RESEARCH WEEKLY: Federal Medicaid Inmate Exclusion Policy Harms Individuals with Severe Mental Illness
By Kelli South
The Federal Medicaid Inmate Exclusion Policy (MIEP) reduces jailed individuals’ access to mental and physical health care after release from jail and increases the likelihood of recidivism, according to a new report written by American University students for the National Association of Counties last week.
The Federal Medicaid Inmate Exclusion Policy “terminates pretrial detainees and convicted inmates’ right to receiving federal health benefits.” This law applies to anyone confined in jail, which means it also terminates health benefits for those who cannot afford bail but are not yet convicted of a crime.
American University partners with National Association of Counties
A group of American University students completing their Master of Public Policy and Administration program recently presented a memorandum for the National Association of Counties (NACo) regarding the effects of the Federal MIEP on local communities and individuals. This memo builds upon a previously released NACo-NSA Joint Task Force Report
that examined the same topic. This new memo adds further research, case law, and recommendations for NACo and other national interest groups in relation to the MIEP federal law.
Effects of MIEP on those with mental illness
The report highlighted several key findings related to how MIEP impacts those with mental illness specifically. There is a significant overrepresentation
of individuals with severe mental illness in our nation’s jails, so purely based on population numbers, the MIEP law disproportionately affects this population. For example, if a person with a serious mental illness is arrested and cannot make bail, thus losing their Medicaid coverage under this law, they face major issues accessing health care when released from jail. This loss in coverage can derail any treatment an individual received before their arrest, possibly changing the trajectory of their illness and resulting in worsened outcomes.
Jail inmates with serious mental illness covered by Medicaid during their incarceration had significantly better access to and greater use of community mental health services upon their release compared to individuals released without Medicaid, according to several reports cited in the memo. Those with Medicaid coverage also had a decline in recidivism compared to those without coverage; 16% fewer were incarcerated again compared to those who did not have Medicaid coverage upon reentry into society.
The federal MIEP law can be costly to individuals and to their local communities. The memo examines the difference between jails and prisons, notably how local and county jails processed 10.6 million individuals in a year compared to federal and state prisons processing less than 607,000 in the same timeframe.
This fact is especially pertinent because jailed individuals are incarcerated for shorter time periods than those in prison. Jailed individuals thus spend more time in their local communities than those in prison, which means available community services primarily treat their health needs. The memo authors argue that this frequent community contact for treatment creates additional financial burden on the community’s public health systems. For people with serious mental illness, this could mean increased use of hospital emergency departments and crisis contacts, among other commonly used community services.
Thus, the memo argues that the MIEP negatively affects the health of individuals in jail and subsequently the public health, safety, and budgets of their local communities. Together, NACo and the National Sheriffs Association call to amend the MIEP to address the health care discrepancies caused by this policy.
- Falcone H, Isaacoff M, Massey K, Torkelson E. (August 2020). “Memorandum to National Association of Counties.” American University.