Dear Chairman Guthrie, Ranking Member Pallone and Members of the Committee,
On behalf of the nation's state and local elected and appointed government officials, we respectfully urge your support for bipartisan legislation that amends the Medicaid Inmate Exclusion Policy (MIEP) of the Social Security Act §1905(a)(A), which revokes federal health benefits for adults and juveniles both during and prior to conviction. By amending this policy, the Reentry Act (HR 2586) and the Due Process Continuity of Care Act (HR1510) will facilitate a crucial path forward for programs that improve health outcomes and reduce rates of recidivism.
Justice-involved people are disproportionately low-income and often have complex and/or chronic medical and behavioral health challenges. A 2014 report from the American Psychological Association revealed 64% of jail inmates, 54% of state prisoners and 45% of federal prisoners reported mental health concerns. In its January 2023 report to Congress, the Medicaid Reentry Stakeholder Group concluded that roughly "80% of returning community members have chronic medical, psychiatric, or substance use disorders."
The costs to individuals and to society are enormous. Without treatment, these individuals are at increased risk of overdose within the first few weeks of reentry. In 2007, before the significant increases in prescription drug misuse of recent years, the National Drug Intelligence Center estimated that $113 billion was associated with drug related crime while the cost of treating drug use was a fraction of the cost to society at $14.6 billion. In 2017, NIH released findings from a study of publicly funded drug treatment facilities in California that concluded that "engagement in treatment for opioid disorders is associated with lower costs of crime in the six months following initiation of treatment, and the economic benefits were far greater for individuals receiving time-unlimited treatment."
The Reentry Act will help pave the way toward improved public health outcomes and public safety. Promising practices in the pre-release population include substance use disorder screening and treatment, post-release medication supply, discharge planning, data sharing between correctional systems and Medicaid agencies, collaboration between correctional systems and community providers and more.
Secondly, the pervasiveness of our nation's mental health and substance use disorder crisis is highly concentrated in our local jails. Across our nation, approximately 11 million people cycle in and out of local jails each year, 60% of whom are pre-trial detainees. The number of individuals being detained pre-adjudication has grown tremendously in the past several decades, mirroring the number of individuals in local jails experiencing mental illness and serious mental illness, often with co-occurring substance use disorders. According to The Council of State Governments, approximately 17% of people entering jails pretrial meet criteria for serious mental illness, and three quarters of people with serious mental illnesses in jails have co-occurring substance use disorder. This population is also by and large eligible, and in many cases, already receiving publicly funded health care.
The Due Process Continuity of Care Act would allow pretrial detainees, who have unfairly been stripped of their federal health benefits prior to due process, to receive Medicaid benefits at the option of the state to facilitate the continuation of necessary treatment for chronic, mental health and substance use disorder conditions.
These are complex issues requiring the efforts of federal, state and local leaders and our organizations stand ready to partner with you to achieve these important outcomes for communities across the country.
Should you have questions or need further information, please contact Lauren Kallins.
Tim Storey
Chief Executive Officer
National Conference of State Legislatures
David Adkins
CEO and Executive Director
The Council of State Governments
Tom Cochran
CEO & Executive Director
The United States Conference of Mayors
Matthew D. Chase
Executive Director/CEO
National Association of Counties
Clarence E. Anthony
CEO & Executive Director
National League of Cities
Cc: U.S. House of Energy and Commerce Committee