Background
The Medicaid Inmate Exclusion Policy (MIEP) is a federal policy in the Social Security Act that denies or revokes federal health benefits for adults prior to adjudication while they await trial in county jail.
Medicaid benefits provided while the individual is incarcerated are limited to covered services when the member is hospitalized for at least 24-hour hours outside the correctional facility.
General Resources
2024 CCI Briefings
As HCPF pursues waivers relating to MIEP, CCI has been conducting briefing meetings to provide counties with updates and solicit feedback on how to implement these waivers in county jails.
CCI Briefing from HCPF - October 24, 2024
CCI Briefing from HCPF - July 17, 2024
CCI Briefing from HCPF - Upcoming
Upcoming briefings will occur on the following days over zoom:
- Friday, January 3, 2025, 10:00 – 11:00am
- Wednesday, April 9, 2025 1:00 – 2:00 pm
For Zoom meeting details or more information, please contact Kieran Boes (kboes@ccionline.org)
Colorado Waiver Attempts / Efforts
While the MIEP is still in place, the federal government has allowed states to pursue a Medicaid waiver that allows Medicaid to be utilized as the individual is preparing to depart from county jail.
In addition, Colorado has made strides to improve access to Medicaid enrollment to individuals as they prepare to depart county jail.
Efforts directed by SB22-196
CCI Staff Summary of bill (resulting reports are linked below)
- Required HCPF to evaluate & determine if they should seek federal authority to provide Medicaid to cover persons “immediately prior to release from county jail or Department of Corrections” (part 1)
- If HCPF determines in this report that it would be inappropriate to seek federal authority, they shall submit a report to the Joint Budget Committee with additional, prescribed information (part 2)
CCI Staff Summary:
- Found a public health & financial benefit to HCPF pursuing a Section 1115 Reentry Demonstration for Medicaid eligible justice-involved population, 90 days prior to release
- The pursuit of a waiver was unlikely to increase state dollar expenditures
- Jail Data:
- 110,500 releases from county jail annually – $76M in Medicaid treatment costs (of which $20M are state funds)
- JBBS (through BHA) covers $16M in GF
- HMA only received information from 4 county jails about expenses related to transitional services
- Potential for $29M in existing state funds to be reinvested in new programs
- Lack confidence on jail analysis
- Implementation
- HCPF should consider a phased implementation approach — narrow the eligibility criteria and/or specifying which facilities are included in the demonstration over time
- Seems to be missing data from the jail side, which makes them less confident in jail settings — possibly additional study/data collection to improve upon
- Additional budget & possibly legislative actions likely are necessary
- HCPF should consider a phased implementation approach — narrow the eligibility criteria and/or specifying which facilities are included in the demonstration over time
CCI Staff Summary:
- While the study found that pursuing a waiver would have health & financial benefits for Colorado, HCPF determined it is inappropriate to seek federal authority without additional legislative & budget authorities.
- Without authorization from the legislature authorizing adjustments of existing GF, the only way HCPF could implement pre-release coverage would be to cut existing programs & benefits
- HCPF recommends not seeking federal authorization unless the Department has the budgetary support & authorization for the complex financing needed to implement this impactful program
- Alternative Plan
- Supporting Justice-Involved Members via ACC Program
- BHA funded services for Criminal Justice-Involved populations
Efforts to improve Medicaid enrollment for individuals in Incarceration
The following two bills made requirements of county jails & county departments of human services to assist individuals in enrolling for Medicaid, as they prepare to depart incarceration
2023 Efforts & Outreach
Federal Advocacy
CCI has long partnered with the National Association of Counties to amend the MIEP.