By Teresa Miller
How Reentry Providers Can Respond to New Medicaid Rules
The implementation of work reporting requirements is among the changes coming to Medicaid following last year’s passage of the One Big Beautiful Bill Act. Access to health care is a lifeline for formerly incarcerated individuals, who, when compared to the general population, experience significant barriers to employment and disproportionately high rates of physical and mental health conditions and substance use disorders (SUDs). Most individuals post-incarceration access healthcare through Medicaid via states’ expansion of Medicaid to low-income adults without dependents and will be subject to these new rules. Steps can be taken now to ensure formerly incarcerated individuals understand and are equipped to meet the new work reporting requirements, so they don’t lose access to health care.
Under the new rules, Medicaid enrollees will need to engage in 80 hours a month of work, education, training, and/or community service or earn a monthly income of at least $580 ($7.25 x 80 hours). State Medicaid agencies will be conducting eligibility renewals once every six months, instead of the current twelve months, and will need to verify compliance with the work requirements at each renewal cycle (or more frequently if the state chooses).
Work reporting requirements are projected to result in 5.3 million people losing Medicaid coverage because of the red tape required to track compliance. Ultimately, the best way to prevent people from losing access to healthcare is to ensure they can qualify for an exemption from the requirements.
Some of the key exemptions for formerly incarcerated individuals include:
- Individuals with a SUD
- Individuals with other health needs (disabling mental health conditions, disabilities, or serious or complex medical conditions)
- Individuals released from incarceration within the last 3 months
- Individuals already complying with TANF/SNAP work requirements
Get Involved and Inform Implementation
States have some flexibility in how they implement the work reporting requirements. As a result, there is an opportunity for reentry organizations to help shape their state’s work reporting policies and procedures to mitigate the harm resulting from these new requirements – that is, to minimize coverage loss and maximize access to health care.
Notably, states should enhance medical screening for all individuals in carceral settings to enable, prior to release, the identification of a SUD, disabling mental health condition, disability, or other medical condition, ensuring the documentation needed for any qualified exemptions. Further, states can ensure their data-matching and communications systems can seamlessly connect carceral facilities and Medicaid agencies, reducing the burden on individuals to obtain and share their records with Medicaid. Combining data-matching with pre-release screening for unsuspending or enrolling in Medicaid can identify a longer-term exemption, reducing the likelihood of coverage loss. Lastly, data-matching can be utilized to automatically ensure that all individuals leaving the carceral setting are, at a minimum, enrolled in the 3-month exemption for people leaving incarceration. Reentry organizations can work with Medicaid agencies and carceral facilities to put these protections in place.
Helping People Navigate the Exemptions
Beyond that, reentry organizations can enhance their own support structures to help people navigate the new work reporting requirements. While the federal government has not issued formal guidance yet about how the exemptions for medical conditions will be operationalized, it has signaled that Medicaid claims data or other provider documentation will be important.
Particularly for people with SUD and/or mental health conditions, where only 1 in 5 individuals and about half of individuals respectively receive treatment in a given year, this reliance on claims data or provider documentation leaves them vulnerable to losing this exemption and ultimately their access to healthcare. If an individual does not receive treatment or have a diagnosis for a specified medical condition, there will be no Medicaid claims or documentation to support an exemption from work reporting requirements.
Organizations can help connect people to medical providers upon reentry so individuals with medical conditions are able to receive a formal diagnosis and the documentation needed to meet the exemption requirements and maintain their Medicaid coverage. It will be imperative that individuals have documentation for any medical conditions that qualify them for an exemption. Community organizations will be critical partners in preventing the projected 5.3 million people from losing coverage, as they can help ensure no individual falls through the cracks and loses access to critical health care.
Teresa Miller is the National Director of Health Initiatives at the Legal Action Center. She advocates at both the state and federal level to improve access to health care for people impacted by the criminal legal system.