Beyond The Inmate Exclusion Project
Breaking The Cycle: The Expanding Role Of Medicaid In The Criminal-Legal System
COCHS’ Beyond The Inmate Exclusion Project, supported through a grant from the Robert Wood Johnson Foundation, examines how Medicaid’s Inmate Exclusion Rule has limited the collaboration between community and correctional health systems. The Social Security Act of 1965 created the inmate exclusion rule, which limited the ability of Medicaid to pay for services for otherwise eligible beneficiaries once someone is incarcerated in a jail, prison, juvenile justice facility or other “public institution.” The rule creates challenges when identifying how to improve coordination between community and correctional settings, and many beneficiaries face delays in establishing care in the community after a stay in a public institution.
In recognition of the negative impact that the inmate exclusion has played in the lives of people involved with the justice system, including health and correctional staff, Congress passed new laws that will require Medicaid-eligible juveniles to begin certain benefits before release and allows states to maintain benefits for juveniles who are pending disposition of charges. In addition, the federal government is approving waivers of the inmate exclusion through Medicaid 1115 waivers.
This project looks at the challenges created by the inmate exclusion and how it has frustrated attempts at improving care for the people involved with the justice system. This project also looks beyond the inmate exclusion to highlight the role that Medicaid could play in local criminal-legal settings.
Why This Matters? People are often involved with the justice system because of untreated behavioral health and substance use needs. This stresses our health and our justice systems and drives poor outcomes for people who are touched by the justice system—whether they are incarcerated there or work there. Identifying opportunities for collaboration creates a stronger health system and decreases reliance on correctional systems.
Who is This For? Anyone interested in improving our health and justice systems through strengthening the role of our community health systems.
What Comes Next? COCHS will continue to explore with you the opportunities to bridge the divide between health agencies and correctional partners in order to heal the damage done by the inmate exclusion.
COCHS has created briefs for pre-trial service providers, prosecutors, public defenders, specialty courts, jails, community corrections, health plans, community providers, and health information technology specialists that can help you begin your journey of connecting jail and community health systems.