Historic Health Changes in the Omnibus Appropriations Bill
January 03, 2023
Dear Colleague:
Over the last two years, we have witnessed a major shift in how policymakers view the health status of people involved with the justice system. The National Academies of Sciences, Aspen Health Strategy Group, and a variety of stakeholders from advocates to sheriffs agree that in order to improve health in carceral settings, care provided in jails and prisons must be included in our broader healthcare systems. This major shift in policy was enshrined in the omnibus appropriations bill that President Joe Biden signed into law on December 29, 2022.
The omnibus bill allows states to choose to make substantial structural changes to how correctional healthcare is financed for eligible, incarcerated beneficiaries and provides a pathway forward for further reforms to improve care for justice-involved people. Sections 5122 of the law amends the Social Security Act to allow states to choose to allow incarcerated young people to maintain their Medicaid benefits as they await disposition of their charges. Presently, a stay in a jail, prison, or juvenile justice facility would end Medicaid benefits for the incarcerated person. This has meant that people who were receiving care in the community lost the connection to their providers in the community and face major barriers reestablishing benefits upon release. Once this law goes into effect, incarcerated people under 21 can continue to receive the care from community providers who offer services in the jail while awaiting disposition of charges. Section 5121 paves the way for smoother transitions to the community by allowing eligible sentenced beneficiaries to receive important screenings, diagnostic services, and referrals thirty days before release from a facility and thirty days of targeted case management after release.
2023 is shaping up to be an important year for the health of incarcerated communities. We will continue to see states and federal policymakers make advances in care for both the pretrial and reentry populations. Legislative avenues exist for further improvements to our safety net systems. Since there is broad bipartisan agreement on this topic, it would not be surprising to see similar bills introduced in the next congress. Sen. Cassidy’s Due Process Continuity of Care Act would act would expand Medicaid for all eligible pretrial beneficiaries. On the reentry side, Representative Tonko’s Medicaid Reentry Act would allow Medicaid benefits to commence thirty-days before release for all eligible beneficiaries.
In the meantime, the Centers for Medicaid and Medicare Services is poised to release guidance and approve state Medicaid waivers aimed at providing Medicaid services for people who are leaving incarceration. This means that state-level engagement remains critical for realizing the opportunities created by the omnibus act and Medicaid waivers. As usual, COCHS remains your partner in advancing health equity by strengthening the health services offered to incarcerated people and strengthening community systems to avoid incarceration.
I wish us all a happy new year,
Dan Mistak
Acting President
Director of Health Care Initiatives for Justice-Involved Individuals