Bill Text (PDF)

Washington (July 18, 2023) – Senators Edward J. Markey (D-Mass.), a member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, and Jeff Merkley (D-Ore.) today announced the reintroduction of the Equity in Pre-Trial Health Coverage Act, legislation that would protect the continuity of federal health benefits under Medicaid, Medicare, Children’s Health Insurance Program (CHIP), and Veterans Affairs for Americans who have been detained while they await trial and, in many cases, remain in custody because they cannot afford bail. This would make it easier for people to continue to access essential health care during and after incarceration, including substance use disorder and mental health treatment. This legislation would partially reverse the 1965 Federal Medicaid Inmate Exclusion Policy.

“Health care should be a right, not a privilege, and that means it should not be contingent on whether a person can afford to pay their bail,” said Senator Markey. “It is long past time for Congress to eliminate discriminatory policies that make it harder for people to get the health care they need, including substance use disorder or mental health services. People who are arrested are so often left behind in our health care system, leaving our poorly-equipped criminal legal system to fill in the gaps will keep working with counties across Massachusetts to break down barriers to essential health care and create a system that puts people’s care before incarceration. I thank Senator Merkley for his continued partnership in making sure that we end these unjust policies once and for all.”

“Americans who have serious health conditions — including those who are awaiting trial — need access to quality healthcare and can’t afford to be kicked off of those benefits,” said Senator Merkley. “In America, you are innocent until proven guilty, and the Equity in Pre-Trial Health Coverage Act will ensure that pre-trial detainees can keep their health coverage and seek the medical treatment they need.” 

Currently, individuals who have been arrested and are able to post bail maintain their coverage. People who remain in custody—but have not been convicted of the crime for which they have been charged—can lose it. As a result, a gap exists in coverage for individuals covered by federal health programs awaiting trial, which keeps them from being able to access essential care in their community and shifts the cost of medical treatment for pretrial detainees to local city, county, and state agencies. This gap is particularly challenging for people with substance use disorders and other mental health conditions which require consistent and sustained medical treatment.

Last Congress, Senator Markey secured provisions in the end-of-year Omnibus spending package which allow Medicaid coverage to be accessible on a state level for juveniles who are in custody pending deposition of charges. The Equity in Pretrial Health Coverage Act would go further, extending coverage to anyone no matter their age.

A copy of the legislation can be found HERE.

Cosponsors in the Senate include Senators Cory Booker (D-N.J.), Alex Padilla (D-Calif.), Dick Durbin (D-Ill.), Sherrod Brown (D-Ohio), Elizabeth Warren (D-Mass.), Amy Klobuchar (D-Minn.), and Tammy Baldwin (D-Wis.).

The Equity in Pretrial Health Coverage Act is endorsed by National Commission on Correctional Health Care, National Sheriffs’ Association, Major County Sheriffs of America National Association of Counties, Massachusetts Sheriffs’ Association, Association of Oregon Counties, Oregon State Sheriffs’ Association, and National Council for Mental Wellbeing.

“All incarcerated individuals have a constitutional right to health care, which many desperately need. The gap in federal health benefits for individuals awaiting trial is unfair and unjust, both to those individuals and to the local agencies that need to cover health care costs. The National Commission on Correctional Health Care, the only organization in the country devoted solely to improving the health care provided in jails, prisons, and juvenile confinement facilities, wholly supports the Equity in Pretrial Health Coverage Act and the continuity of care it would provide,” said Deborah Ross, CEO of the National Commission on Correctional Health Care.

“Individuals in pre-trial custody are presumed innocent until proven guilty and, therefore, should continue to receive their Medicare, Medicaid, CHIP, and VA benefits. This is why Major County Sheriffs of America believes Congress should enact the Equity in Pretrial Health Coverage Act. Passing this bill is not only good public health policy; it is also good public safety policy,” said Megan Noland, Executive Director of the Major County Sheriffs of America.

“Oregon is in the midst of an unprecedented shortage of housing and substance abuse treatment. Community members are entering our jails and youth detention facilities with immediate and complex health needs. Uninterrupted Medicare, Medicaid, and veterans’ benefits will allow for better coordination of health care services and improved health outcomes, lowering short-term costs to local taxpayers and long-term costs to the federal government,” said Derrick DeGroot, Klamath County Commissioner and President of the Association of Oregon Counties.

“People living with a mental health or substance use challenge are overrepresented in the criminal justice system. At no point should a justice-involved individual be denied access to mental health and substance use disorder care based on a change in health care coverage. Continuity of care is critical, especially for those living with mental health and substance use challenges – it not only helps save lives but also reduces recidivism. We applaud Senator Markey for prioritizing this issue and look forward to working with him and his fellow lawmakers to continue closing gaps in access to care,” said Chuck Ingoglia, President and CEO of the National Council for Mental Wellbeing.

“The Massachusetts Sheriffs’ Association, and the 14 duly-elected Sheriffs of the Commonwealth, unequivocally and overwhelmingly support the Equity in Pretrial Health Coverage Act. The current inequities place an undue strain on our law enforcement, public safety, public health, our communities at large, and most importantly, the individuals themselves. The Sheriffs have been advocating for years for the need to eliminate the Federal Medicaid Inmate Exclusion Policy. Expanding the health coverage for eligible incarcerated individuals pending disposition of charges can and will change lives,” said Nicholas Cocchi, President of the Massachusetts Sherriffs’ Association.

“This legislation furthers the commitment of federal health benefits under Medicaid, Medicare, CHIP, and Veterans Affairs. This would be another great step in helping many sheriffs with the continuation of health care services that their community members need,” said Jim Skinner, Sheriff of Collin County, Texas.