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As we confront the prospect of a second Trump administration and the significant harmful impact of his proposed policies, CLASP stands prepared for this moment and remains committed to doing the work to slow down, minimize, and prevent or mitigate damage to families with low incomes, workers, children, immigrants, and people of color. As such, CLASP offers a virtual space for us as partners and coalitions to come together and hear from movement leaders in the broader social and economic justice ecosystem. Together we discussed how we will move forward, leverage opportunities, and take on the inherent threats to both our democracy and our collective fight against poverty, racial injustice, and other inequities.

View the recording of the event below:

 

By Suma Setty, Wendy Cervantes, and Juliana Zhou
CLASP submitted this statement for the record on December 10, 2024 to the U.S Senate Judiciary Committee for a hearing titled “How Mass Deportations Will Separate American Families, Harm Our Armed Forces, and Devastate Our Economy.” This statement highlights the impacts mass deportations will have on children in immigrant families. The threat and reality of increased immigration enforcement, especially parent-child separation, has profound negative impacts on children and communities. These impacts include mental and physical harm, educational setbacks, developmental delays, and economic and housing insecurity. The statement also addresses the immediate and long-term consequences that will cause additional ripple effects on the well-being of families, especially when combined with other harmful anti-immigrant rhetoric and policy.
Read the statement here.

The statement can be attributed to Olivia Golden, Interim Executive Director at the Center for Law and Social Policy (CLASP)  

November 6, 2024, Washington, D.C.—Today, as we confront the prospect of a second Trump administration, we are deeply concerned about the significant impact of his administration’s policies. We know what his intentions are because he has stated them many times: to target immigrant communities, people of color, women, and LGBTQ Americans; to harm workers and people with low incomes, including threatening job protections and the right to unionize, for the benefit of billionaires; and to threaten core public programs and the capacity of public officials to do their jobs honestly, fairly, and without fear.

CLASP is prepared for this moment, informed by our experience in responding to the first Trump administration, which previewed all these threats. Our preparations include strengthening the powerful coalitions we are already engaged in, including those that protect immigrant families and children, and building new ones where needed; working with partners to build on our collective knowledge and expertise to slow down, minimize, and where possible prevent or mitigate damage; standing ready to build on our powerful past record of documenting the harm when it happens and telling the story to the public; moving the vision forward in the states; and bringing our deep knowledge into partnership with organizing and movement leaders.

CLASP has a long history of and commitment to advocating for the safety, rights, and economic security that families with low incomes, workers, children, and immigrants deserve. As these communities stand to lose the most under another Trump administration, it’s more important than ever that we remain steadfast in advocating for social, economic, and racial justice.

Donald Trump and his advisors have made no secret about their roadmap for administration priorities. It’s a path that will benefit the very wealthy while creating and exacerbating hardship for millions.  CLASP fought the fight to resist these priorities and elevate a very different vision during his first administration, and we are committed to doing so again.  As we prepare for this work, we are inspired by the partners who share this work with us.

By: Suzanne Wikle 

In 2024, a record 21.4 million people received their health insurance through the Affordable Care Act (ACA) Marketplaces. Enrollment gains among Black, Latino, and people with low incomes drove the increased enrollment. Sustaining the policy choices that led to record enrollment and adding in long overdue eligibility for people with Deferred Action for Childhood Arrivals (DACA) status will be important to keep up the momentum and keep affordable health insurance available. With these policies in place, 2025 is poised to be another record-breaking year for Marketplace enrollment.  

Several policies have led to this historic enrollment, but the gains are not guaranteed to stay, unless Congress acts.  

Enhanced Premium Tax Credits
People receive premium tax credits to purchase health insurance through the ACA Marketplaces when they do not have other affordable options. The premium tax credits lower the amount people pay every month for their premiums. Starting in 2021 the tax credits were enhanced, making Marketplace plans much more affordable. People earning less than 150 percent of the federal poverty level can be insured for $0 monthly premium; for those who had out-of-pocket costs, their premiums were reduced an average of 44 percent.  

Since the enhanced tax credits became available, 83 percent of the growth in Marketplace enrollment has been by people with incomes less than 250 percent of the federal poverty level. Black and Hispanic enrollment increased the most. Compared to 2020 (non-enhanced tax credits), enrollment in 2023 (with enhanced tax credits) increased by 95 percent among Black enrollees and 103 percent among Latino enrollees. Enrollment among American Indians and Alaskan Natives grew by 59 percent;, multiracial enrollment grew by 28 percent;, white enrollment grew by 25 percent;, and Asian-American, Native Hawaiian, and Pacific Islander enrollment grew by 14 percent. 

What’s at stake: The enhanced tax credits for Marketplace enrollments are slated to end on December 31, 2025. Congress must act to extend or make permanent the enhanced tax credits that have led to record enrollment, particularly among people with low incomes and people of color. Without Congressional action, we can expect to see fewer people enrolling in Marketplace coverage, greater out-of-pocket costs for those who do enroll, and an increase in the number of people without health insurance. An individual making $21,000 per year would have to pay nearly $800 more in annual premiums, and a family of four making $60,000 would see an annual premium increase of $2,700.  

DACA Eligibility for ACA Marketplace Tax Credits 

 When the annual open enrollment period begins on November 1, 2024, an exciting and long overdue new policy will take effect. People with DACA will be newly eligible to buy health insurance and receive tax credits through the Marketplace. The Congressional Budget Office estimates that around 100,000 people with DACA will enroll for 2025 coverage. The new policy also clarifies that other vulnerable youth, such as those who have been approved for Special Immigrant Juvenile status and those applying for asylum, will also be eligible for coverage.  

What’s at stake: DACA eligibility for Marketplace coverage is being challenged by some states. Oral arguments were held on October 15, 2024, but at the time of publication, people with DACA will still be able to enroll in Marketplace coverage and receive tax credits when open enrollment begins on November 1, 2024. 

The progress made connecting people with affordable health insurance options is the direct result of important policy changes. In order to continue the progress and not lose ground – especially for Black people, Latinos,  DACA recipients, and immigrant youth – we must ensure the right policies stay in place. Congress must act to continue enhanced premium tax credits beyond 2025 and ensure DACA recipients and immigrant youth continue to have access to affordable health care.  

 

By Celeste Dorantes

History of Exclusion

In 2012, the Obama Administration announced the Deferred Action for Childhood Arrivals (DACA) program. DACA has allowed hundreds of thousands of young people to work and live in the United States without fear of deportation—including becoming our teachers, health care providers, and caregivers.

Yet, due to restrictive policies, they have been almost completely barred from purchasing health coverage and accessing federal public benefit programs. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 prevented lawfully present immigrants, including deferred action recipients with DACA, from accessing Medicaid, CHIP, SNAP, and other public benefits.

Those restrictive policies set a dangerous precedent in excluding immigrants from federal policies, including barring DACA recipients from further care. When the DACA program began, recipients were explicitly excluded from being able to purchase health plans on the Affordable Care Act (ACA) Marketplace.

Since the inception of DACA in 2012, more than 800,000 DACA recipients have been barred from coverage through the ACA.

Ensuring DACA Recipients have Access to Care

In May 2024, the Biden Administration finalized a rule that would allow DACA recipients to purchase ACA Marketplace plans and become eligible for the accompanying tax credits and subsidies beginning in the fall of 2024. This rule is expected to expand health coverage to over 100,000 uninsured DACA recipients. However, barriers to Medicaid, SNAP, and other federal public benefits still persist for DACA recipients. Those barriers mean that DACA recipients, and often their family, go without care they may need.

Access to health care is a human right. The Biden Administration’s final rule extending ACA Marketplace coverage to DACA recipients and other immigrant youth is an important step in ensuring everyone has access to the health care they need. However, DACA recipients continue to remain ineligible for Medicaid, CHIP, and other critical public benefits. We urge Congress to support policy solutions that remove harmful and unnecessary barriers for immigrants’ access to care by cosponsoring:

The LIFT the BAR Act (H.R.4170/ S.2038)

The HEAL for Immigrant Families Act (H.R. 5008 / S.2646)

Washington, D.C. September 10, 2024 – Today’s release of the U.S. Census Bureau’s report on poverty and income shows that a strong economy matters for workers and families – yet far more is needed to reduce poverty. Income rose at all levels, including for the lowest-paid workers, and median household incomes increased 4 percent from 2022, the most significant increase in household income since 2019. These improvements contributed to a small decrease in the official poverty rate from 11.5 percent in 2022 to 11.1 percent in 2023.

Yet poverty overall, and particularly for children, continues to be stuck at far too high a level. According to the 2023 Supplemental Poverty Measure, many U.S. children continue to live in poverty: the rate climbed slightly from 2022 to a level of 13.7 percent, twice as high as in 2021 when the fully refundable child tax credit and other public programs cut child poverty to a historic low of 5.2 percent.

“This year’s U.S. Census Bureau report serves as a reminder for our nation to make the critical policy choices needed to address poverty, especially child poverty. We know what’s effective: policies to make the economy work for low-wage workers and policies to invest in crucial public supports such as the refundable child tax credit, health care, and nutrition supports – a strong safety net,” said Olivia Golden, interim executive director of CLASP. “These policies are also crucial to addressing the persistent and damaging effects of racism on children and families. The strong policies in the COVID response legislation were designed to reach Black families, Latino families, and families with the fewest resources – and, after initial gaps, children in immigrant families who make up a very large share of U.S. children. As a result, these policies cut child poverty in half across the board.”

Today’s report showed that the overall poverty rate in 2023 of 12.9 percent was roughly the same as in 2022 when poverty stood at 12.4 percent. In addition to the increase in overall child poverty rates, racial and ethnic disparities in child poverty also increased, with 20.3 percent of Black children and 22 percent of Hispanic children experiencing poverty compared to just 7.2 percent of white children. These figures reflect the Supplemental Poverty Measure, which looks at the resources that people have available after taking into account taxes, transfers, and work expenses, and uses an annually adjusted threshold based on the cost of a package of necessities.

The slight decrease in overall poverty reflected in the Official Poverty Measure, which considers only cash income, was driven by the strong economy. This was also seen in the overall increases in cash income for all workers, even those with very low incomes. This reflects tight labor markets that are good for workers who are paid low wages. Inflation has gone down significantly from 7.7 percent in 2022 to 3.9 percent in 2023, creating a path for real income growth in 2023. However, persistent racial and ethnic disparities remain in real median household income, driven by historical and current structural racism in education, housing, and hiring resulting in unequal access to good jobs.

The Census report also found that the share of people lacking health insurance throughout 2023 held steady at 8 percent. Policy matters to this result as well. Two different policies created during the pandemic contributed to a reduction in people lacking health insurance over the past several years. We are likely not yet seeing the full effects of the ending of protections for Medicaid members and other health care expansions provided during the COVID pandemic that served as a safety net for people who lost jobs or faced other economic and coverage disruptions. During the pandemic, states were not allowed to disenroll people from Medicaid. Since this protection ended, more than 12 million people have lost Medicaid coverage. In addition, those purchasing insurance through the Affordable Care Act’s Marketplace have had significantly more affordable options due to increased tax credits provided during the pandemic. But those tax credits are set to expire at the end of 2025 unless Congress acts.

 

By Fiona Lu

Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) communities have historically been overgeneralized into one racial category. This has minimized the individual struggles of each ethnic group, including disparities in poverty levels and health outcomes across multiple populations. For instance, data from KFF shows that 63 percent of Marshallese live at or below 200 percent of the federal poverty line, while as little as 12 percent of Indian Americans do. As the most ethnically, culturally, and linguistically diverse group in the United States, the AA and NHPI populations often face distinctive challenges that require thoughtfully tailored services, such as addressing food insecurity.

The Model Minority Myth and Data Aggregation

The model minority myth is at the root of many forms of racial discrimination and invisibility AA communities face. The term was first used in the 1960s to label Japanese Americans as quiet, hardworking, and economically successful, despite Japanese American internment during World War II. The model minority label intended to frame Japanese Americans and, later, all AAs, as the antithesis of Black Americans, who were on the forefront of demanding justice during the Civil Rights Movement. The model minority myth masks the struggles of certain Asian ethnic groups or individual families that grapple with poverty, war trauma, and other challenges. NHPI communities, which are often conflated with AA communities, have their own histories of militarization and colonialism and face displacement from their indigenous lands. These socio-political histories manifest as challenges in attaining education, accessing quality jobs, combating health disparities, and increasing incarceration rates.

To counter the cultural overgeneralization that AAs and NHPIs face, there have been demands to disaggregate data about various AA and NHPI groups. Although the U.S. Census has considered NHPIs as a separate racial category since 1997, many other forms of data collection do not. Disaggregating data can highlight specific disparities the NHPI community faces, such as that in 2020, the average median household income was $91,989 for AAs and $66,406 for NHPIs.

How Food Insecurity Affects AA and NHPI Populations

Just as AA and NHPI populations have the greatest wealth gap, food insecurity is also stratified among various ethnic groups. The 2014 National Health Interview Survey and Data revealed that as many as 1 in 5 (20.5 percent) NHPI adults had experienced food insecurity. Data also analyzed from the California Health Interview Survey about six AA subgroups (Chinese, Japanese, Vietnamese, Filipino, Korean, and South Asian) found that Japanese Californians experienced the lowest levels of food insecurity at 2.28 percent, while Vietnamese Californians experienced the highest levels of food insecurity at 16.42 percent.

Some factors that are particularly correlated with higher levels of food insecurity for AAs and NHPIs include whether individuals are foreign-born, undocumented, older, or have limited English proficiency. These findings highlight the urgent need for more services tailored toward serving vulnerable AAs and NHPIs, who often face language barriers, cultural stigmas, and limited access to resources when seeking help.

The Challenges in Tackling AA and NHPI Food Insecurity

The Supplemental Nutrition Assistance Program (SNAP) is the most widespread and effective tool for fighting hunger. However, AA and NHPI communities encounter significant barriers to utilizing SNAP, and their participation rates are significantly lower than the U.S. average. Although 25.1 percent of Malaysian Americans experience poverty compared to 15.5 percent of all Americans, only 3.2 percent are enrolled in SNAP, compared to 13.7 percent of the U.S. population. In a qualitative study focusing on Chinese, Filipino, Tongan, and Vietnamese populations in the Greater Los Angeles region, researchers found both structural and cultural barriers to enrolling in California’s SNAP program, including long applications, a lack of translation services, the social stigma of poverty, and a strong cultural emphasis on both family reliance and self-reliance.

How to Support Healthy Food Access for AA and NHPI Communities

Ensuring food security for AA and NHPI communities will require a holistic approach that engages policymakers, community organizations, agencies, and philanthropy, among others. Some examples of how to support food access include:

Addressing food insecurity for our most vulnerable minority populations means understanding the cultural, social, and economic issues those communities face and what processes have shaped and continue to perpetuate them. For the AA and NHPI communities, this means engaging in intentional and culturally responsive solutions, from community engagement in data collection and policymaking to direct service.

By Jesse Fairbanks

The Department of Housing and Urban Development (HUD) is planning a pilot program to provide direct rental assistance to some people who are eligible for housing choice vouchers (HCVs). Giving cash instead of vouchers to eligible renters is a monumental change that signals trust in HCV participants. While this change has the potential to simplify the program, the pilot could endanger participating tenants in some states by removing oversight of housing quality. The pilots therefore need to be combined with strengthened protections for tenants nationwide.

HCVs currently assist over five million people in approximately 2.3 million households. Unlike public housing, HCVs depend on the private rental market to supply housing. People participating in the HCV program pay 30 percent of their income to rent a unit from a private landlord, and their voucher generally covers the rest. Unfortunately, the program doesn’t work so simply for most eligible people.

HCVs are unreliable for two major reasons. First, the program is severely underfunded. Only one in four people who are eligible receive a voucher. Applicants remain on the waitlist upward of two years. Second, a person’s ability to use their voucher depends on conditions outside of their control such as landlord participation or local housing markets. As a result, HCVs are the most challenging public benefit to use. One federal study estimated that 40 percent of people who receive a voucher are unable to find a unit, and lose their voucher.

Finding affordable, quality housing that meets an entire family’s needs and is owned by a landlord willing to accept a voucher can feel impossible.

Because vouchers depend on the private market, landlords have significant power to decide whether people with vouchers can use their benefits. Average rents often exceed the amount that public housing authorities are willing to subsidize in places where landlords rapidly raise rents. Many landlords just choose not to participate in the HCV program, citing burdens such as the housing quality inspection. They are legally allowed to refuse vouchers as payment in a majority of states or cities. The fundamental power imbalance between landlords and tenants that harms all people navigating the private rental market also prohibits the HCV program from serving more people.

HUD’s proposed design for direct rental assistance could eliminate some of the excuses landlords give for not participating in the program. It could also increase participants’ autonomy during the housing search.

Under HUD’s design, households selected for a voucher would receive funds by direct deposit from a public housing agency. Each household would then be responsible for paying the full rent to their landlord. A well-designed pilot that deposits money for rent directly into HCV participants’ bank accounts would demonstrate trust in people who receive public benefits, signaling that they are deserving of the community’s help. In contrast, programs that monitor or restrict how people can use their assistance imply that recipients are too incompetent to help themselves. Centering recipients’ autonomy in program design supports the broader narrative shift we need to make programs anti-racist.

However, simply providing cash instead of a voucher won’t help tenants find a unit, as landlords will still know they receive assistance. Many landlords refuse to rent to people participating in the HCV program because of racist or classist stereotypes about people who receive public benefits as not being “quality” tenants. These property owners will continue to find workarounds to discriminate against people with vouchers in places without strong source-of-income protections.

HUD’s proposed design could increase landlord participation by eliminating two of the requirements they find burdensome. For households that received direct rental assistance, there wouldn’t need to be a Housing Assistance Payment (HAP) contract between the landlord and the public housing agency because the tenant would issue the full rent payment. Additionally, the tenant would bear primary responsibility for inspecting the unit. Landlords would no longer be asked to leave their units empty until a lengthy inspection and all repairs deemed necessary by the public housing authority are completed, which landlords claim reduces their profits.

There is valid concern among advocates that weakening housing authorities’ oversight during the housing search will expose more tenants to substandard living conditions. Federal data suggest a little over 3 percent of renters with very low incomes endure severe maintenance issues such as inadequate plumbing, but the potential consequences are life-threatening for people who do. These violations are more common in places with older housing stock or weak laws enforcing habitability standards. They’re also challenging to detect with an untrained eye. Rather than unilaterally eliminate the inspection, housing authorities should be encouraged to allow recipients to determine the most appropriate inspection process for themselves, providing several options such as having a professional inspector double-check the unit after they’ve moved in.

All of these changes would make the experience of renting as an HCV participant more similar to the experience of someone without assistance. This shift may disadvantage recipients in places without strong laws protecting or empowering tenants.

For example, tenants in almost 20 states are not legally allowed to withhold rent when a landlord fails to supply quality housing as written in a lease or local law. Strong rent-withholding laws enable tenants to more safely band together and organize rent strikes if a landlord refuses to bargain with them. These laws are a significant source of power for tenants determined to improve their housing quality. Roughly the same number of states don’t permit tenants to repair maintenance issues and deduct the costs from the rent, either. In theory, a pilot that provides cash instead of vouchers could harmonize with laws that empower tenants to withhold rent when a landlord fails to provide safe housing. But state laws differ dramatically. HCV recipients in places with weak tenant protections may need a HAP contract to preserve minimal rights to a safe home.

The changes HUD has proposed will not right the imbalance of systemic power between landlords and tenants at the core of HCVs’ ineffectiveness. With the rollout of these pilots, the Biden-Harris Administration must explore administrative levers available to standardize tenant protections for people in federally assisted housing, while also pressuring Congress to pass a national tenants’ bill of rights.

By Jesse Fairbanks, Amira Iwuala, Parker Gilkesson Davis, and Kathy Tran

In 2021, the Center for Law and Social Policy (CLASP) began a community engagement effort called Community-Driven Policies and Practices (CDPP). The project was led by CLASP staff and a steering committee of community members known as the Core Collective. Together, we facilitated a series of power-building sessions in Baltimore, Las Vegas, and Tribal Nations in the Pacific Northwest. Our goal in these sessions was to create a safe, inspiring space for people experiencing poverty to dream up policies with the potential to deliver economic justice and strategies to advance them. The sessions culminated in an advocacy plan to implement a policy goal that each group believed would advance their vision for economic justice.

The first half of this report summarizes CDPP, including the project’s guiding principles, planning team, and engagement strategy. This section also spotlights the advocacy plans that community members drafted while participating in CDPP power-building sessions.

Using CDPP as a case study, the second half of this report explores best practices for engaging people with lived experience of poverty in nonprofit advocacy, based on the ideas of CLASP staff, the Core Collective, and community participants. Each grouping of recommendations is divided into actions that could be carried out by staff leading community engagement and structural changes that would need to be spearheaded by leaders in nonprofits. The recommendations for nonprofit leadership require large-scale changes to the policies, practices, and norms that traditionally govern nonprofit advocacy. We acknowledge that most of these structural changes have not been implemented by CLASP or similar nonprofits.

The recommendations fall into five main categories, all of which are essential goals that nonprofits should keep in mind when engaging community members:

  1. Building Trust and Secure Relationships
  2. Subverting Power Dynamics Rooted in Systemic Injustice
  3. Partnering with Community from Design Through Implementation and Evaluation
  4. Recruiting and Onboarding Community Members
  5. Creating Valuable Experiences for Community Members

The 50+ recommendations in this report are not an exhaustive list of all engagement strategies available to nonprofits. Community engagement is a boundless practice shaped by grassroots leaders over time, with roots in Indigenous democratic decision-making. Our intention with this report is to compile recommendations that, in the experience of CLASP staff, promote meaningful community engagement led by nonprofits or governments.

policy and community engagement goals and steps a graphic that describes all fo the steps needed to engage with communities when determining policy solutions for people with low incomes in poverty

Through CDPP, we were able to assess the merit of a national nonprofit practicing direct, place-based community engagement. We found that direct connections to national nonprofits can provide value to community members through professional development opportunities, access to people in positions of systemic power, and resources to sustain their advocacy. Place-based projects led by a national organization can expand the tools available to local groups to make large-scale policy change. The value that national organizations can provide community members, however, can be stunted by long-standing norms within nonprofits and philanthropy. This report argues that the individual actions of nonprofit staff can only go so far to ensure meaningful community engagement. The entire system underpinning nonprofit advocacy needs reform to sustain staffs’ efforts to create valuable experiences for community members that inspire them to continue fighting for important policy changes.

>> Read the report here

By Juliana Zhou

The Centers for Medicare and Medicaid Services (CMS) announced a novel Section 1115 waiver opportunity in April 2023 that allows states to offer Medicaid services to individuals who are leaving incarceration. Twenty-two states have already submitted demonstration applications extending Medicaid benefits to qualified pre-release individuals, and CMS has approved applications from California, Washington, Montana, and Massachusetts. The pre-release Medicaid waiver is a major opportunity for states to close the health equity gap for formerly incarcerated individuals and help those leaving incarceration thrive in their home communities.

Individuals leaving incarceration face serious negative health outcomes and a high risk of death due to overdose in the weeks immediately after their release. The carceral health care system has a demonstrated record of racial disparities, chronic health neglect, and inaccessible processes. CLASP urges states to center the rights and privacy of systems-involved populations and guard against the reach and influence of the criminal legal system into the lives of those transitioning back into the community.

Some States Are Investing in Community-Based Care, But More Can Be Done

A key opportunity in the new pre-release Medicaid option is the chance for states to invest in community-based care for individuals leaving incarceration, as Massachusetts has done. The state’s approved demonstration covers community and peer-provided services including doulas; uses its capacity-building funds to offer facility-based care coordinators from community-based providers; and includes a reinvestment plan that would invest federal matching funds into community-based services to support healthy transitions and/or diversion from involvement in the criminal justice system. Massachusetts demonstrates its prioritization of community repair over punitive community supervision for returning individuals through its meaningful engagement with and investment in community-based providers.

The Majority of States Are Opting for the Maximum Pre-Release Period Allowed

The pre-release coverage period ranges from 30 to 90 days, the maximum allowed by CMS. Just over half of the states that have submitted a demonstration waiver have opted for the maximum, and seven of the remaining 10 states have opted for the minimum. We urge all states to opt for the full 90-day pre-release period to maximize the number of people who can benefit from these programs. Having the time to establish a consistent treatment plan prior to release can improve health outcomes for individuals leaving incarceration.

Eligibility Criteria Limit the Equity Impact of Pre-Release Medicaid

Many states’ waiver demonstration applications are part of larger state efforts to address the opioid and mental health crises. Five states limit their demonstration’s eligibility criteria to only individuals suffering from substance use disorder and/or severe mental illness. By over-defining qualifying conditions, states are hindering the impact of this transformative policy opportunity. Incarcerated populations are more likely to have chronic health conditions such as high blood pressure, asthma, cancer, and infectious diseases (e.g., hepatitis C and HIV) than the public. All these conditions can be debilitating or even fatal if not medically monitored.

Eligibility can also be limited by the carceral setting a person is preparing to leave. Whether someone is incarcerated in a state or local jail, prison, or youth correctional facility should not determine if they qualify for pre-release services. States that want to roll out their pre-release Medicaid program methodically should instead consider implementing a timeline for gradually expanding the program to additional facilities rather than setting limitations on facility participation from the outset.

To truly and effectively support an incarcerated individual’s transition back into the community, Medicaid re-entry programs should cover the health care needs of all individuals who would otherwise qualify for Medicaid if not for their incarceration status, regardless of their carceral setting or medical condition.

Only A Few States Plan to Offer Full Medicaid Benefits and Services

Many states’ waiver demonstrations only cover a limited set of Medicaid benefits to individuals prior to their release, which often include case management, medication-assisted treatment, counseling, and a 30-day supply of medication upon release. Only Arkansas, Rhode Island, Utah, and Vermont plan to offer all the health care services included in their state health plans. Some states offering a limited set of benefits also include additional housing or nutrition services targeting health-related social needs.

Conclusion

States have an enormous opportunity through the Medicaid re-entry waiver to invest in community and peer health workers and prioritize community care within the health care system. Sadly, pre-release Medicaid enrollment flexibilities have limited value in the 10 remaining states that have not expanded Medicaid. CLASP hopes that when implementing these waivers, states will learn the lessons of the failed mass incarceration movement and center the health and support needs of individuals transitioning back into the community.