August 11, 2021

Cassidy, Colleagues Introduce Bill to Provide Medicaid Due Process for Americans Awaiting Trial

WASHINGTON – U.S. Senators Bill Cassidy, M.D. (R-LA), Jeff Merkley (D-OR), and Ed Markey (D-MA) introduced the Due Process Continuity of Care Act. The bill amends Medicaid Inmate Exclusion Policy (MIEP) to ensure that pre-trial detainees are not kicked off Medicaid prior to ever being found guilty of a crime. MIEP denies federal benefits to individuals who are incarcerated and applies both to those who have been found guilty of a crime and those held pending adjudication who are still presumed innocent (Pretrial status detainees).

This denial of federal benefit without due process also shifts the full financial burden of health care of inmates on to local jails and taxpayers. The weight of this burden is severely straining local jail budgets and resulting in unmet care needs of pretrial status detainees, which comprise approximately two-thirds of people held in local jails. 

“It saves money for taxpayers if somebody who’s currently on the right medicine for their conditions can stay on that medicine. It costs taxpayers money if they stop the medicine, get sicker and then have to go through the whole process to get their condition controlled once more,” said Dr. Cassidy

“In America, you are innocent until proven guilty,” said Senator Merkley. “Too many Americans with health conditions lose their health insurance because they can’t make bail. Congress must uphold the core tenet of our judicial system and take action to ensure that Americans who are awaiting trial are not stripped of their health care coverage. Whether or not you have money for bail shouldn’t determine whether you lose Medicaid.”

“Our justice system also should be based on the principle of Medicaid until proven guilty. Individuals who have not been convicted of a crime should not lose lifesaving health care coverage simply because they were unable to make bail,” said Senator Markey. “It is past time to end this unfair and discriminatory practice that not only exacerbates health issues like diabetes and opioid addiction among individuals who would otherwise have access to their health care coverage, but it strains local budgets. I’ve worked with counties across Massachusetts to call attention to this shameful policy and identify solutions, and I am grateful to my Senate colleagues for their partnership in righting this injustice.”

The bill also provides $50 million in planning grant dollars for the HHS Secretary to award to states with the goal of providing additional support to states, counties and local jails for implementing this policy, improving the quality of care provided in jails and enhancing the number of available providers to treat this population.  

Local jail admissions resemble the emergency department, receiving those with the highest acuity of mental illness and substance use disorder. Most inmates in local jail have had a mental illness or substance use disorder diagnosis. 

Diagnoses of Jail Inmates


Chronic Medical Condition


Mental Health Disorder


Substance Use Disorder


Incarcerated people experience chronic diseases, mental illness, and substance abuse at higher rates than the general population. More than 95 percent of local jail inmates eventually return to their communities, bringing their health conditions with them.

The Due Process Continuity of Care Act will:

  • Amend the MIEP to allow for Medicaid coverage of health care services for pre-trial detainees;
  • Provide planning grant dollars to states for implementation of the MIEP repeal; and
  • Bring financial relief to state and local taxpayers for the cost of providing services to this population.

The bill is endorsed by the following groups: National Association of Counties, Major County Sheriffs of America, and National Sheriffs’ Association. 

“The Medicaid Inmate Exclusion Policy often interrupts needed medical, mental health, and addiction treatment for jail inmates who disproportionately suffer from chronic medical conditions and substance use disorders,” said National Association of Counties Executive Director Matthew Chase. “Stripping or suspending federal health benefits from pre-trial detainees, who are presumed innocent, presents constitutional issues, and also leads to poorer health outcomes and higher recidivism. We thank Senator Cassidy for introducing this important bill that will ensure pre-trial detainee access to Medicaid, a key measure in protecting the care continuum and strengthening public safety.”

“The National Sheriffs Association writes to express our strong support for the bipartisan legislation to remove the restriction on Medicaid coverage for pretrial inmates in custody and urge the Committee and Senate to consider the legislation,” said National Sheriffs’ Association Executive Director and CEO Jonathan Thompson. “Passage of this vital legislation would take a necessary and important step toward improving health outcomes for incarcerated individuals, reducing recidivism, and restoring the federal, state, and local partnership in delivering safety-net benefits.”