By Phillip Galli, PhD

As part of a much larger piece of legislation (the Social Security Act), the Medicaid Inmate Exclusion Policy or MIEP prohibits the use of federal funds to cover health care costs while an individual is incarcerated. That presents a challenge as many incarcerated people are also recipients of Medicaid coverage due to existing on the lower end of the socioeconomic status (SES) ladder. In the St. Croix County (WI) Jail, no health care bills are sent off for insurance processing, independent of type of insurance coverage (public vs. private) the incarcerated patient has. Instead, patients are responsible for paying the county back for all treatment and medication services provided. As one might expect, those costs place an added burden on a person as they leave jail and attempt to reestablish ties in the community.

There are instances in which family members may pick up medications in the community and drop them off at the jail for their loved one, but that is the exception rather than the norm. In practice, individuals who have experience paying for care received while in custody may elect to go without treatment and medications while incarcerated, rather than accumulate a large bill. These extraordinary choices jeopardize their health, especially for those who may be experiencing a crisis in the form of behavioral health (mental health and/or substance use) challenges. Unfortunately, these difficult choices leave vulnerable individuals to suffer further while also putting other incarcerated individuals and correctional staff at risk.

At the state and federal levels, there are pieces of legislation that may provide some relief for both facilities and those who are incarcerated. In Wisconsin, applying for a Medicaid Section 1115 Waiver would allow Medicaid coverage to be expanded to pretrial detainees (those not yet convicted of a crime) and others within roughly 30 days of release. At the very least, that would allow for some continuity of care as individuals are set to release back into the community. That is especially important with the average length of stay in most local jails being about 11 days. The policy would also fit with the presumption of innocence for pretrial detainees.

At the federal level, two bills are being proposed: the Due Process Continuity of Care Act would allow pretrial detainees to keep those benefits while incarcerated, and the Reentry Act would incorporate those within 30 days of release to set up outpatient care and medications.

Legislative action both locally and at the federal level would help to alleviate some of the negative outcomes associated with the MIEP. Much of this work speaks to reentry and setting up incarcerated individuals for success as they transition back into the community.

For more information, see the following NCCHC position statements:

• Eliminating Financial Assessments for Health Care Services During Incarceration (2022)
• Health Care Funding for Youth in Custody (2025)
• Optimizing Insurance Coverage for Individuals Pre- and Postrelease (2024)

Phillip Galli, PhD, is the director of Justice Support Services for St. Croix County, Wisconsin.