Washington, D.C. — This week, Representatives Annie Kuster (D-NH) and Don Bacon (R-NE) introduced the Rehabilitation and Recovery During Incarceration Act, bipartisan and bicameral legislation to reform the Medicaid Inmate Exclusion policy. Specifically, this bill would provide Medicaid coverage to people incarcerated in public institutions seeking mental health and substance use services. U.S. Senator Cory Booker (D-NJ) leads this legislation in the Senate. 

This bipartisan, bicameral legislation would reform the Medicaid Inmate Exclusion policy, which prohibits Medicaid from covering people who are incarcerated or awaiting trial, regardless of prior eligibility. Allowing Medicaid to pay for services such as medications for opioid use disorder (MOUD) in prison and jail settings would help end the substance use crisis, lower the risk of overdose, and better prepare justice-involved individuals for community reentry.

Full bill text is available here.

“Ending the substance use disorder epidemic requires an all-of-government approach — that includes addressing the connection between addiction and recidivism in the justice system,” said Congresswoman Kuster, founder and co-chair of the Bipartisan Mental Health and Substance Use Disorder Task Force. “The data is clear: a failure to treat substance use disorder in our prisons prevents individuals from fully recovering and reentering their communities. This bipartisan legislation to end the outdated and flawed Medicaid Inmate Exclusion policy will save communities money and better support those with substance use disorder, mental illness, and trauma.”

“Rates of substance abuse and addiction among inmates is disproportionately high,” said Congressman Bacon. “Drug use increases the risk of recidivism and further criminal activity. Without addiction treatment, inmates are set up to fail, costing lives and money. The Rehabilitation and Recovery for Inmates Act will give people a chance to escape this devastating cycle.”

"Failing to provide medical coverage for mental health and substance treatments for people while incarcerated perpetuates health disparities and increases the risk of recidivism,” said Senator Booker. “Ensuring access to treatment isn’t just the right thing to do based on our values, but it’s in the best interest of our communities and our public safety—these services provide people a fighting chance at a successful reentry post-incarceration. That is why I will be introducing this bicameral and bipartisan legislation that would ensure comprehensive coverage for mental health and substance use services throughout the time a person is incarcerated to disrupt the cycle of recidivism and provide people with the help they need. Ensuring that our criminal justice system focuses on rehabilitation will save taxpayer dollars and make our communities safer and stronger."

Nearly two-thirds of justice-involved individuals have a substance use disorder, and a majority of this population goes untreated. Failing to provide medical coverage for people while incarcerated worsens health outcomes and heightens their risk of serious illness and injury upon release. The current system of providing care is a financial burden to states and localities. The average cost to provide health care in prisons and jails varies widely, but it is an estimated average of $5,720 per inmate, with the majority of the financial burden falling on states and counties.

This bill would lessen the financial burden on our communities and fix the broken system of treatment by:

• Allowing states to allow Medicaid and CHIP to cover mental health and substance use services for eligible inmates;
• Providing a 100% federal medical assistance percentage (FMAP) to states who choose this option;
• Requiring states to reinvest additional funds in technology and data sharing between State Medicaid programs, jails and prisons, and community-based providers and organizations; 
• Mandating a report from the Comptroller General on the impact of the coverage option.

Endorsing organizations include the American Society of Addiction Medicine, the Boston Medical Center Health System, the Drug Policy Alliance, the National Commission on Correctional Health Care, and the Kennedy Forum.

Kuster is the founder and co-chair of the Bipartisan Mental Health and Substance Use Disorder Task Force, a group of over 140 Democratic and Republican lawmakers focused on bridging the partisan divide to tackle the mental health and substance use disorder crises, stopping the flow of these dangerous drugs into our communities, expanding access to treatment and care, and helping save lives.

The Task Force’s 2023 Legislative Agenda is available here.

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