Last week, a group of House members introduced a bill to provide Medicaid coverage to people in the last 30 days of their sentence in prison or jail. The Medicaid Reentry Act would give states a powerful tool to reduce the drug overdose deaths ravaging the country.
The legislation has support on both sides of the aisle and in both houses of Congress. The House members leading the fight for the bill include Representatives Paul Tonko, a New York Democrat; Michael Turner, an Ohio Republican; John Rutherford, a Florida Republican; and David Trone, a Maryland Democrat. In the Senate, Democrat Tammy Baldwin of Wisconsin and Republican Mike Braun of Indiana are introducing companion legislation to the House bill.
Medicaid, the most common type of insurance among people moving through the criminal justice system, is deactivated upon incarceration. States and localities are thus responsible to pay for all of the health care provided to inmates, which they unsurprisingly generally keep to a minimum. In a perfect world, the prison and health bureaucracies would instantly restore Medicaid coverage at the moment of release. Still, in this world, many former inmates are put back on the insurance program belatedly, if at all. This creates a window of extreme vulnerability in which many lives are lost.
During the two weeks after release, former inmates have a death rate 12.7 times higher than other residents of the same state. The leading cause is drug overdose because incarcerated individuals lose physical tolerance for drugs (especially opioids) during their enforced abstinence, which makes any return to use extremely dangerous.
Rhode Island has shown that it doesn’t have to be this way. Since 2016, the Ocean State has funded medication and counseling for opioid-addicted people from the moment of entry into prison and continuing seamlessly into community care after their release. The Medication-Assisted Treatment program, or MAT, begun under then Governor Gina Raimondo (now the Secretary of Commerce), cut post-incarceration overdose deaths by two-thirds after the program was introduced.
Another wise measure, but one that’s inadequate as a national solution, was the 2018 First Step Act, which mandated that addiction-focused pharmacotherapy be available in federal prisons. President Joe Biden announced in the State of the Union address this winter that access would be universal in federal correctional facilities by this summer. But this reform affects a small proportion of inmates in the United States because incarceration is mainly a state and local matter.
Reactivation of Medicaid during incarceration is the financial carrot that could persuade states and localities to expand addiction treatment for inmates. California took a huge step recently by securing a waiver to become the first state to fund health services through Medicaid before inmates are released. Several other states have also applied for waivers, and Dr. Rahul Gupta, the director of the White House Office of National Drug Control Policy, has expressed support for granting them.
That would be significant progress. That said, a state-by-state waiver process is a slow-moving train at a time when we need high-speed solutions to the opioid epidemic. By immediately granting the power to use Medicaid to fund health care in correctional facilities in all 50 states, the Reentry Act, with its bipartisan support, exemplifies the rapid policy action that is needed. Congress should pass—and the President should sign—this lifesaving legislation.
