The U.S. Constitution is clear: individuals are presumed innocent until proven guilty. Despite this clear constitutional mandate, people who receive federal health benefits such as Medicaid, Medicare or CHIP benefits for juveniles are stripped of those benefits when arrested and jailed for an alleged crime, before conviction. From that starting point comes this report by a joint task force of the National Association of Counties and the National Sheriffs’ Association.

The Medicaid Inmate Exclusion Policy (MIEP), which denies or revokes federal health and other benefits, is a violation of the equal protection and due process clauses of the 5th and 14th amendments of the U.S. Constitution, respectively. This policy also places undue financial and administrative burdens on local jails and produces unfavorable health outcomes for individuals and communities. By contrast, the uninterrupted provision of health care helps our residents break the cycle of recidivism exacerbated by untreated physical and mental illnesses and substance use disorders.

To address the challenges posed by the MIEP, NACo and NSA formed a joint task force representing county leaders, law enforcement, judges, prosecutors, public defenders, behavioral health experts and veterans’ service providers. Over the past year, our joint task force explored the impacts of this federal policy and its contribution to the national behavioral and mental health crisis and rates of recidivism in our nation’s jails.

As detailed in this report’s data on local justice systems, counties nationwide — especially our jails — face an increasing number of pre-trial detainees and inmates experiencing mental health complications, often with co-occurring substance use disorders. Local jails serve as one-stop treatment centers for individuals with these illnesses. Without adequate community resources, jails have become de-facto behavioral health hospitals and treatment facilities.

Access to federal health benefits for non-convicted individuals would allow for improved coordination of care, while at the same time decreasing short-term costs to local taxpayers and long-term expenses to the federal government. Cost savings could be invested to improve post-release care coordination that would decrease crime, reduce recidivism, and greatly contribute to the overall health and safety of our constituents.

Through the recommendations brought forth in this report, the members of our joint task force hope to demonstrate that improving care coordination across federal, state and local governments can alleviate the strain that the Medicaid Inmate Exclusion policy has placed on our local criminal justice system, our counties and most importantly, our residents.