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Medicaid; Prisoners; Community Health Services; Patient Protection and Affordable Care Act (ACA)


The Patient Protection and Affordable Care Act (ACA) provides an unprecedented opportunity for millions of poor men and women to obtain insurance coverage to address their substantial acute, chronic, physical and behavioral health care needs. The ACA raises Medicaid eligibility levels to 133 percent of poverty, thereby enabling adults with or without children to qualify for coverage. A substantial percentage of the newly eligible population will be jail-involved individuals – people who have had interactions with the legal system over the course of a year, including as an inmate at a county or city jail. Many of these individuals are in jail pending disposition; they have not been convicted of a crime but are nevertheless held as an inmate, often because they do not have the resources to satisfy bail requirements. Under current rules, individuals in jail pending disposition are ineligible for Medicaid services. They may enroll in the program but their status as an inmate results in their being ineligible for benefits.

The ACA explicitly allows incarcerated individuals pending disposition to be classified as qualified to enroll in and receive services from health plans participating in state health insurance exchanges if they otherwise qualify for such coverage. Furthermore, individuals who satisfy bail requirements and are released into the community pending disposition will be eligible for Medicaid under the ACA if they meet income and other program requirements. This leaves a group of high need, low-income and vulnerable individuals left out of comprehensive health coverage because of their place of residence.

This paper describes the jail population and offers 10 reasons why individuals in jail pending disposition should be eligible for Medicaid coverage. Covering individuals pending disposition through Medicaid:

  1. Targets a highly vulnerable group of poor adults with substantial physical, mental health and substance abuse needs
  2. Fulfills the spirit of the Affordable Care Act by increasing access to comprehensive coverage
  3. Advances equity
  4. Provides health insurance for a disproportionately chronically ill population
  5. Increases integration and coordination of care by reducing gaps in health care
  6. Positions jails as potential enrollment catchment areas for vulnerable populations
  7. Reduces health system, Social Security Supplemental Security Income, and criminal justice costs
  8. Provides access to health care at very low cost to states
  9. Advances public health and social stability
  10. Improves quality of care and data monitoring

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