be re-established, again
resulting in delay or denial of services.
Beyond access to basic health care needs, criminal justice-involved individuals are more likely to
experience substance use disorders and mental health conditions.
34
Substance abuse and demand for
health-related services increased during the COVID-19 pandemic.
35
Approximately sixty-five percent of the U.S. prison population has an active substance use disorder.
36
However, only a small portion of individuals with a substance use disorder receive treatment while
incarcerated.
37
According to one study, individuals recently released from incarceration are over forty
times more likely to die from an opioid overdose than the general population.
38
The weeks immediately
following reentry are when individuals are most vulnerable to relapse and recidivism.
39
However,
people who are enrolled in health care coverage when released are more likely to use community-based
services that could help reduce their chances of recidivating.
40
Further, many reentry providers, including some HHS grantees, particularly those who engage with
clients for mental health and substance use disorders, report that obtaining clients and referrals during
the pandemic has been difficult for their reentry programs. Prior to the pandemic, reentry programs
were required to begin assessment and pre-release services for incarcerated individuals while they were
still incarcerated, a certain number of months prior to release. However, due to the public health
emergency and following guidance from the Centers for Disease Control and Prevention (CDC), most
jails and prisons closed to outside visitors, including service providers, during the pandemic, and
grantees were therefore not allowed to provide in-person services pre-release. The pandemic also
changed the way assessments and pre-release services were handled. Grantees had to transition to jail
and prison staff referring potential client’s names to grantees so they could reach out by phone, or by
other methods or platforms, such as letters, email, or virtual videoconference, to encourage participation