Treating Addiction Behind Bars: How Medicaid Is Changing Correctional Healthcare

A landmark rule change finalized in 2024 overturns Medicaid’s longstanding ban on using funds to provide healthcare, including substance use disorder treatment, to incarcerated populations. It marks one of the most significant shifts in correctional healthcare policy in decades.

Opioid drugs, especially powerful synthetic opioids like fentanyl, were involved in most of the more than 106,000 fatal overdoses in 2021, a 16% increase from 2020.

The majority of people in prison have a substance use disorder (SUD), a treatable mental health condition that, when left untreated, can wreak havoc on all areas of a person’s life.

Due to the nature of the disease of addiction, people living with an SUD often have a difficult time controlling their substance use, despite any negative consequences.

From Federal Prisons To State Prisons

Under the rule change, states can now apply for Medicaid 1115 waivers to fund mental health and substance use disorder services in jails and prisons. This is a significant expansion of coverage for a population that has historically been excluded from Medicaid reimbursement. Several states have already moved to implement these waivers.

Approximately 25% of all Americans received Medicaid benefits in 2022. For low-income individuals, Medicaid is the largest source of funding for healthcare services.

Federal policy has increasingly recognized incarcerated people, along with rural and Tribal populations, as underserved communities requiring targeted investment in substance use disorder prevention, treatment, and recovery services.

Addiction In Our Prisons

It’s hard to know precisely how many incarcerated people have an SUD, but the National Institute on Drug Abuse (NIDA) estimates that about 65% of all inmates do.

NIDA estimates that another 20%, who didn’t meet the official criteria for an SUD, were under the influence of drugs or alcohol when they committed a crime.

Overall in America, about 40 million people ages 13 and over are living with addiction, or about 12% of the population, according to the 2020 National Survey on Drug Use and Health.

How Treatment Helps Prison Populations

Substance use disorder treatment is effective. For people in prison, receiving treatment can mean the difference between staying out of jail once released or returning behind bars.

It can also provide them with the mental clarity and tools to meet the challenges of life, improve their mental health, and succeed in their relationships and work.

Fights Recidivism

According to NIDA, decades of scientific evidence has shown that providing addiction treatment to incarcerated people with SUDs results in fewer crimes when they are released.

People who receive SUD treatment while in jail or prison also have an easier time adjusting back to daily life, such as by meeting work or family responsibilities.

They are also less likely to fall into a pattern of returning to jail, which is known as recidivism.

A recent study by the U.S. Sentencing Commission found that about half of the 25,000+ inmates surveyed were re-arrested after leaving federal prison, most within two years.

Harvard Political Review reports that America has one of the highest recidivism rates in the world, with 76.6% of prisoners rearrested within five years of their release.

Aids Long-Term Recovery

Evidence-based treatment methods are central to helping people who are incarcerated build a foundation for long-term recovery.

Medications for opioid use disorder (MOUD) combine the use of medications like buprenorphine with behavioral therapy to treat opioid use disorder.

Buprenorphine, the first medication that could be prescribed by physicians to treat opioid use disorders, helps people overcome addiction in a few ways.

Using buprenorphine helps with recovery by:

• reducing cravings
• diminishing opioid withdrawal symptoms, which include flu-like symptoms and severe anxiety
• improving safety, if overdose occurs
• lessening the chance of misuse

One study in support of buprenorphine’s effectiveness showed that participants receiving the medication were almost twice as likely to remain in treatment and not relapse.

Prevents Overdose Deaths

According to U.S. News and World Report, the leading cause of death among people newly released from prison is drug overdose.

This is partly due to the fact that their tolerance levels decrease while incarcerated, so they aren’t able to tolerate the same amount of the drug as before they were in prison.

The buprenorphine study mentioned above also revealed that people not receiving the treatment had a 20% mortality rate.

An Opportunity To Address Racial Disparities

According to Pew Research Center, the gap between imprisoned white people and Black people in America may be shrinking, but it is still very significant.

Substance use disorder treatment can help rehabilitate people in prison and get them the care that they need to cope with stress and difficulties in healthy ways.

Imprisonment Rates

In 2017, for every 100,000 Black people in the U.S., 1,549 were imprisoned. For every 100,000 white people, 272 were imprisoned, and for every 100,000 Hispanic people, 823 were imprisoned.

This makes the rate of imprisonment for Black Americans nearly six times that of white Americans, and double that of Hispanic Americans.

We also know that most people who are incarcerated have an SUD. This indicates that the “war on crime” could represent a failed opportunity to provide medical care where it was and is needed most.

Poorer Quality Of Health

Black Americans and other people belonging to minority groups are among the people facing social and racial health disparities in America today.

Health disparities are preventable differences in a population’s health and wellness stemming from economic, environmental, social, and geographic disadvantages.

These disadvantages, which can be the result of racism, often lead to increased stress and trauma.

Experiencing ongoing stress and repeated trauma can increase a person’s susceptibility to substance use disorder and other mental health conditions.

Get Help For An Addiction Today

If you or a loved one is battling a substance use disorder, treatment is available, and recovery is possible.

Browse our directory or reach out to the Substance Abuse and Mental Health Services Administration (SAMHSA) for more information about addiction recovery.

Written by the Addiction Resource Editorial Staff