Julie McLafferty, MA  | Project Assistant, Policy Research Associates, Inc.

Whether working inside a correctional facility or coordinating a transition for an individual on release, understanding the basics around benefits is the first step to ensuring continuity of care for individuals with a serious mental illness or medical impairment. Intentional discharge planning from incarceration back into the community includes an assessment of eligibility for benefits and healthcare coverage. Research suggests that gaining (or regaining) access to Medicaid or Medicare and/or Supplemental Security Income (SSI)/Social Security Disability Insurance (SSDI) benefits upon release could reduce the likelihood of recidivism by alleviating healthcare and housing barriers.[i]

Many people are confused about the distinction between SSI, SSDI, Medicaid, and Medicare, and how incarceration can affect eligibility for benefits or coverage. The Social Security Administration (SSA) administers the SSI and SSDI programs, whereas the Centers for Medicare and Medicaid Services (CMS) administer the Medicare and Medicaid programs. Navigating the benefits process can be challenging, especially when overlaid with the complexities of the criminal justice system. Depending on the length of incarceration, there may be no effect, a temporary suspension, or a complete termination of benefits during a jail or prison stay. Traversing these systems, establishing relationships, and connecting with different organizations is key to success.

The SSI/SSDI Outreach, Access, and Recovery (SOAR) model, sponsored by the Substance Abuse and Mental Health Services Administration, is a national program designed to increase access to disability income benefit programs administered by SSA for eligible adults and children who are experiencing or at risk of homelessness and have a serious mental illness, medical impairment, and/or a co-occurring substance use disorder. The SOAR model is a collaborative effort by corrections, behavioral health systems, and SSA to connect individuals with needed services and SSI/SSDI application assistance. Case managers, probation officers, jail staff, and other administrators can work with SOAR State and Local Leads to navigate the benefits system within their state. The SOARWorks directory provides contact information for SOAR Leadership in each state.

The below information summarizes navigating the SSA and healthcare coverage application processes while incarcerated if the individual is not already a recipient.

Quick Facts: Applying for Coverage

Benefit Type Federal Eligibility Criteria   Federal Guidelines: Applying for Coverage While Incarcerated if Not Already a Recipient
Supplemental Security Income (SSI) SSI is a federal benefit for people with limited income and resources who are disabled, blind, or age 65 or older. Generally, SSA requests that prerelease applications be submitted 30 days before release. However, if a pre-release agreement is established with the local Social Security office, this timeframe can be increased to up to 120 days before the anticipated release date. Benefits cannot begin until release.
Social Security Disability Insurance (SSDI) A program funded through payroll taxes that offers monthly payments to people under the age of 65 who meet SSA’s definition of disability and have sufficient work credits. Generally, SSA requests that prerelease applications be submitted 30 days before release. However, if a prerelease agreement is established with the local Social Security office, this timeframe can be increased to up to 120 days before the anticipated release date. Benefits cannot begin until release.
Medicaid A joint federal and state program that provides healthcare coverage to those who meet criteria. Income, household size, disability, family status, and other factors determine Medicaid qualification. Eligibility rules differ between states. Check to see if your state is a Medicaid expansion state.

In most states, eligibility for SSI confers eligibility for Medicaid. In some states, a separate Medicaid application is required, and 11 states have established additional rules for Medicaid eligibility. Check with your state Medicaid office for your local policies and procedures.

Federal regulations do not prohibit an individual from applying for Medicaid while incarcerated.

Check your individual state’s policy for Medicaid enrollment regulations during incarceration.

Medicaid won’t pay for medical care while an individual is incarcerated,* but if the individual is enrolled in Medicaid during incarceration, they may be able to get needed care more quickly after release.

If you’re from a Medicaid expansion state, you may be more likely to receive coverage.

*If an incarcerated individual receives care outside of a correctional facility, such as a hospital, and is admitted for 24 hours or more, state Medicaid agencies can obtain federal reimbursement that covers at least half of the off-site inpatient costs.

Medicare A federal program that provides health care to those who meet the eligibility criteria.

Individuals 65 and over become eligible for Medicare if they receive or qualify for Social Security retirement cash benefits.

Individuals under 65 who are eligible for SSDI are also eligible for Medicare after a 24-month qualifying period.

Determine eligibility with the Eligibility & Premium Calculator.

An individual who turns 65 and becomes eligible for Medicare while incarcerated can enroll during the Initial Enrollment Period (IEP).

Failure to enroll in Medicare during the IEP while incarcerated could result in a delay in health coverage upon release.

Time spent incarcerated does not count towards the 24-month waiting period for incarcerated individuals under 65. Once SSDI benefits are reinstated after release, time counted toward the 2-year waiting period will resume.

Listed above are the general federal eligibility guidelines. Explore your state’s Medicaid and Medicare policies to determine local eligibility criteria, and use the Benefit Eligibility Screening Tool (BEST) to see what benefits an individual may be eligible for in your state by filling out the questionnaire. Correctional facility information is embedded within this tool.

Quick Facts: Current Benefit Recipients

Current SSI/SSDI benefit recipients can be impacted during incarceration depending on the length of stay and other factors. Individuals receiving benefits that are temporarily suspended can contact the Social Security office with their release date and necessary paperwork to have their benefits reinstated. A representative will provide further instructions. Individuals receiving benefits who have had their benefits terminated must reapply through SSA. As noted above, a prerelease agreement can allow an eligible individual to apply for benefits before release.

Table 1. SSI Eligibility While Incarcerated

Incarceration Time Effect on SSI Benefits Action Needed Upon Release
<1 full calendar month No effect None
1-12 calendar months Suspended Can be reinstated upon release
12+ consecutive calendar months Terminated Must reapply

Source: www.ssa.gov/reentry/benefits.htm

Table 2. SSDI Eligibility While Incarcerated

Incarceration Time Effect on SSDI Benefits Action Needed Upon Release
<30 days No effect N/A
>30 days convicted and confined Suspended Can be reinstated upon release

Source: www.ssa.gov/reentry/benefits.htm

Medicaid eligibility is impacted differently during incarceration. While individuals may remain enrolled, they cannot have services covered by Medicaid except for qualifying hospitalization incidents. However, some states terminate or suspend Medicaid enrollment during incarceration, which may require that paperwork be filed to restart coverage following release from a correctional facility. Additionally, if an individual receives Medicaid due to their SSI eligibility, any termination of SSI eligibility will then affect their eligibility for Medicaid.

Medicare recipients are generally not covered while incarcerated. It is usually best to keep Medicare Plan A and B coverage while incarcerated, to avoid late enrollment penalties and gaps in coverage upon release. Individuals who cannot afford to pay the Part B premium during incarceration can actively withdraw from Part B while staying enrolled in part A.

Download Promoting Reentry Success through Increased Access to Social Security Benefits for more information on how incarceration affects current benefit recipients.

The Affordable Care Act’s healthcare coverage expansion included increased funding for the widespread training and hiring of healthcare navigators to help individuals throughout the Medicaid and Medicare process. Search by ZIP code to find a navigator near you.

Navigating the Process: Program Examples

Yuma, Arizona: Applying for Healthcare Coverage

Arizona Complete Health, an integrated care facility in Yuma, Arizona, assists justice-involved individuals with accessing health care. The facility utilizes Health-e-Arizona Plus, an electronic healthcare application system. Program staff members are embedded in the jails to assist clients who are eligible for Medicaid coverage to submit their application. Coverage will activate upon release once the release paperwork is submitted to CMS. If an individual is released before the application process has started, Arizona Complete Health will connect their on-staff benefits navigators or case managers with the clients to bring them directly from the jail facility to the Department of Economic Security office. Connecting an individual to a healthcare navigator or case manager, whether in a facility or after release, is the first step in getting an application for Medicaid coverage started.

Mecklenburg County, North Carolina: Applying for SSA Benefits

Proof of release and other required paperwork is necessary for a complete application for benefits and/or healthcare coverage. However, some counties within North Carolina allow for the submission of SSI/SSDI applications 30 days before release, while others do not. Previously, Mecklenburg County only allowed for the submission of an application once an individual was already released. Case managers working with clients in Mecklenburg County saw the advantage of starting the benefit application process early. Through coordination with stakeholders, an agreement was made between the local sheriff and the local Social Security office that now allows case managers in Mecklenburg County to submit applications 30 days before release. This helped increase access to healthcare coverage as well, since North Carolina allows individuals that qualify for SSI to receive Medicaid benefits. This partnership demonstrates how a lengthy and often complex process can sometimes be significantly streamlined by establishing connections and agreements with stakeholders. Coordinating with other providers in the area can ensure continuity of care from correctional facilities to the community.

SOAR in the Oklahoma Department of Corrections

The Oklahoma Department of Mental Health and Substance Abuse Services, the Department of Corrections (DOC), and the Oklahoma Disability Determination Division (DDD) have developed a collaborative process that supports efficient and quality SSI/SSDI applications to increase first-time application approvals for incarcerated individuals with serious mental illness.[ii] Social services specialists, discharge managers, and psychologists each play critical roles in the process, and SSA and DDD have written policies and procedures for flagging and reviewing applications received from this population. Offenders designate DOC personnel as their appointed representative, electronic applications are thoroughly completed 6 months or fewer before the projected release date, psychological summaries and additional relevant medical information are faxed referencing the respective bar code created by the DDD, and follow-up telephone interviews with DDD are coordinated when necessary. The completion of the appropriate consent forms supports direct communication between prison-based staff and SSA/DDD personnel. In 2018, Oklahoma DOC staff assisted with 302 SSI/SSDI applications and achieved a 75-percent approval rate.

Additional Resources

[i] Dennis, D., Ware, D., & Steadman, H. J. (2014). Best practices: Best practices for increasing access to SSI and SSDI on exit from criminal justice settings. Psychiatric Services, 65(9), 1081-1083. doi: 10.1176/appi.ps.201400120

[ii] SAMHSA SOAR Technical Assistance Center. (2019). 2018 SOAR outcomes.