Medicaid and Access to Health Care During and After Incarceration

doctor's coat with stethoscope

The Solomon Center for Health Law and Policy held the final event in its Spring Spotlight Series on Prison Health with a panel discussion on Medicaid Waivers, Prison Health, and Reentry on April 20.

The event was co-sponsored with the SEICHE Center for Health and Justice at the Yale School of Medicine and the Arthur Liman Center for Public Interest Law at Yale Law School.

Abbe R. Gluck ’00, Alfred M. Rankin Professor of Law and founding Faculty Director of the Solomon Center for Health Law and Policy, moderated the discussion, which featured Cynthia Jackson, a Community Health Worker at Hennepin Healthcare; Carole Johnson, Administrator of the U.S. Health Resources & Services Administration (HRSA); Sara Rosenbaum, Harold and Jane Hirsh Professor of Health Law and Policy at the George Washington School of Public Health; and Dr. Tyler Winkelman, Co-Director of the Health, Homelessness, and Criminal Justice Lab at the Hennepin Healthcare Research Institute.

Rosenbaum set the stage for the discussion and spoke about the Medicaid program and how the issue of coverage for people while incarcerated and upon reentry has been a longstanding issue, since the inmate exclusion policy was established in 1965 when Congress first created the Medicaid program. She explained that the exclusion prohibits Medicaid from covering most health care for people in a carceral setting, despite the fact that many justice-involved individuals qualify for Medicaid. Some states have submitted Section 1115 Waivers for demonstration projects that would allow Medicaid payment for health care provided to Medicaid recipients while incarcerated.

Johnson spoke about the role HRSA plays, particularly through its role with Federally Qualified Community Health Centers (FQHCs) and assisting people upon release. Johnson noted how HRSA intervened when the COVID-19 pandemic led many states to release a large number of incarcerated individuals. Jackson then spoke about the complexity of the issues she sees when working with patients who are recently released. She noted the importance of other social safety net services in people’s lives that can take precedence over health care. People often aren’t as worried about routine health care if they are concerned with finding stable housing.

Finally, Winkelman addressed what might be possible if the inmate exclusion policy were rescinded. He spoke about the idea of an FQHC inside prisons and jails, and questioned whether prisons and jails are adept at using Medicaid for justice-involved individuals.