Promising new law allows Medicaid expansion to those leaving prison

By Alexandria Staubach

Among the nearly three dozen new laws Gov. Tony Evers signed recently is one generating hope within the prison reentry community because it allows expansion of Medicaid coverage for those nearing the end of incarceration and returning home.
 
While the impact of the new law, Act 233, will not be felt immediately, there is nevertheless cause for excitement for those involved in reentry services.
 
“We don’t know how this is going to pan out,” said The Community’s Shannon Ross, on a call with Wisconsin Justice Initiative. “But we’re opening up a runway here. It is really exciting.”
 
The Federal Inmate Exclusion Policy currently prohibits the use of federal Medicaid funds and services for those held in public institutions. But in some counties, a prison may be the largest healthcare provider.
 
Act 233 requires that the Wisconsin Department of Health Services submit a waiver request to the U.S. Department of Health and Human Services for a pilot project to provide “prerelease healthcare coverage” to incarcerated individuals for up to 90 days if the person is otherwise eligible.
 
Permitted waivers from Medicaid requirements (known as section 1115 waivers) offer states an avenue to test innovative approaches for Medicaid dollars.
  
The ability to provide services through Medicaid for 90 days before release, in and of itself, would significantly improve continuity of care, but such a program has even more potential.

The new law specifically references case management services and medication-assisted treatment for all types of substance use disorders for 90 days before release, plus a 30-day supply of prescription medication. Successful waivers in other states have been worded similarly but have ended up reaching further.

The deviation activities should “promote the objectives of the Medicaid program,” but the states have some flexibility in how that money is spent, according to the federal Medicaid website. 
 
KFF, an independent news source for health policy, has been tracking these waivers across the country since the waiver program’s inception. More than 66 waivers have been approved across 47 states, with an additional 34 pending across 27 states. The bulk, like Wisconsin’s planned application, deal with expanded eligibility groups, especially for those returning from incarceration.
  
In both red and blue states, 24 of these waivers (whether pending or approved) have dealt with broader reentry services. Some provide behavioral health or community-based benefits.
 
Connecticut’s application reveals that states can put more on the table than health care coverage. While the application lists case management services, medication-assisted treatment for substance use disorders, and a 30-day medication supply, it also provides for “one-time transition and moving costs, housing deposits, and medically necessary appliances and home accessibility modifications.”
 
In Hawaii, the funds have also been used to help fund reentry housing, Ross told WJI.
 
DHS has until Jan. 1, 2027, to submit its waiver application under Act 233. The department's comments in support of the legislation give no hints at what the final application could include, but “case management services” included in the new law could be broad.
 
DHS did not respond to a request for comments.