November Spotlight on Criminal Justice: Fixing Healthcare Gaps Protects Public Safety

Improving public safety, strengthening reentry outcomes, and treating people with basic dignity require fixing one of the most counterproductive gaps between our justice and healthcare systems: the disruption of Medicaid coverage when someone becomes involved in the justice system and when they reenter society following incarceration.

This problem strikes at the heart of our constitutional values. Every day in America, people detained pretrial lose Medicaid access even though they are legally presumed innocent. Care coverage can be suspended or terminated within days for individuals who cannot afford bail or who live in jurisdictions that rely heavily on pretrial detention—meaning those with chronic illnesses, mental health needs, or substance use disorders lose access to treatment before they are proven guilty.

In addition to being illogical, this practice is fundamentally inconsistent with due process. If the government insists someone is innocent until proven guilty, then it should not strip them of healthcare coverage simply because they are awaiting court dates in a jail cell—regardless of one’s opinion on the breadth of Medicaid coverage or its long-term sustainability in our budget.

Currently, Medicaid is the largest provider of healthcare coverage for individuals who enter the criminal justice system prior to incarceration in state facilities. However, due to the federal Medicaid Inmate Exclusion Policy, these individuals lose coverage upon detention—pretrial included. The Due Process Continuity of Care Act would address this inequity by ensuring coverage is not terminated during pretrial incarceration.

The proposed legislation would not change eligibility or provide new benefits; instead, it would prevent a bureaucratic disruption that leaves counties, jails, and community providers scrambling to fill the gap in coverage. And not only would preventing this gap square public policy with constitutional protections, it would also result in smoother care coordination, lower jail healthcare costs, and fewer people falling through the cracks when they leave detention—many within days or weeks. Maintaining coverage during this time helps prevent people from returning home sicker, destabilized, or more vulnerable to crisis than when detained.

But the discontinuity does not end there. People who are convicted and serve time in jails and prisons also face healthcare-related challenges that undermine successful reentry. The termination of Medicaid upon incarceration leaves eligible individuals in a precarious situation upon release if their coverage is not reinstated right away. People often return to their communities without active healthcare coverage or access to needed medications, treatment, or care. The higher rate of behavioral health disorders— including substance use and mental health disorders—within the incarcerated population makes losing access to needed treatments a direct threat to public safety.

The Reentry Act offers a straightforward fix by allowing states to activate an eligible person’s Medicaid benefits 30 days before they leave custody. Similar to the Due Process Continuity of Care Act, the Reentry Act does not expand Medicaid eligibility or alter who qualifies. Instead, it helps ensure that those who are eligible do not return home with piles of paperwork and other hurdles standing between them and the treatments needed for successful reintegration.

This policy is not theoretical, though—it has been proven. States piloting pre-release Medicaid activation via Section 1115 waivers (currently approved in 19 states) have documented reductions in overdose deaths, higher engagement in behavioral health services, and lower emergency room utilization. Whenever people leave custody with active health coverage, they are more likely to stabilize, secure employment, reconnect with family, and avoid the costly cycles of relapse and rearrest.

Both of these bills share a simple through line: Continuity of care creates continuity of stability. When healthcare is uninterrupted, individuals fare better, local governments save money, and communities become safer. These reforms also strike a balance between fairness and fiscal responsibility, fixing outdated policy barriers without expanding eligibility or imposing burdensome new mandates. Enhancing public safety, honoring constitutional principles, and supporting stronger communities are all laudable goals furthered by ensuring healthcare coverage follows people both into and out of the justice system.