JULY 22, 2026
States Building Medicaid-to-Incarceration Bridge Programs Face Setbacks Under Federal Budget Law
Nineteen states have received federal approval to begin providing Medicaid coverage to incarcerated individuals in the weeks before their release, with four states — California, Washington, Montana, and New Hampshire — already enrolling people. The One Big Beautiful Bill Act (H.R. 1) is imposing work requirements, more frequent eligibility checks, and budget cuts on Medicaid, which has caused at least three states — Oregon, Rhode Island, and Michigan — to pause or rescind their reentry programs. In April, Louisiana became the first state to receive Trump administration approval for such a program, offering a narrower set of covered services than earlier Biden-era approvals.
For decades, federal Medicaid dollars were largely prohibited from paying for health care provided to people while incarcerated, leaving counties and states to cover those costs. Research shows that people leaving incarceration face sharply elevated risks of death in the first weeks after release, particularly from drug overdose, and many exit with untreated mental illness, substance use disorders, and chronic disease. Courts have ordered improvements in roughly half of state prison systems.
In 2018, Congress directed federal health officials to work with states on ways to improve care for people leaving prison and jail. The Biden administration approved 19 states to offer Medicaid coverage 30 to 90 days before release, with eight additional states and Washington, D.C., also seeking approval. In the four states that have begun operating these programs, tens of thousands of people are being screened for substance use disorders, connected to medications, and linked to care before release. Washington state officials reported that people who received pre-release Medicaid were less likely to return to jail or prison, though it is too early to measure broader outcomes on mortality or emergency room use.
The passage of H.R. 1 has complicated expansion of these programs. Oregon Medicaid Director Emma Sandoe said her state still wants to bring Medicaid into jails and prisons but must first implement new work requirements and eligibility checks mandated by the law, saying "what physically can be done with the amount of time, with the amount of resources available, is limited." Michigan rescinded its application in December 2025, citing insufficient funding, and Rhode Island also paused its effort. Advocates and policy experts said most states are still moving forward for now, but the administrative burden of OBBB compliance has forced some to deprioritize reentry work.