This is part of our Medicaid Concepts series, in which we try to provide a high level overview of key concepts in the Medicaid industry today.

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Medicaid and Telehealth: Interview with Dr. Shannon Dowler

Guest bio Dr. Shannon Dowler is a family doctor born, raised and trained in North Carolina. She has spent the past twenty years pursuing health access, equity and quality in Western North Carolina. In 2019 she became theChief Medical Officer for North Carolina Medicaid. You can also learn more about

Medicaid and Jail Health Episode 2: Interview with Blaire Bryant

Guest bio Blaire Bryant is the Associate Legislative Director for Health at the National Association of Counties. In this capacity she works with county officials across the nation to set NACo's policies on matters related to health policy and the public health system. Blaire holds a B.A. in Biopsychology from

Medicaid and Jail Health Episode 1: Interview with Dr. Evan Ashkin

Guest bio Evan Ashkin, MD, is the founder of the Formerly Incarcerated Transition (FIT) Program, which aims to help recently released inmates with chronic illnesses to receive proper medical care upon rejoining their communities. Ashkin also serves as professor in the Department of Family Medicine at the UNC School of

Topic overview

What do we mean by jail health?

In general this discussion includes both healthcare services while incarcerated and during the transition period once the individual leaves prison and returns to society. While incarcerated, there are a range of services and contractors who provide physical and mental health services to prisoners. When offenders exit prison, there are programs operated by health plans and states to assist in the transition.

What role does Medicaid play in this area?

Medicaid can cover services for inmates and returning offenders. Before the Affordable Care Act in 2014 (ACA) many states did not choose to provide services to inmates under Medicaid because they usually did not meet eligibility criteria (non-disabled adults without dependent children). ACA provided new funding via the “expansion” group category that made it easier for prisoners to be eligible while inside.

Many states follow CMS guidance on suspending (vs terminating) inmate coverage once they enter prison. This allows the state to more easily resume coverage once the offender returns (which is a critical time period of transition, with much higher changes of mortality and other negative outcomes). This also allows for Medicaid to cover off-site healthcare services such as inpatient stays, even when the inmate goes back to prison after the stay.

States that do cover eligible prisoners usually exclude them from managed care capitation arrangements (instead covering them under their fee for service program).

States and health plans continue to try and improve the healthcare services provided to incarcerated and returning members. For returning members, Medicaid programs and plans focus on provider coordination, job services and closing gaps related to social determinants of health.