19 States Have Expanded Medicaid for People Exiting Incarceration, Saving Lives and Taxpayer Dollars. New York Isn’t One of Them.

Under federal law, Medicaid is automatically suspended during incarceration. But for over a decade, the state health department has considered extending coverage to those soon-to-be-released from county jails and state-run prisons.

The expansion, under what’s called a Section 1115 waiver, could provide a lifesaving bridge for a population with high rates of chronic illness, addiction, and mental health disorders — and potentially save the state millions of dollars.

Nineteen states, including California, Kentucky, and Montana, have secured federal approval for their own versions of the program. Several others, including New York, have waiver requests awaiting review.

But New York hasn’t updated its request in years. It would need to be rewritten to align with 2023 federal guidelines that require a minimum of pre-release services, like case management, addiction medications, and counseling. The health department declined to explain the delay or to say whether it will submit a revised petition.

It may now be too late; if the department did rewrite the request, it could face long odds under President Donald Trump. But in the meantime, New York has options closer to home to help recently released people access health care.

“We’ve seen states be really, really creative about what they’re able to cover within that waiver,” said Megan French-Marcelin of the Legal Action Center, a nonprofit which has pushed New York to move forward with the effort. She said the state had missed a chance at being an early adopter of expanded Medicaid for released inmates. “Funding-wise, this would save the state millions.”

Chronic health conditions like diabetes and asthma are much more likely to go untreated behind bars, and expanding health care before people are released can improve outcomes and decrease mortality.

Research suggests Medicaid access is also tied to higher rates of post-release employment and reduces recidivism, which in turn saves money. (New York counties spend more than $225 to jail an individual for one night. Prison is even costlier at $315 a day, or $115,000 annually.)

With progress on a federal waiver seemingly stalled, French-Marcelin hopes the state legislature will take up the charge. In June, the state Senate passed a bill that would provide “presumptive” Medicaid eligibility to everyone exiting jails and prisons across the state for up to 60 days, starting from the day of their release. However, the Assembly’s version of the bill didn’t get far before lawmakers went home for the year.

Senator Gustavo Rivera, who sponsored the Senate version of the bill and chairs the chamber’s health committee, wrote in an email to New York Focus: “People return to our communities from incarceration with high rates of mental illness, substance use disorder, and other conditions, but they aren’t provided with the tools to succeed in reentry — like the ability to make doctor’s appointments or obtain medications.”

“We cannot be surprised by the high rates of morbidity, including overdoses, among recently released New Yorkers,” he said.

Amy Paulin, the chair of the Assembly’s health committee, did not respond to questions about the bill or why it didn’t get a vote in her committee.

But the health department was less clear on where things stand in local jails, writing only that it was “working with the New York State Division of Criminal Justice Services (DCJS) to determine whether there is a data sharing pathway that would allow the Department to be notified of admissions and releases from local jails.”

A DCJS spokesperson said the agency does not track any information related to Medicaid enrollment and referred Focus back to the health department.

Without an official mandate on the books, it’s up to individual counties that operate local jails to decide what, if any, reentry services to offer. The results, according to French-Marcelin, are a mixed bag.

Some counties told the Legal Action Center they work with an insurance navigator to help some or all reentrants get enrolled or reinstated in Medicaid. Others said they didn’t have the staffing or know-how to help, and a few said they had to stop offering Medicaid assistance due to a lack of funding.

Planning ahead is key to disrupting that cycle, said Ben Deeb, a peer advocate and supervisor at Healing Springs who helps coordinate Saratoga County Jail reentry efforts. Like Richardson, Deeb was formerly incarcerated and is recovering from addiction.

Deeb regularly receives a list of individuals scheduled for release from the jail within the next six weeks. After meeting with those individuals to discuss their health needs, he forwards their information to an insurance navigator at Saratoga Hospital who assesses their eligibility for Medicaid.

“Saratoga is way ahead of the curve,” said Deeb. “That is not the case everywhere else. There’s a lot of people leaving correctional facilities with nothing.”

Captain Daniel Morley of the Saratoga County Sheriff’s Office said the program goes hand in hand with policing efforts, since it reduces the number of people with repeat offenses. “You give someone the opportunity for success when they get out of jail. It makes a huge difference if you don’t — you’re basically putting them back into the cycle they came from,” he said.

Morley thinks Saratoga County’s model can be replicated elsewhere in the state, but it ultimately comes down to local support. “There has to be a desire,” he said. ”It’s going to depend on the county.”

Several counties have signaled their support for expanding reentry healthcare. In February, the New York State Association of Counties passed a resolution urging Governor Kathy Hochul and the health department to move forward with an updated federal waiver.

Greene County, just south of Albany, is among the majority of counties that do not currently provide Medicaid enrollment services to those being released, according to the Legal Action Center. The county Social Services Commissioner, Kira Pospesel, voted in favor of the resolution.

“It ends up saving money over time, we’re not dealing with crisis after crisis,” said Pospesel.