An "inmate exclusion" rule in Medicaid makes it so when someone gets incarcerated, they lose their access to medical care. (Photo by David McNew / Getty Images)
Almost everyone in prison or jail will return home at some point, but for decades, New Mexico and other states have defaulted to kicking them off the rolls for health coverage while they’re incarcerated, which some experts say can lead to more harm in their communities once they get out.
But the federal government last month gave New Mexico more leeway with its Medicaid program, so the state will be able to enroll people in Medicaid on their way out of state prisons, local and tribal jails, juvenile detention facilities, and state forensic hospitals like the one in Las Vegas, N.M.
Even though many people who get caught up in the criminal legal system are eligible for Medicaid, nearly all incarcerated people enrolled in the program lose coverage when taken into custody because of federal law which established the Medicaid Inmate Exclusion Policy, or “inmate exclusion.”
So when someone gets incarcerated, they not only risk losing their job, their housing or connections to loved ones, they also lose their access to medical care beyond the walls.
With the exclusion rule in place now, Corrections Department staff tell people in prison they need to follow up with a doctor once released to keep getting their medications, including for chronic conditions “but really, it is difficult for them to go out, get that appointment and show up,” said Wence Asonganyi, Health Services administrator for the Corrections Department.
The Centers for Medicare & Medicaid Services on July 26 approved New Mexico’s request for a waiver to the exclusion policy.
It may cut the chances of people committing another crime once out, called recidivism, said Haven Scogin, deputy director of reentry for the New Mexico Corrections Department.
Studies have shown interventions like medication-assisted treatment for substance use disorder during incarceration and after release are important for preventing recidivism.
“This is a structural way we can address barriers to health care coverage,” Scogin said.
The waiver also allows people to get a 30-day supply of their meds as they get out.
Asonganyi said he hopes the waiver will allow medical providers to meet incarcerated people face-to-face, either virtually or in-person, while they’re still inside, so they know where they’ll be going and who they’ll be meeting.
The waiver requires state governments not only refer people to appointments but also to sit with them in the waiting room, support them through the process, and try to sign them up for other benefits, said Alex Castillo Smith, deputy secretary of the Health Care Authority.
The waiver would allow more people held in state prisons to get medication-assisted treatment, as soon as the Corrections Department writes rules, which is expected to happen in September, Asonganyi said.
Ten other states recently got the green light for similar changes to their Medicaid programs, with another 13 states still waiting on approval, said Jon Courtney, deputy director of the Legislative Finance Authority.
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State needs to find providers
New Mexico’s program is not up and running, and will need more work to bring providers on board both inside and outside the walls. The Corrections Department has started discussions with those specializing in behavioral health and mental health in the community, Scogin said.
Under the reentry waiver, incarcerated people could get on Medicaid and start getting care between one and three months before release.
Under the waiver, a primary care doctor will see their patients inside, assess their needs, and come up with a plan for when they get out.
Providers working in the New Mexico prison system also don’t bill Medicaid, Asonganyi said, and would need to be set up so they can in order for the waiver to work.
Expected to launch July ‘25
Castillo Smith said the next step for the Health Care Authority and the Corrections Department is to write a more fully fleshed-out plan, which is due to the feds on Jan. 1.
In the meantime, they’re writing the rates for providers to charge for incarcerated people’s care, and rewriting contracts with the insurance companies to formalize their eligibility.
Between January and June, HCA will then educate and train community members, she said. The waiver services will go live in July next year.
The Corrections Department’s working group assigned to implement the waiver was expected to meet for the first time on Friday to start talking about timelines, Scogin said.
Next summer and fall, the feds will be monitoring the program to determine whether the services under the waiver will remain a permanent part of New Mexico Medicaid, Castillo Smith said.
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