On October 17, U.S. Senators introduced two bills to improve health care access for pre-trial detainees. The bills address a policy known as the Medicaid inmate exclusion, which prohibits inmates of public institutions (including county jails) from accessing benefits under Medicaid, Medicare, the Children’s Health Insurance Program (CHIP) and Veterans Affairs health services. This prohibition makes no distinction between pre-trial detainees presumed innocent and convicted inmates.

The first piece of legislation, titled the Equity in Pre-Trial Medicaid Coverage Act (S. 2628) and sponsored by Sens. Ed Markey (D-Mass.), Jeff Merkley (D-Ore.), Sherrod Brown (D-Ohio) and Dick Durbin (D-Ill.), would amend the Social Security Act to remove limitations on Medicaid coverage for pre-trial inmates of public institutions. The second piece of legislation, titled the Restoring Health Benefits for Justice-Involved Individuals Act (S.2626) and sponsored by Sen. Jeff Merkley (D-Ore.), would take similar steps to remove inmate limitations on benefits under Medicare, the Children’s Health Insurance Program (CHIP) and Veterans’ Affairs health services.

Restoring access to federal health benefits for pre-trial detainees is a key legislative priority for the Health Care and Jails Task Force between NACo and the National Sheriffs’ Association (NSA). Over the past several months, Task Force members have worked closely with congressional offices to develop these proposals. Official introduction of the legislation follows a Task Force advocacy day on Capitol Hill in October 2019, during which members met with congressional members to urge support for these measures.

Going forward, both the Equity in Pre-Trial Medicaid Coverage Act and the Restoring Health Benefits for Justice-Involved Individuals Act must still be considered in the U.S. Senate committees of jurisdiction before being brought to a vote. The Task Force is working to identify potential sponsors for these bills in the U.S. House.

For additional information on these legislative proposals, please see the following links:

• Equity in Pre-Trial Medicaid Coverage Act (Legislative text)
• Senators Markey, Merkley, Brown and Durbin introduce legislation to protect Medicaid access for those who cannot afford bail (Press release)
• Restoring Health Benefits for Justice-Involved Individuals Act (Legislative text)
• Merkley introduces legislation that protects access to critical health programs for those who cannot afford bail (Press release)

More information on the NACo-NSA Health Care and Jails Task Force can be found at the following links:

• NACo-NSA Health Care and Jails Task Force (Landing page)
• NACo, Sheriffs' Association talk fix for health care in jails (NACo County News article)
• Reinstate Federal Health Care Benefits for Non-Convicted Justice-Involved Individuals (One-pager)
• Federal Policy Impacts on County Jail Inmate Health Care & Recidivism (Legislative brief)