Medicaid and Corrections

Recent Medicaid guidance and legislative developments offer new opportunities for correctional leaders to leverage Medicaid to enhance outcomes for people who are incarcerated. With the passage of the SUPPORT Act, the Consolidated Appropriations Acts of 2023 and 2024, and new guidance around the Medicaid Section 1115 Reentry Demonstration Opportunity, prisons and jails have more opportunities to work with their state Medicaid agencies to support individuals not only during incarceration but also during the critical transition from incarceration to the community.

This webpage provides a curated list of resources to support correctional leaders in taking full advantage of these new opportunities.

Medicaid and Corrections

 

Top Resources

Why This Matters

In 1965, the Social Security Act created Medicaid as an insurance program to support access to health care for persons with limited income. The Social Security Act (Sec.1905(a)(A)) prohibits the use of federal funds and services for medical care provided to inmates of a public institution (excluding hospitalizations of more than one day). The Social Security Act does not make a statutory distinction between a person who is convicted and a person incarcerated prior to conviction.   
  
As a result of this “inmate exclusion policy,” state Medicaid and correctional systems have operated mostly independently, despite serving overlapping populations. Recent changes to Medicaid policy enacted by Congress and new guidance from the Centers for Medicare and Medicaid Services (CMS) for designing demonstration projects to improve care transitions for Medicaid-eligible individuals who are incarcerated and returning home to their communities represent a transformative shift in how health care and related services can be managed within correctional settings and during reentry. These changes open new avenues for funding and support, authorizing correctional facilities to address the health and health-related social needs of people who have been incarcerated more effectively.   
  
Medicaid funding can play a crucial role in long-term outcomes for people who are incarcerated. Until recently, Medicaid could only be leveraged to support individuals after release from correctional facilities, but with the new federal changes, Medicaid funding is now also available to support individuals in the crucial weeks prior to release. This will help facilitate health care continuity, ensuring that individuals receive necessary medical, mental health, and substance use disorder services both during and after incarceration. The ability to provide and connect individuals with Medicaid-funded services prior to release helps bridge critical gaps in care and supports their journey toward successful reentry. It can also potentially ensure fewer gaps in physical health, mental health, and substance use services during reentry.  
  
Because health-related social needs, such as housing stability, employment, education, and food nutrition, significantly overlap with criminogenic risk and needs, these changes to Medicaid represent an opportunity to transform correctional health care, improve reentry outcomes, and ultimately contribute to the broader goal of public health and safety. By leveraging Medicaid funds to address these needs, correctional facilities can help reduce recidivism and promote healthier, more stable communities. 

How Medicaid Can Help Graphic
Bridget Degnan, “How Medicaid Can Help” (New York: The Council of State Governments Justice Center, 2024).