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On Friday, lawmakers in the Wisconsin Assembly voted in favor of a bill seeking Medicaid coverage for people in Wisconsin prisons and jails. Supporters hope it will help recently incarcerated people avoid addiction and overdoses. 

Rep. Shelia Stubbs (D-Madison) said her experience working for the Wisconsin Department of Corrections has given her firsthand knowledge about the impact AB 604 will have. She said it will improve access to treatment and case management and ease the financial burden on justice-involved Wisconsinites. 

The bill would give incarcerated people a greater chance of maintaining sobriety and preventing overdose after release from prison, Stubbs said. After a Minnesota study about the causes of death of recently incarcerated people, researcher Tyler Winkelman said that “substance use is clearly the main driver of death after release from both jail and prison.”

Medicaid is prohibited from paying for services provided during incarceration, barring some exceptions involving inpatient services or an eligible juvenile under 21 years old. The National Association of Counties published a toolkit critical of the “inmate exclusion policy,” arguing in part that it unfairly revokes federal health benefits from people who are being detained prior to trial and have not been found guilty.  

The bill would pursue a path offered by the federal government that allows for a partial waiver of the policy. 

The proposal directs the Department of Health Services to request a waiver to conduct a demonstration project; 19 states have approved waivers and nine states including Washington D.C. have pending waivers, as of November 21. 

A waiver would allow for prerelease health care coverage under the Medical Assistance program, which provides health services to people with limited finances, for up to 90 days before release of an eligible incarcerated person. Coverage would be provided for case management services, medication-assisted treatment for all types of substance use disorders and a 30-day supply of prescription medications. 

The bill garnered support from lawmakers from both parties and from WISDOM and EX-Incarcerated People Organizing, groups that advocate for incarcerated people. 

The Assembly’s vote to seek the coverage for incarcerated people comes on the heels of its vote to accept a federal expansion of Medicaid coverage for women for one year after they give birth. 

For the waiver, the state seeks federal Medicaid coverage for services that are currently funded with state or local dollars, the state has to reinvest any savings in state or local funds. Savings would be invested in programs to increase access to or improve the quality of health care for incarcerated people. 

In the Department of Corrections fiscal estimate, the DOC said that in fiscal year 2025, the agency spent $500,000 on the 30-day medication supply dispensed for incarcerated people pre-release, $300,000 on pre-release medication assisted treatment medications and $3.9 million on the Opening Avenues to Reentry Success (OARS) program. The OARS program supports the transition from prison to the community of incarcerated people living with a severe and persistent mental illness who are at medium-to-high risk of reoffending. 

The agency estimated it may have over $750,000 in potential cost savings if the waiver is approved and implemented. 

Because not all incarcerated people will qualify, the estimate assumes that half of the medication supply and medication assisted treatment medications costs will be reimbursed, as well as 10% of the OARS program costs. There may be other costs DOC can have reimbursed.

AB 604 would require the Department of Health Services to submit the waiver request no later than Jan. 1, 2027. 

The bill now goes to the state Senate. Supporters of the bill include the Wisconsin Medical Society, the National Alliance on Mental Illness Wisconsin, the Medical College of Wisconsin and the Wisconsin Counties Association.