Medicaid Restriction for Inmates Creates a Perfect Storm for County Jails

March 6, 2020 Updated: March 6, 2020

County prisons have a growing population of inmates with mental health, substance abuse, and chronic health issues for which counties are shelling out billions in taxpayer dollars to provide treatments within local jails.

According to the National Association of Counties (NACo), 44 percent of the inmate population has a significant mental health issue, and 63 percent have drug dependency or drug abuse issues.

The Medicaid Inmate Exclusion Policy of 1965 restricts pre-trial prisoners from accessing their full federal health benefits, often disrupting their mental health treatment and costing local officials and taxpayers billions of dollars annually.

County governments run 2,875 of the nation’s 3,160 local jails. According to NACo, “local jails annually admit 18 times more individual than state or federal prisons.”

The National Association of Counties estimates that it would cost the federal government a little over $3 billion annually to provide Medicaid benefits to pre-trial inmates, which is significantly lower than what counties pay now.

When a person is arrested and put in jail, city and county governments are mandated to pay the costs for the inmate’s health care until that person is tried. If convicted, federal or state governments generally pick up the costs of medical treatment through the rest of the sentence.

A Republican sheriff of Louisiana’s St. Charles Parish, Greg Champagne, said the federal policy denying pre-trial persons access to their health benefits violates their constitutional rights under the Fifth and 14th Amendments.

Some county law enforcement officials say taking away benefits from those who cannot afford to post bail is discriminatory. Those whose families can post bail keep their healthcare while they await their trial date.

Those who cannot afford to post bail get their healthcare coverage cut off, which often means either stopping or changing psychiatric or chronic-illness medications, which leaves the inmate in a vulnerable situation.

Local officials have seen that the denial of federal health benefits is linked to high risks of mortality, relapse in mental health illness, and recidivism.

According to NACo, “70 percent of the 2 million youth arrested every year in the U.S. suffer from a mental health condition” and “96 percent of jail detainees and inmates do not receive a prison sentence and return to the community.”

A group of bipartisan county sheriffs, commissioners, and other local officials have been lobbying Congress to change this long-standing policy and let pre-trial detainees retain their health coverage while in custody.

“The Medicaid Inmate Exclusion (MIE) forces many individuals involved in the justice system into a vicious cycle of addiction, incarceration, and recidivism that devastates families and communities, and drains state and local budgets while harming public health and our economy,” said Congresswoman Annie Kuster (D-N.H.).

There is currently legislation in the Senate to reverse the Medicaid Inmate Exclusion Policy and allow those arrested to keep their federal medical insurance coverage, enabling the continuity of treatment and taking the financial burden off local governments.

Advocates say access to Medicaid while awaiting trial is constitutionally aligned because it assumes innocence until proven guilty.

Proponents for providing federal medical coverage to inmates also point to the fact that the continuity of treatment makes communities safer and healthier.