Sending Office: Honorable Ann M. Kuster
Sent By:

Endorsed by: National Sheriffs Association

American Corrections Association

American Association for the Treatment of Opioid Dependence

National Association of Counties

Association of State Correctional Administrators

Facing Addiction

Community Oriented Correctional Healthcare Services

Dear Colleague,

An estimated 65 percent of people in U.S. prisons and jails meet the clinical criteria for substance use disorder (SUD), and 37 percent have been diagnosed with mental health disorders.  Of this population, 25 percent have co-occurring SUD and mental health
issues. However, very few receive treatment that would reduce recidivism and save states money.

Prison healthcare is known to be challenging, and many prison healthcare systems have been the subject of lawsuits citing inadequate treatment and, in some cases, wrongful death. Spending on inmate healthcare varies widely across the country. And, inconsistent
data collection, and a lack of metrics makes evaluating the quality of care difficult.

The consequences of underfunded prison and jail healthcare systems are far reaching and impact our communities daily. The vast majority of inmates will one day return to their communities, bringing with them untreated addictions, mental illnesses, and communicable
and chronic diseases.  People released from prison or jail will put an incredible burden on state and local public health infrastructure. Emergency departments and first responders are among the first to feel the strain imposed by the untreated chronic diseases
often affecting formerly incarcerated individuals. Even in Medicaid expansion states, most people released from prison or jail will qualify for Medicaid and strain that system with conditions that were under treated for months, or even years during incarceration.
In most states, this strain on the public health infrastructure comes after millions spent on insufficient inmate healthcare that neither prepares inmates for re-entry into society, nor provides taxpayers with the return on investment they expect.

Much of the problem comes from the Social Security Act barring the use of federal funding to pay for health care services for “inmates of a public institution.” Otherwise known as the Medicaid Inmate Exclusion (MIE), this archaic prohibition of federal aid
means the burden of healthcare for the prison and jail population falls largely to states and counties. Since Medicaid was initiated in 1965, the U.S. inmate population has grown by 650 percent: from approximately 200,000 to 1.5 million inmates.

The enormous growth of the prison population since the establishment of Medicaid has resulted in a inmate healthcare crisis that has grown well beyond the resources of states and counties. Providing Medicaid and its standard of care can help to improve prison
and jail health systems across the country by ensuring treatment for SUD and mental illness, protecting public health through the treatment of infectious diseases, and reducing recidivism. Reform is desperately needed.

A preliminary evaluation of prison healthcare spending by states compared with Medicaid spending on equivalent aged enrollees suggest that the states stand to save tens to hundreds of millions of dollars per year, if those otherwise qualified were able to
receive Medicaid while incarcerated.

Repeal of MIE through my bill, the Humane Correctional Health Care Act, is a solution to this growing problem and can transform prison and jail healthcare systems from a social and economic hindrance into an important tool in the fight against SUD, mental
illness, and associated societal problems.  The Humane Correctional Health Care Act will also save the states millions of dollars that can be used to provide community-based treatment.

If you would like to cosponsor or have questions, please contact my staffer Kevin Diamond


Ann McLane Kuster

Member of Congress

Related Legislative Issues

Selected legislative information: HealthCare, Judiciary

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