Medicaid Coverage For People Who Are Incarcerated

Where We Stand

NAMI believes that all people with mental health conditions who are incarcerated deserve access to quality mental health treatment. NAMI supports the continuation of Medicaid coverage for people with mental health conditions who are justice-involved and calls for the repeal of the Medicaid Inmate Exclusion Policy.

Why We Care

On any given day, approximately 44% of people incarcerated in jails and 37% of people in state and federal prisons have a history of mental illness. Jails and prisons have become America’s de-facto mental health providers but are often unable to provide adequate care as part of a system that is not built to provide health services.

Medicaid is a critical source of care for many people with mental illness. Yet, federal law prohibits the use of Medicaid funds for services provided to an “inmate of a public institution,” which includes people who are incarcerated in jails, prisons, detention centers or other correctional facilities. Known as the “Medicaid Inmate Exclusion Policy,” this policy has resulted in states terminating or suspending benefits for people who receive care through Medicaid, even if they are incarcerated for a short period of time. Once incarcerated, the individual’s health care becomes the responsibility of the state and local governments that run the over 1,800 state prisons and 3,000 local jails nationwide. Shifting between two systems of health care causes many people to become disconnected from treatment, disrupting their overall health.

Allowing Medicaid coverage to continue for those in custody would make it easier for people with mental illness to receive continuous care — both when they become incarcerated and when they reenter the community. Additionally, it could potentially improve the quality of care in jails and prisons because they would have to adhere to federal health care standards mandated under the Medicaid program.

In absence of a full repeal by Congress, NAMI supports state efforts to provide continuity of health care for people who are justice-involved.

How We Talk About It

• Jails and prisons are at the center of America’s mental health crisis, serving as the default providers of mental health care for the more than 2 million people who are incarcerated every year.
• The Medicaid Inmate Exclusion Policy, which blocks states from using Medicaid funds for health care in jails and prisons, makes continuity of care even harder for the 35% of people in state and federal prisons and 44% of people in jails who have a history of mental illness.
• Medicaid is the nation’s largest payer for mental health services, providing health coverage to more than one in four U.S. adults with a serious mental illness.
• Yet because of the Medicaid Inmate Exclusion Policy, many people with mental illness who are incarcerated lose their health care coverage — causing interruptions to their mental health care and resulting in their conditions getting worse.
• This is an outdated policy that doesn’t work for states, counties and the millions of people who are justice-involved.
• Allowing people to stay on Medicaid would make for an easier transition when people with mental illness are released.
• They would be better able to continue their care and move into the community healthier and ready to get a job, housing, and reconnect with friends and family.
• Congress should repeal the Medicaid Inmate Exclusion in federal law, helping states and local communities improve the standard of care for people with mental illness who are incarcerated.

What We’ve Done

• NAMI letter to Congressional Bill Sponsors on Medicaid Reentry Act
• NAMI letter to CMS on the Medicaid Inmate Exclusion