Medi-Cal is an essential program for individuals transitioning out of incarceration. Roughly more than one million adults and youth involuntarily enter or are released from a California public carceral system annually. Disabled and Black, Native American, and Latinx individuals are vastly overrepresented in prisons and jails. In addition, people confined in prisons and jails have significantly higher medical needs, both behavioral and physical, than individuals out of jail and prison. At least 80 percent of individuals who are incarcerated in California are eligible for Medi-Cal and would benefit from Medi-Cal covered services.
Federal law prohibits the use of federal dollars to pay for Medicaid-covered services for any adult who is an “inmate of a public institution.” This inmate exclusion means that incarcerated individuals have no access to Medicaid-funded services and resources during their incarceration. The inmate exclusion, however, must not be confused with Medicaid eligibility itself since a person’s custody status does not impact their Medicaid eligibility.
For instance, in 2022, California enacted a new state law that requires all counties to suspend Medi-Cal benefits for both adults and youth who are incarcerated, rather than terminating an individual’s Medicaid eligibility upon entry into a correctional facility (federal law requires all states to do the same beginning in 2026). Suspension pauses the enrollee’s Medicaid benefits during their incarceration and the pause is lifted upon the individual’s release. Suspension allows for a seamless transition to reactivate Medicaid coverage and ensures that individuals released from incarceration immediately have access to the health care services and supports they need.
Although the inmate exclusion is not a Medicaid eligibility prohibition, it has been identified as a significant barrier for individuals to receive access to services during incarceration and immediately upon reentry back into their communities. Recognizing the importance of getting individuals who are incarcerated access to health care services to help advance health equity, as part of the California Advancing and Innovating Medi-Cal Initiative (CalAIM), California has implemented the Justice-Involved Initiative. This Initiative aims to improve access to and quality of health care for justice-involved populations as they re-enter into their communities.
The Justice-Involved Initiative supports individuals who are incarcerated by enforcing a mandatory pre-release Medi-Cal application process, offering a targeted set of Medi-Cal services 90 days before their release, and connecting individuals to Medi-Cal services that will help with their transition post-release, such as Behavioral Health Linkages, Enhanced Care Management, and Community Supports. The Initiative will ensure that people who are in carceral settings are enrolled in Medi-Cal and connected with services upon entry.
All of the CalAIM Justice-Involved Initiatives have already been implemented through the state or are in the process of launching throughout the state. To learn more about some of the CalAIM Justice-Involved Initiatives and Medi-Cal eligibility for incarcerated individuals, please read our newly launched resources:
Medicaid Eligibility for Incarcerated Individuals in California
Medi-Cal Services and Supports for Californians Transitioning Out of Incarceration
