About the Task Force
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https://www.youtube.com/embed/KrMiJ8XUsVA How the Medicaid Inmate Exclusion is Impacting Local Justice Systems |
Convened in March 2019, the National Association of Counties (NACo) and National Sheriffs' Association (NSA) joint task force is made up of NACo and NSA members representing county leaders, law enforcement, judges, prosecutors, public defenders, behavioral health and veterans’ services, who- over the next few months- will be dedicated to exploring and raising awareness about the impacts of the the Medicaid Inmate Exclusion Policy (MIEP), a federal policy strips federal health and veterans benefits from individuals upon admission to jail – not upon conviction, and its contribution to the national behavioral and mental health crisis as well as rates of recidivism in our local jails.
About NACo |
The National Association of Counties (NACo) strengthens America’s counties, including nearly 40,000 county elected officials and 3.6 million county employees. Founded in 1935, NACo unites county officials to advocate for county government priorities in federal policymaking; promote exemplary county policies and practices; nurture leadership skills and expand knowledge networks; optimize county and taxpayer resources and cost savings; and enrich the public’s understanding of county government. |
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About NSA |
The National Sheriffs’ Association is one of the largest associations of law enforcement professionals in the U.S., representing more than 3,000 elected Sheriffs across the nation, and with a total membership of more than 20,000. NSA is a non-profit organization dedicated to raising the level of professionalism among Sheriffs, their deputies, and others in the field of law enforcement, public safety, and criminal justice. Throughout its 78-year history, NSA has also served as an information resource for all law enforcement, as well as state governments and the federal government. |
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Task Force Members |
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https://www.youtube.com/embed/sSq76d53tgc San Bernardino County, Calif. Sheriff's Department on the Medicaid Inmate Exclusion Policy |
What Is the MIEP?
The Social Security Act (Sec. 1905(a)(A)) prohibits use of federal funds and services, Children’s Health Insurance Program (CHIP) and Medicaid, for medical care provided to “inmates of a public institution.” This federal law, known as the "Medicaid Inmate Exclusion Policy" does not differentiate between a convicted inmate and a person incarcerated prior to conviction.
Key Terms |
Pretrial detainee A term used to describe an individual that is legally detained but has not been convicted of crime. This includes a person awaiting trial, being tried, or awaiting a verdict. Post-Conviction Refers to the legal process which takes place after a trial results in conviction of the defendant. After conviction, a court will proceed with sentencing of the guilty party. Sentencing can include any combination of community service, forfeiture of property, fines, and incarceration. Courts may also exercise their sentencing discretion and order a term of probation. Recidivism The process by which a previously incarcerated individual commits other crimes resulting in arrest or conviction. Constitutionality The quality or state of being constitutional; being in accordance with the provisions of a constitution. Reentry The transition of offenders from prisons or jails back into the community. |
Key Talking Points |
Counties are required by federal law to provide adequate health care for approximately 10.6 million individuals who pass through 3,100 local jails each year with an average length of stay of 25 days Medicaid is the single largest source of funding for behavioral health services in the United States, and the number of inmates who are eligible for health coverage has increased as more states have accepted Medicaid expansion More than 95 percent of prisoners eventually return to the community, bringing their health conditions with them. However, in many states, federal benefits are completely terminated instead of being suspended, and it can take months for former inmates to reenroll and regain their benefits following reentry Having access to federal health benefits while awaiting trial and presumed innocent aligns with an individual’s constitutional rights Access to federal health benefits for non-convicted individuals would allow for improved coordination of care, and also decrease short-term costs to local taxpayers and long-term costs to the federal government Providing access to federal health benefits for those awaiting trial and verdict decisions would help counties break the cycle of recidivism caused or exacerbated by untreated mental illness and/or substance use disorders, thereby improving public safety |
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Task Force Goals and Objectives
In its efforts to to reduce jail inmate recidivism through the continuity of health services, the work of the joint Task Force will center around 4 key objectives and 3 core focus areas, outlined in the drop downs below.
Objectives |
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Goals |
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Public Advocacy
How the Medicaid Inmate Exclusion is Impacting Local Justice Systems |
https://www.youtube.com/embed/KrMiJ8XUsVA
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Call to Action |
Reach Out to Your Congressional RepresentativeOne of the primary goals of this Task Force is to advocate for federal policy change that will allow non-convicted individuals entering the criminal justice system to continue to have access to federal health benefits. Obtaining bi-partisan support for the legislation outlined above is the key to moving these efforts forward. To assist with this we are asking that you contact your congressional representatives and request their support. Share Your StoryTell us how the MIEP policy has impacted both pretrial detainees in your county jails and your surrounding community through a short testimonial. Testimonials can be submitted in written form or in a 3-5 min video. Below are some questions to help guide your remarks.
Testimonials can be submitted to Paul Guequierre (pguequierre@naco.org) or reach out to any NACo or NSA staff lead for questions! Data CollectionNACo & NSA are also soliciting the help of the Task Force in collecting data that supports our advocacy efforts. We are looking for data on the following items:
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Press & Media |
Press ReleaseIn the News
County News |
Legislative Advocacy
Since the start of the 116th Congress in January, legislators on Captiol Hill have introduced proposals that could improve the federal, state and local partnership in providing safety-net services to pretrial incarcerated individuals. Below, please see a status update on moving pieces of legislation that NACo and NSA are currently monitoring. Our goal is to obtain bipartisan support for legislation around this issue.
Senate |
There are currently two bills introduced in the U.S. Senate that would address the MIEP. Senators Ed Markey (D-Mass.), Merkley (D-Ore.), Brown (D-Ohio) and Durbin (D-Ill.) have introduced S.2628, the Equity in Pretrial Medicaid Coverage Act. This legislation would amend Title XIX of the Social Security Act to remove a limitation on an individual’s eligibility for medical assistance under the State Medicaid plan while the individual is in custody pending disposition of charges. Additionally, Senator Merkley (D-Ore.) introduced S.2626, the Restoring Health Benefits for Justice-Involved Individuals Act of 2019. This bill would remove limitations on inmate eligibility for Medicare, the Children's Health Insurance Program (CHIP) and veteran's health benefits. We urge you to contact your Senators and ask them to co-sponsor these two pieces of legislation. |
House |
In the U.S. House, we are awaiting the introduction of companion legislation to address the MIEP. We urge you to contact your House Representatives and ask them to introduce legislation that would restore pretrial detainee access to federal health benefits. |
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Task Force Resources
Learn More about the MIEP |
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Estimated Cost of Health Care in Local Jails |
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Learn More About the Medicaid Program |
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Veterans in Our Local Justice System |
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View Recordings of Task Force Meetings |
