Under a bill signed Wednesday by Gov. Tony Evers, Wisconsin will seek health care coverage from the federal government for certain services for incarcerated people. 

A statement from Evers’ office said that AB 604 — now Wisconsin Act 233 — aims to improve health outcomes and reduce disruptions in care and rates of people committing new crimes. 

As people with substance use disorders return to the community from jail or prison, they are especially vulnerable to dying from an overdose. Supporters of the new law hope it will aid them.

A federal “inmate exclusion policy” limits incarcerated people’s ability to use Medicaid, but under the new law the state will apply for a waiver, taking advantage of an exception outlined by the federal government. 

The Wisconsin Department of Health Services will submit a request for a waiver to conduct a demonstration project to provide incarcerated people with health care coverage for certain services for up to 90 days before release. 

The department will request coverage for case management services, medication-assisted treatment for all types of substance use disorders and a 30-day supply of prescription medications. If the waiver is approved, incarcerated people would have to be otherwise eligible for coverage under the Medical Assistance program in order to qualify. 

As of Nov. 21, 19 states have approved waivers and nine states including Washington D.C. have pending waivers. 

The Wisconsin Department of Health Services must submit the waiver request by Jan. 1, 2027. The department told the Examiner in November that it needed the authority that the bill would provide before it starts work on putting together the details of the waiver. 

‘The care they need to live’

Rep. Shelia Stubbs (D-Madison), one of the lawmakers who introduced AB 604, said in a statement Wednesday that the bill gives incarcerated people “a greater chance of maintaining sobriety, preventing overdose, and remaining healthy after they rejoin the community.” 

The criminal justice advocacy organization WISDOM was among groups that expressed support for the bill. Tom Denk, the co-president of one of WISDOM’s affiliates, said in an emailed statement that this law is very personal to him and called it “a step forward.”

Denk, who was released from prison to extended supervision in 2022, said he’s had friends in and out of facilities and had too many die because of a lack of services. 

He said that “my own struggles, the trauma, and the deaths of some of my best friends are what motivated me to get involved in advocating for a better system.”

“Medications, and access to medical care, will literally save lives,” Denk said. “Too many people don’t have either, when they’ve left facilities.” 

Denk also emailed the Examiner a statement signed by Bev Kelley-Miller, who wrote that she lost her 22-year-old daughter, Megan Kelley, to a preventable heroin overdose. Kelley-Miller wrote that her daughter had an ankle bracelet “but that didn’t stop her from using.” 

Kelley-Miller, who expressed support for AB 604, wrote that substance use disorder is a medical condition and that using substances is not a choice once you are addicted. 

“I wish Megan was still here,” Kelley-Miller wrote. “Since she’s not, I advocate for others to receive the care they need to live.”

The Wisconsin State Senate passed a bill last week that will request funding for health care coverage for incarcerated people from the federal government. State Assembly lawmakers had already passed the bill last month. 

In a Facebook post last week, Sen. Jesse James (R-Thorp) celebrated the measure and said he hopes Gov. Tony Evers will sign it into law. 

James said that “as people leave our correctional system, they have a 40 TIMES higher risk of overdose death within the first TWO weeks after release.” This appeared to be a reference to a North Carolina study of opioid overdose death rates between 2000 and 2015. 

“This bill is a great step forward for Wisconsin as it ensures we become a healthier, safer community,” James said.  

The vote was nearly unanimous, with only Sen. Steve Nass (R-Whitewater) voting no. 

A federal “inmate exclusion policy” limits incarcerated people’s ability to use Medicaid, but the bill seeks to have the state apply for a waiver under an exception outlined by the federal government. 

Under the bill, the state’s Department of Health Services would submit a request to conduct a demonstration project to provide 90 days of prerelease coverage to incarcerated people for case management services, medication-assisted treatment for all types of substance use disorders and a 30-day supply of prescription medications. Incarcerated people would have to be otherwise eligible for coverage under the Medical Assistance program, which provides health services to people with limited financial resources.  

The advocacy organization WISDOM celebrated the Senate’s passage of the bill in an email newsletter signed by Mark Rice, the group’s transformational justice campaign coordinator. 

Rice said that full implementation of the bill would reduce needless suffering and the number of people being detained, benefit public safety, save resources and put more people on a path to successful reentry into society. 

In written testimony dated Oct. 31, director Dawn Buchholz of the Juneau County Department of Health Services said that passing the bill “will help us provide crucial services to inmates reentering our communities.”

“In the past, our agency literally completed hundreds of suicide and other behavioral health assessments for inmates experiencing emergency mental health and substance use crises in the Juneau County Jail,” Buchholz testified. “This was a frustrating process because while we can assess inmates, we cannot provide them with mental health or substance abuse treatment due to Medicaid rules.”

Buchholz testified that providing prerelease coverage to incarcerated people, along with a 30-day supply of prescription medications, “will help our agency work more effectively with our jails and prisons, result in a seamless reentry into community behavioral health services and decrease recidivism.”

DOC communications director Beth Hardtke referred the Examiner to the DOC fiscal estimate for information on what the agency is currently able to provide and the potential impact of the legislation. 

The department estimated it may have over $750,000 in potential cost savings if the waiver is approved and implemented, allowing the state to expand health care access for incarcerated people. 

The Examiner reported last month that in the fiscal estimate, the DOC said that in FY 2025, the agency spent $500,000 on the 30-day medication supply dispensed for incarcerated people before they were released, $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. 

Because not all incarcerated people will qualify, the estimate assumes that half of the medication 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. 

The Examiner previously reported that states have to reinvest federal matching funds received for carceral health care services currently funded with state or local dollars. Reinvested money must go toward activities that increase access or improve the quality of health care services for people who are incarcerated or were recently released, or for health-related social services that may help divert people released from incarceration from involvement in the criminal justice system. 

In the fiscal estimate, the DOC said that incarcerated people in local detention facilities may also be eligible for the services. This could result in local cost savings in addition to DOC cost savings. The department couldn’t estimate the potential local cost savings of the bill because not all local detention facilities provide the same type or level of services.  

Hardtke noted that the bill only allows the state to apply for the federal waiver, and it isn’t guaranteed that a waiver would be approved. 

As of Nov. 21, 19 states had approved waivers, according to the health policy research organization KFF. Nine, including the District of Columbia, had pending waivers. 

In an email to the Examiner in November, the Wisconsin Department of Health Services said the bill requires the three services that the waiver would need to include to be submitted to the Centers for Medicare and Medicaid Services. The bill doesn’t require other criteria for the project, aside from current Medicaid eligibility requirements. 

Beyond those requirements, the department said it needs the authority that the bill would provide before it starts work on putting together the details of the waiver. The bill requires the department to submit the request for a waiver by Jan. 1, 2027.