Wilson Center Releases Policy Brief on Medicaid Access

a patient having consultation with doctor. The patient is on the sofa and the doctor holds a clipboard in front of her. Today the Wilson Center for Science and Justice at Duke Law releases a new Policy Brief: Ensuring Access to Medicaid During and After Incarceration: Key Policy Considerations in the Wake of Medicaid Expansion in North CarolinaOn March 27, 2023, Governor Roy Cooper signed legislation to expand access to Medicaid, which will make an estimated 600,000 North Carolinians newly eligible for coverage, and this brief makes recommendations on how best to ensure Medicaid expansion accounts for the needs of formerly incarcerated individuals. 

“Access to healthcare is crucial to the wellbeing of individuals returning to communities after incarceration, and Medicaid expansion offers a unique opportunity to ensure that more justice-impacted individuals have access to that care,” said the Wilson Center’s Behavioral Health Policy Analyst Megan Moore.  

An estimated 50% of people in state prisons were uninsured at the time of their arrest, and incarcerated people are significantly more likely to experience behavioral health and chronic medical conditions. Healthcare access improves health outcomes and reduces mortality risk. Further, in other states where Medicaid has been expanded, evidence shows significant decreases in drug arrests, violent offense arrests, and low-level offense arrests.   

The Wilson Center recommends that policy makers: 

  • Amend NC’s Section 1115 Waiver to allow incarcerated individuals to use their Medicaid coverage to connect to community providers up to 90 days prior to release, including case management services and institutional in-reach. 
  • Fully implement NC FAST data sharing system between North Carolina jails and NC DHHS to better ensure coverage reinstatement for individuals leaving jails. 
  • Use the Medicaid expansion bonus funds to support reentry services across the state, including universal Medicaid screening. 
  • Require Medicaid managed care plans to provide care coordination services in jails and prisons to improve continuity of care. 
  • Implement universal Medicaid screening for individuals sentenced to probation. 
  • In partnership with local jails and the DMV, DAC or DHHS should create a standardized jail release form that would ensure formerly incarcerated individuals can more easily obtain required identification documents for Medicaid enrollment. 

“While we know implementing expanded Medicaid will take many months, now is the time for strategizing and planning to make sure expansion is as smooth and impactful as possible. We hope that North Carolina government actors and policy makers will consider these recommendations to best ensure that all North Carolinians, including those incarcerated and formerly incarcerated, will have access to this critical healthcare,” said Wilson Center Policy Director Angie Weis Gammell.  

Media contact: Jennifer Melton