NACo Derides Medicaid Inmate Exclusion Policy as Unconstitutional

NACo urges Congress to take action on policy dating back to 1965 that strips healthcare benefits from inmates who have not been convicted of a crime and are awaiting trial.

According to a press release by NACo, the Medicaid Inmate Exclusion Policy (MIEP) “strips federal health benefits from individuals admitted to jail before they are convicted of a crime.” The result is a denial of federal benefits to pre-trial detainees and any members of their family that are covered, regardless of their constitutional right to presumed innocence under the law. Adversely, people who can afford to bail out keep their coverage.

A study by NACo holds company with other research across the country showing that serious mental illnesses and substance use disorders are three to four times more common among local jail inmates than the general population. The cost for services falls on county governments where the full expense is shifted to the local tax payer in order to fund hospitals and healthcare treatments. For scale, 90 percent of the nation’s local jails are operated by county governments and those facilities hold a population 18 times that of the federal and state prisons combined, according to the NACo report.

The Manhattan Institute compiled recent estimates of eligible inmates costs that could be redistributed back to the federal government in the range of $5.4B to as much as $60B. An article published in January 2022 by Sarah Wang of the Petrie-Flom Center at Harvard Law, and citing the Kaiser Family Foundation, additionally highlighted that an amendment to repeal the MIEP could save local governments in states like Maryland, who have expanded Medicaid, $4.7B per year.

Previous efforts by NACo to reform the MIEP have been covered on the Conduit Street Blog.