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Connecting Recently Incarcerated People Living with HIV to Health Coverage and Care By Chris Wade, HIV Care Connect Project Coordinator

Health coverage may be available for those recently incarcerated

HIV exists in the nation’s prisons and jails just as it does in surrounding communities. People living in prisons/jails are also more likely to be poor, non-White, and have higher rates of mental illness and substance abuse compared to people who aren’t incarcerated . Coverage through Medicaid or Marketplace qualified health plans (QHPs) can help meet complex medical needs. In addition, for people living with HIV (PLWH) the Ryan White HIV/AIDS Program (RWHAP) remains available to fill in gaps in HIV care and medication access, and can often provide financial help with premiums and out-of-pocket costs, as well as case management and other services.

incarceratedCoverage eligibility for people involved with the criminal justice system

Coverage eligibility rules for incarcerated persons can be complicated. Here are important facts to keep in mind.

Medicaid: Individuals can enroll in Medicaid anytime during the year, but Medicaid cannot pay for services while they are incarcerated. Center for Medicaid Services (CMS) encourages states to suspend rather than terminate coverage during incarceration.

Marketplace: PLWH can maintain Marketplace coverage while incarcerated if they are classified as ‘pending disposition of charges’ (in other words, being held without a conviction before sentencing or other final settlement of a case). However, this information must be reported to the Marketplace, and individuals must continue paying health insurance premiums. The Federal marketplace provides more information, including eligibility for probationers and parolees.

Special enrollment period (SEP): All released individuals have access to a SEP that allows them to enroll in a QHP within 60 days of release. If they do not enroll within this time period, they must wait until the next open enrollment period.

Strategies to improve enrollment: There are many strategies that states, RWHAP agencies, and case managers can employ to improve enrollment and linkage to care for recently incarcerated PLWH. States can ensure that a short-term supply of ART is made available to PLWH upon release through ADAP, and strive to cultivate a statewide network of agencies to support recently released PLWH. Service providers can collaborate with the criminal justice system to institute discharge planning for inmates that includes: making an appointment with a health care provider, assisting with enrollment in health coverage, and providing a supply of HIV medications. Service providers can also work to ensure that the same case manager stays with the client pre and post release, and that all case managers are trained in substance use and mental health issues. Case managers should work to build trust with clients, help with enrollment paperwork, and support linkage to care and services upon release. It is particularly crucial to connect clients to stable housing, employment, and community support systems.


Chris wadeChris Wade, HIV Care Connect Project Coordinator

Illinois Public Health Association, HIV Care Connect

(309) 453-9042 mobile

HIV Care Connect is a program of the Illinois Public Health Association and is funded by the Illinois Department of Public Health