Inside Health Policy: Bipartisan, Bicameral Bill Would Extend SUD Care To Incarcerated
By Dorothy Mills-Gregg

Reps. Annie Kuster (D-NH) and Don Bacon (R-NE) unveiled a bill Thursday (Dec. 7) that would let Medicaid pay for behavioral health treatment in criminal justice settings, reforming the so-called Medicaid Inmate Exclusion policy in a way that advocates say would lower the risk of overdose and better prepare incarcerated people for community re-entry. Sen. Cory Booker (D-NJ) introduced the bill’s companion in the upper chamber.

Lawmakers passed a couple inmate exclusion policy reforms in last year’s omnibus, but they focused on justice-involved teenagers. Beginning Jan. 1, 2025, states must screen Medicaid-eligible teens for specific conditions, including behavioral health screenings, and provide treatment within 30 days of the youth’s scheduled release. States will also be able to receive Medicaid reimbursements for medical services provided to teens waiting for the results of their trial.

But Bacon, Booker and Kuster say it’s time to expand behavioral health care access to people who are incarcerated and otherwise eligible for Medicaid.

The bill would provide full federal Medicaid reimbursement to states that decide to cover mental health and substance use services for eligible inmates. It would also require states to reinvest any additional funds into technology and data sharing between the state Medicaid program, jails and prisons and community-based providers and organizations.

The bill also would direct the Comptroller General to report to Congress on the results of the new option, including the number of incarcerated people, their access to health care services along with its quality, and any impact maintaining Medicaid coverage while incarcerated had on recidivism.

“The data is clear: a failure to treat substance use disorder in our prisons prevents individuals from fully recovering and reentering their communities,” Kuster said in a statement. “This bipartisan legislation to end the outdated and flawed Medicaid Inmate Exclusion policy will save communities money and better support those with substance use disorder, mental illness, and trauma.”

Advocates say the current process of providing behavioral health care in the criminal justice system has been a financial burden on states and localities, who bear the brunt of the estimated $5,720 per inmate on average to provide health care in prisons and jails -- though that number varies widely.