Why We Need to Ease the Path to Post-Prison Health Care

Medicaid is a lifeline for people returning from incarceration but there are too many hurdles, and new work requirements will make things worse. Governments need to take some important steps now.

OPINION | April 29, 2026 •

Sam Schaeffer, Center for Employment Opportunities

A prison infirmary. Between 39 and 43 percent of incarcerated people have at least one chronic health condition, and the vast majority of those leaving prison qualify for Medicaid. (Adobe Stock)

When people leave prison, they don’t just re-enter society. They return to parenthood, housing and job searches. Navigating our complicated, costly health-care system often determines success or failure during re-entry. For Victor, coming home to two young children meant needing medication and transportation to medical visits for him and his family. Medicaid was a lifeline: It covered both. For Denise, returning from prison meant pushing through a slow benefits enrollment process so she could afford her prescriptions. Medicaid got her on a waiting list for housing assistance to cover a security deposit and first month’s rent.

Every year in America, about 600,000 people are released from prison. Between 39 and 43 percent of incarcerated people have at least one chronic health condition. When people have health-care coverage, they are more likely to find work and less likely to end up back in the criminal legal system. The vast majority of those re-entering their communities qualify for Medicaid, but too many never get enrolled. Paperwork hurdles, confusing rules and lack of support keep enrollment rates far too low.

Come Jan. 1, 2027, Medicaid will change drastically. A program of labyrinthine difficulty will get even harder, and those low enrollment rates are likely to plummet further. That’s because for the first time in the program’s history Medicaid will include nationwide work requirements. To qualify for coverage, someone coming home from prison will have just 90 days to show they are working 80 hours a month or participating in other qualifying activities. But for someone with a criminal record, finding a job after years disconnected from the labor market is not realistic in the first three months after release.

Right now, there is little clarity about how these new rules will work, and even less preparation to make sure people don’t lose access to health care simply because of a complicated system and work requirements.

What we do know is that work requirements have no substantial effect on long-term employment outcomes and exacerbate the rate of poverty. Last year, for example, I testified before Congress about an unintended yet devastating Catch-22 that pushed people enrolled in Supplemental Nutrition Assistance Program (SNAP) Employment and Training off of the food assistance program. We know work requirements create barriers for people and cause these kinds of benefit cliffs. If Medicaid adds work requirements without accounting for past failures and justice-impacted people’s real barriers to employment, we risk repeating the same mistakes.

Equipped by our organization’s decades of expertise in workforce development, we are calling for the federal and state governments to take three steps:

First, the exemption period for people returning from incarceration must be increased from three months to at least 12 months. A three-month timeline is simply unrealistic. Facing a myriad of challenges caused by legal restrictions, discrimination, fines and fees, and unstable housing or transportation, 27 percent of justice-impacted people remain unemployed a year after release. A yearlong exemption period becomes a golden opportunity for states to invest in job training.

Second, we need to support people leaving prison and jail in finding work. Not all work looks the same. Subsidized jobs and paid training programs are often the first, if not the only, doorway back into the workforce. States need to put resources behind evidence-based programs putting justice-impacted people on the path to family-sustaining careers. Programs that offer immediate employment and flexible income support can help people meet work requirements. States will see the positive results: people maintaining coverage, a reduction in costly emergency room visits and more people steadily employed.

Finally, states must ensure that public benefit programs talk to each other. Nationally, Medicaid has never had work requirements, so there isn’t a communication system between agencies to ensure continuity of coverage. People are at great risk of falling through the cracks. H.R. 1, also known as the One Big Beautiful Bill Act, counts SNAP work requirements toward fulfilling Medicaid work requirements. That information should be automatically shared across responsible agencies. People should not have to prove the same thing over and over to different bureaucracies just to be insured.

Big changes are coming to Medicaid in just a few months. If we fail to plan ahead now, the consequences will be familiar and costly: worse health, higher unemployment and more people cycling back into the legal system. This isn’t about whether people want to work. It’s about whether we build systems that give them a fair chance to succeed.

Sam Schaeffer is the executive director and chief executive officer of the nonprofit Center for Employment Opportunities (CEO), the nation’s largest re-entry employment organization. Before joining CEO in 2009, Schaeffer served as director of economic development for U.S. Sen. Charles E. Schumer of New York.

Governing's opinion columns reflect the views of their authors and not necessarily those of Governing's editors or management.