The following is an opinion piece.

Support for second chances runs deep in American culture.  We demand responsibility, expect resiliency, and reward those who help themselves.  Our judicial system also rests on principles of restitution, and, for those leaving prison, reintegration. We impose punishment and expect reform. 

But second chances are difficult to get especially for those who are sick when they leave prison. 

Over 600,000 people are released from jail and prison every year, and up to half of those in prison have a chronic illness, a rate far higher than in the general population. Many also suffer from a psychiatric disorder, in part because jails have progressively housed more and more people not being served by long-defunct psychiatric institutions.  

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Losing Medicaid Coverage

Yet when they leave prison, many people are left without adequate health insurance. Almost all incarcerated people on Medicaid lose that coverage when they are imprisoned, and returning to Medicaid can often be difficult, making it much harder to find care on the outside.  

If we provided those leaving prison with insurance, we would help them do exactly what we expect of them: To find new opportunities, including long-term jobs; to provide for their families; to engage with their communities and give back some of what they might have taken away.                 

Some politicians recognize the need to fix this self-defeating gap and realize too that we already have many resources in place to help.  In 2021, U.S. Rep. Paul Tonko, D-New York, introduced HR 955, the Medicaid Reentry Act, which garnered bi-partisan support to give Medicaid to inmates nearing release.

It was supposed to be in the Omnibus bill that passed in December, but it was left out of the final version. The bill did include provisions to improve access to behavioral health in general and required states to provide 12 months of continuous eligibility for children while allowing the same for postpartum women. Those are laudable, but it doesn’t make sense to leave out current and former inmates.  

Legislative Initiatives

States have made some progress in fixing this indefensible gap. For instance, most states now suspend rather than terminate Medicaid benefits for those entering prison, facilitating enrollment before release. Some states also connect incarcerated people to wraparound services before release, recognizing their many needs.  The Centers for Medicare and Medicaid Services recently announced they will allow Medicaid to pay for some services for those nearing release from California prisons.  Other states, including some traditionally red ones, may soon follow with similar initiatives (see a list of 15 states).

It’s time to extend a helping hand and sharpen our system of justice. Medical assistance of this sort is likely to help many others. Many people returning from prison are parents. Extending health benefits to parents will help them be more supportive.  

Preventing Recidivism

Health benefits for those nearing release will also benefit communities, preventing recidivism and enhancing public safety. The needs of current and former inmates are often complex, involving multiple illnesses or complex behavioral problems. But none of these problems is untreatable. A course of cognitive behavioral therapy has been shown to be effective in reducing subsequent behavioral problems among those in prison, even among those serving in maximum security facilities.  

Health insurance helps keep people from entering or returning to prison or entering in the first place. In states that expanded Medicaid, arrest rates fell 20% to 32% compared to states that did not expand the program. A similar study found increased access to Medicaid reduced recidivism among those convicted of violent and public order crimes, a pattern likely explained by access to addiction treatment.

Because giving a person Medicaid is much less costly than incarcerating them, the cost savings from expanding Medicaid is considerable, especially if the services former inmates need can be given in a relatively short period.    

Our prisons are already in the business of providing care. The constitution prohibits cruel and unusual punishment and prisons are obligated to provide care to avoid the cruelty of withholding treatment.  

By enhancing their health coverage, and easing the path to reintegration, we can create a prison system that saves money and promotes the ideal of justice.

Jason Schnittker is a Senior Fellow of the Leonard Davis Institute of Health Economics, a Professor of Sociology at the University of Pennsylvania, and co-author of Prisons and Health in the Age of Mass Incarceration.


Jason Schnittker, PhD

Professor, Sociology, School of Arts and Sciences

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