Boone County News Release

Press Archives Press Room

For Immediate Release

Media Contact:
Janet Thompson
District II Commissioner
Phone: (573) 886-4307


Paul Guequierre
Communications Director
National Association of Counties
Phone: (202) 942-4271

Report: Federal Policy on Inmate Health Care Leads to Poor Health Outcomes and Increased Likelihood of Reoffending

Report by joint task force of the National Association of Counties and National Sheriffs’ Association details the impact of the federal Medicaid Inmate Exclusion Policy, lays out steps governments can take to address the problem

WASHINGTON – Approximately 11 million people cycle in and out of local jails each year, with the majority suffering from substance abuse issues, mental illness or both. The health needs of those incarcerated in local jails are exacerbated yet are often not being met. The Medicaid Inmate Exclusion Policy (MIEP) strips federal health care benefits, such as Medicaid, Medicare and Children’s Health Insurance Program (CHIP) for juveniles upon admission to jail, not adjudication. The antiquated policy does not acknowledge the difference between pre-trial detainees – who are presumed innocent under the Constitution – and those who have been convicted of a crime. According to a report released today by a joint task force of the National Association of Counties (NACo) and the National Sheriffs’ Association (NSA), the MIEP leads to poor health outcomes and increased recidivism.

“We know mental illness and substance abuse issues are often major factors in an individual’s involvement with the criminal justice system. By working toward changing the parts of our system that serve as roadblocks, we are working toward providing safer jail environments for both detainees and corrections officers, better health outcomes, and lower risk of recidivism, especially amongst juvenile offenders,” said Janet Thompson, Boone County District II Commissioner, who was appointed to the Task Force when it was formed in 2019. By serving on the Task Force, Commissioner Thompson is ensuring the interests of Boone County are being represented.

“As a nation, we have abandoned the health care needs of our most vulnerable residents,” said Mary Ann Borgeson, NACo president and Douglas County, Neb. commissioner. “By making 911 a hotline for those in need of mental health services, we send people experiencing a behavioral health crisis to jail at a time when we should instead be providing them with resources and care in the community. We are assured better health outcomes when the burden of care is not placed on local law enforcement.”

“It is imperative that everyone of us speak up, speak loud for what we need to continue to provide health care to those who have not been convicted of a crime and to ensure that our jails are safe and providing the programs they need,” said David Mahoney, NSA vice president and Dane County, Wis. Sheriff. “If we as a nation could repeal the Medicaid Inmate Exclusion Policy for pre-trial detainees, it would not only be the right thing to do, it would be the smart thing to do for our county taxpayers, our county boards, our county administrators and us as a nation.”
By the numbers:

  • 40 percent of jail inmates have a chronic medical condition
  • 44 percent of jail inmates have been diagnosed as having a mental disorder
  • 63 percent of jail inmates have a substance use disorder
  • 70 percent of the 2 million youth arrested every year in the U.S. suffer from a mental health condition
  • 96 percent of jail detainees and inmates do not receive a prison sentence and return to the community

Local jails have become the de facto behavioral and mental health treatment facilities and have assumed the liability as well. Across the nation, there is growing reliance on local jails to serve as “one-stop” treatment centers for these afflictions. Under current law, those who can afford to post bail keep their health care while those unable to pay – who are often most susceptible to illness – face a gap in coverage. Research shows gaps in coverage lead to higher rates of recidivism resulting in over-incarceration. 

The double standard created by MIEP is putting undue strain on our local judicial, law enforcement, public safety and human services systems leading to increased health care costs and poorer health outcomes. Having access to federal health benefits for non-convicted individuals would allow for improved coordination of care, while decreasing short-term costs to local taxpayers and long-term costs to the federal government.

This report by the NACo-NSA Joint Task Force on Pre-Trial Detainee Health Care and Recidivism gives an overview of pre-trial populations, their health care needs and the current state of the health care they are receiving, as well as recommendations for policy makers, and best practices for local governments and justice systems. The report also details the legal implications of the Medicaid Inmate Exclusion Policy.

The report calls Section 1905(a)(A) of the Social Security Act (MIEP) to be clarified and interpreted to allow the continuation of federal benefits, such as Medicaid, Medicare and CHIP for those enrolled and eligible individuals who are pending disposition in local jails, especially those individuals suffering from mental health, substance abuse and/or other chronic illnesses, in accordance with their Constitutional rights to due process and equal protection under the Fifth and 14th Amendments.  

Read the full report and learn about the NACo‑NSA Joint Task Force on Pre-Trial Detainee Health Care and Recidivism here.


The National Association of Counties (NACo) strengthens America’s counties, including nearly 40,000 county elected officials and 3.6 million county employees. Founded in 1935, NACo unites county officials to advocate for county government priorities in federal policymaking; promote exemplary county policies and practices; nurture leadership skills and expand knowledge networks; optimize county and taxpayer resources and cost savings; and enrich the public’s understanding of county government.

The National Sheriffs’ Association is one of the largest associations of law enforcement professionals in the U.S., representing more than 3,000 elected Sheriffs across the nation, and with a total membership of more than 20,000. NSA is a non-profit organization dedicated to raising the level of professionalism among Sheriffs, their deputies, and others in the field of law enforcement, public safety, and criminal justice. Throughout its seventy-eight year history, NSA has also served as an information resource for all law enforcement, as well as State governments and the Federal government.