The Unfair Roadblock: Individuals leaving jail and prison often need a range of services – including alcohol and drug, mental health, and other health care treatment – to make a successful transition from incarceration to the community. Medicaid can often pay for these services, yet most states fail to put mechanisms in place to ensure that Medicaid is available to individuals who were on Medicaid when incarcerated upon their return to the community. Research shows that providing individuals with access to health care services upon release from confinement reduces the likelihood of recidivism, and federal requirements mandate that individuals who entered prison with Medicaid must be returned to Medicaid eligibility rolls immediately upon release.

How to Remove the Roadblock: States and localities should suspend rather than terminate Medicaid for inmates entering prison and should require the prescreening of incarcerated individuals so that those who are eligible receive Medicaid as soon as possible after their release.

This tool kit provides materials that advocates can use as they seek to establish policies in their states to provide eligible individuals with immediate access to Medicaid upon release from jail or prison.

Additional information on this issue can be found in the Legal Action Center’s report, After Prison: Roadblocks to Reentry, at

The Problem Posed by the Lack of Immediate Access to Medicaid Upon Release From Prison or Jail

More than 630,000 people are released from state and federal prisons every year, a population equal to that of Baltimore or Boston, and hundred of thousands more are released from local jails. This population includes some of the least healthy people in the country. According to a 2002 federal study, The Health Status of Soon-to-be-Released Inmates: A Report to Congress , tens of thousands of inmates are released into the community every year with undiagnosed or untreated communicable disease, chronic disease, and mental illness. Few have health insurance or can afford necessary medical care.

Without access to services, individuals leaving prisons and jails cannot get the medical care and social services they need to establish stability in the community, which can frequently lead to homelessness and return to criminal activity. Failing to enroll eligible individuals leaving prisons and jails in Medicaid represents a missed opportunity to improve individual and community health and public safety and to reduce the high costs of preventable illnesses.

Failing to restore Medicaid for eligible inmates who were enrolled in Medicaid when they were incarcerated runs afoul of federal law. In a letter written in 2001 reaffirming an earlier ruling by the prior Administration, Tommy Thompson, Secretary of the United States Department of Health and Human Services, stated that incarcerated individuals may not be terminated from Medicaid until a redetermination has been conducted. In addition, he wrote, “Unless a state determines that an individual is no longer eligible for Medicaid, states must ensure that incarcerated individuals are returned to the Medicaid eligibility rolls immediately upon release, thus allowing individuals to go directly to a Medicaid provider and demonstrate his/her Medicaid eligibility.” Click here for a downloadable version of this letter.

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Why Providing Medicaid Upon Release is Beneficial

There are a number of important benefits that arise from ensuring that individuals have immediate access to Medicaid upon release from confinement. These include:

  • Increasing public safety by reducing rearrest rates, criminal activity, and increased use of drug treatment and other health care services.

A recent study conducted by the Urban Public Health Department at Hunter College, City University of New York , found women released from New York City jail who were enrolled in Medicaid were less likely to be rearrested and less likely to report illegal activities than women without Medicaid coverage. These women were also more likely to participate in residential drug treatment and use other health care services.

Numerous studies have found that treatment is effective at reducing drug use and crime, including the following:

    • A 1997 Rand Corporation study found that drug treatment was 15 times more effective at reducing serious crimes committed against people and property by drug offenders than mandatory minimum sentences.

    • The National Treatment Improvement Evaluation Study (NTIES, 1998) found that participants in treatment reduced their drug use by 50 percent, including decreasing their crack use by 50.7 percent and their heroin use by 46.5 percent.

  • Bringing states into compliance with federal law which requires that individuals who entered jail or prison with Medicaid must be returned to the Medicaid rolls immediately upon release.


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Advocates interested in working with their localities and states to provide access to Medicaid may find many allies in this effort. Correctional and criminal justice officials frequently support the effort to provide individuals released from jail and prison access to Medicaid because these officials understand the link between lack of access to these services and their returning to criminal activity. Other agencies that provide services to individuals who cycle through jails and prison, such as shelters, also understand that failure to address health and social problems contributes to homelessness and rearrest.

In advocating for immediate access to Medicaid upon release from prison and jail, advocates may want to make the following practical points:

  • In order to comply with federal policy that requires individuals who entered jail or prison with Medicaid to be returned to the Medicaid rolls immediately upon release, states should suspend an individual’s benefits while s/he is incarcerated, rather than terminating them.

  • Prisons and jails should begin the Medicaid application process for incarcerated individuals before they are released so that they can receive benefits as soon as possible after their release, easing their transition back into the community.

  • The Social Security Administration (SSA) has procedures in place to allow for the processing of applications for individuals currently incarcerated who appear likely to meet SSI criteria when they are released. State Medicaid agencies could adopt similar procedures for their programs.

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If your state is considering legislation or policy changes to provide individuals leaving jail and prison with immediate access to Medicaid, alerting supportive groups and individuals and asking them to urge their local legislators and policymakers to support the legislation or new policy is an effective way to bring about change. Click here for a model Action Alert you can shape for your specific needs and use to seek grass roots support.


Click here for a model Sample Letter you can send along with the Action Alert to help your grass roots supporters write to their elected officials urging them to support legislation or policy changes to provide individuals leaving jail and prison with immediate access to Medicaid. Once again you can shape this Sample Letter to meet your specific needs.


1The Health Status of Soon-to-be-Released Inmates: A Report to Congress, National Commission on Correctional Health Care (2002).

2Letter from Tommy G. Thompson, the Secretary of Health and Human Services to the Honorable Charles L. Rangel.

3The authors of the study are Nicholas Freudenberg, Distinguished Professor of Urban Public Health at Hunter College, City University of New York; Dr. Joshua Lee, at the Program in Health Service Research and Clinical Epidemiology, Weill Cornell Medical College; and Martha Crum, a doctoral student in sociology at the CUNY Graduate Center. The study was funded by Robert Wood Johnson Foundation. A paper describing these findings has been submitted for publication.

4Center for Substance Abuse Treatment (CSAT), NTIES: The National Treatment Improvement Evaluation Study, p. 7 (Sept. 1996).

5SI 00520.900 Prerelease Procedure – Institutionalization.

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