The Reincorporation of Prisoners into the Body Politic: Eliminating the Medicaid Inmate Exclusion Policy
Incarcerated people are excluded from Medicaid coverage due to a provision in the Social Security Act Amendments of 1965 known as the Medicaid Inmate Exclusion Policy (“MIEP”). This Article argues for the elimination of the MIEP as an anachronistic remnant of an earlier era prior to the massive growth of the U.S. incarcerated population and the expansion of Medicaid eligibility under the Patient Protection and Affordable Care Act of 2010. It explores three reasons for eliminating the MIEP. First, the inclusion of incarcerated populations in Medicaid coverage would signify the final erasure from the Medicaid regime of the distinction between the “deserving” and “undeserving” poor and is consistent with and in furtherance of the ACA’s ultimate goal of universal health insurance coverage. Second, elimination of the MIEP furthers the bipartisan criminal legal system reform focus on reducing recidivism through effective reentry. Current efforts to use Medicaid to facilitate reentry require careful workarounds of the MIEP. Elimination of the policy would reduce logistical hurdles to ensuring continuity of care and enhance rehabilitation services provided during incarceration. Third, eliminating the MIEP coalesces with the goals of the emerging discourse around health justice, and specifically, its focus on how social determinants of health drive inequities. In including a health justice framework, this Article seeks to enrich the discussion in two directions. In the first instance, health justice illuminates structural factors such as discrimination and poverty that are root causes of health inequities and must be addressed alongside immediate health needs. At the same time, this Article aims to deepen the health justice discussion with a sharper focus on the role of incarceration in perpetuating health inequities, and the ways in which extending Medicaid access to incarcerated populations can improve treatment of immediate needs while also addressing structural inequities that cause and are caused by justice system involvement.