When enacted in 2021, the expanded Child Tax Credit (CTC) significantly reduced child poverty to historic lows and helped close the racial wealth gap. However, with its expiration, millions of children have fallen back into poverty. Learn how we can restore and expand this critical support to ensure lasting benefits for families and children. Read more to explore the path forward for a fully refundable CTC.
By Julianna 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.
The following statement can be attributed to Elizabeth Lower-Basch, deputy executive director for policy at the Center for Law and Social Policy (CLASP).
Washington, D.C., June 27, 2024–Today in a pair of cases, the Supreme Court’s conservative majority overturned a 40–year–old precedent, known as “Chevron deference,” which generally required courts to defer to the expertise of agency rulemakers. This precedent has supported tens of thousands of rules used by federal agencies to execute regulatory authority on topics from the environment to financial services to patient, consumer, and worker protections, and protected them from frivolous lawsuits. With this change, all regulations will be much more vulnerable to litigation – which will delay implementation even when the regulations are eventually upheld – and judges will be able to make decisions grounded in their personal opinions rather than the substantive knowledge of agency experts.
Exactly how damaging this decision will be remains to be seen; Justice Roberts in his decision claims that it “does not call into question prior cases that relied on the Chevron framework.” But the decisions in Loper Bright Enterprises v. Raimondo and Relentless, Inc. v. Department of Commerce raise the stakes for judicial appointments at all levels, as well as increase the need for Congress to pass detailed legislative instructions that leave less room for judicial meddling. Because countless federal regulations support people with low incomes, these decisions have the potential to significantly affect their lives.
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Income is where the most striking disparities lie. U.S households with an income approaching $100,000 are most likely to purchase plant-based alternatives, but most of those making less than $45,000 rarely do. One reason is federal assistance like the Supplemental Nutrition Assistance Program, or SNAP, often provides too little financial help to make them affordable.
“It’s just a question of cost, and if that is going to be feasible for them, to make sure they make it through the month,” said Parker Gilkesson Davis, a senior analyst at the Center for Law and Social Policy who studies nutrition and poverty.
CLASP submitted comments in support of Connecticut’s Section 1115 waiver demonstration, which would provide pre-release Medicaid services to individuals leaving incarceration and improve continuity of care into the community upon release and during re-entry. CLASP appreciates Connecticut’s broad definition of qualifying conditions to include intellectual disability, acquired brain injuries, pregnancy and post-partum status, and chronic illnesses. If approved, the proposed demonstration would promote health equity and address the health needs of Connecticut’s most vulnerable populations.
In April 2023, the Centers for Medicare and Medicaid Services (CMS) issued guidance to state Medicaid agencies detailing opportunities to expand Medicaid coverage to people up to 90 days before they are released from incarceration. Through a state flexibility known as a Section 1115 demonstration waiver, states may extend coverage to a population that is currently excluded from receiving Medicaid services.
As states have applied for and implemented these “pre-release” waivers, CLASP has submitted several public comments in support of states using their waiver demonstrations to connect people in carceral settings with community-based health care and non-punitive social and behavioral health services ahead of their release. Research shows that incarcerated people have higher rates of mental illness, substance use disorder, and chronic disease than the general population. Gaps in health care coverage and racial disparities in incarceration rates are key drivers of health disparities for people of color.
CLASP’s vision for re-entry requires prioritizing community repair and an active divestment from community supervision, including parole and probation systems. Community supervision continues to criminalize individuals and relegates them to second-class citizenship. Community repair, on the other hand, is an anti-carceral policy approach that requires removing corrections and law enforcement from the re-entry process altogether. In seeking approval for 1115 Medicaid demonstration waivers, states should steer investments away from carceral systems and toward community-based supports for people returning to their communities after incarceration.
CLASP has submitted comments on the following 1115 demonstration waivers:
Washington (August 2022)
New Mexico (January 2023)
North Carolina (December 2023)
June 12: Ashley Burnside presented at the Guaranteed Income Now Conference, hosted by the Economic Security Project in Detroit, Michigan.
This statement can be attributed to Parker Gilkesson Davis, senior policy analyst, Public Benefits Justice, Center for Law and Social Policy.
Washington, D.C., May 24, 2024—Early this morning on a vote of 33 to 21, the U.S. House of Representatives Agriculture Committee passed the Farm Bill, which includes provisions that could strip roughly $30 billion in food assistance from SNAP households over the next decade. CLASP is deeply concerned about this cut resulting from the bill’s failure to maintain the necessary updates to the Thrifty Food Plan (TFP), the underlying formula for determining SNAP benefits.
In 2021, the U.S. Department of Agriculture modernized the TFP for the first time in nearly 50 years to reflect current food prices and dietary needs, resulting in a 21 percent increase in SNAP benefits per person. This 2021 update, which provided an extra $36 per month to SNAP participants, was crucial in ensuring that SNAP participants could afford a nutritious diet. Restricting future evaluations of the TFP undermines this progress and represents one of the largest cuts to SNAP benefits since 1996. Ensuring that SNAP benefits are sufficient is essential for promoting economic justice and addressing food insecurity.
The bill falls short in other crucial ways. It doesn’t include adequate protections to prevent benefit theft through EBT card skimming and lets the authority to reimburse participants for stolen benefits expire. We are also concerned about the enhanced data collection on SNAP food purchases as this could lead to greater food policing of SNAP participants in the name of “diet quality.” The bill also doesn’t address college hunger, allow beneficiaries to purchase hot foods, or ensure that all green card holders in the United States can access SNAP.
We urge the full House of Representatives and the U.S. Senate to reject the harmful proposals of this bill. We also urge Congress to uphold the integrity of the TFP for the well-being of all individuals and families experiencing poverty, include financial protections for victims of benefit theft, and collect data to expand and not limit participants’ purchasing power.