S. 5231: Equity in Pretrial Health Coverage Act

This bill would change federal health coverage rules so that people who are in custody but have not yet been convicted—that is, those waiting for charges to be resolved—can still receive benefits under certain programs. It would remove or narrow current restrictions in:

• Medicaid
• Medicare
• CHIP (the Children's Health Insurance Program)
• Department of Veterans Affairs health care

What would change

Under current rules, people in public institutions such as jails are often not eligible for benefits while they are incarcerated. This bill would make an exception for people who are in custody pending disposition of charges, meaning they are being held before their case is finished and have not yet been convicted. In practical terms, the bill would allow coverage for health care services during that pretrial detention period.

Program-by-program summary

• Medicaid: States would no longer be able to deny Medicaid coverage solely because a person is in pretrial custody. The bill also adjusts related Medicaid payment rules so care or services provided during that time can be covered.
• Medicare: Medicare’s inmate exclusion would be modified so it would not apply to services furnished to people in custody pending disposition of charges.
• CHIP: Children in public institutions who are awaiting disposition of charges would not be treated as excluded from CHIP during that period. The bill also keeps in place a rule requiring certain screenings, diagnostic services, referrals, and case management services for children shortly before release, while adding the pretrial custody exception.
• Pregnant women and children in CHIP-related rules: The bill updates conforming language so the same pretrial custody exception applies in relevant CHIP provisions covering children and pregnant women.
• VA health care: The Department of Veterans Affairs would have to change its regulations so that veterans in custody pending disposition of charges are not excluded from VA health care under the inmate rule.

When it would take effect

Most of the changes would start on the first day of the first calendar quarter that begins more than 60 days after enactment. The VA-related change would take effect immediately upon enactment.

Relevant Companies

None found