Every day across this country, thousands of people presumed innocent are locked up awaiting trial. For many of them — particularly those battling substance use disorders or mental illness — that jail cell is more than just a loss of freedom. It often comes with the loss of health care coverage.
In many states, Medicaid and other health care benefits are suspended or terminated the moment the patient is booked into jail. This policy puts lives at risk and creates gaps in care. And for those of us who have lived through addiction or worked alongside people in recovery, we know just how dangerous that gap can be.
Our prison and jail systems need the Due Process Continuity of Care Act, because it will help maintain Medicaid coverage during pretrial incarceration. It’s up to Congress to follow through and pass this important piece of legislation, to shift from a model that prioritizes severe punishment to one that prioritizes care and continuity. People are struggling and deserve a chance to get better, not get worse, simply because they were arrested.
The link between incarceration and behavioral health is no coincidence. So many people end up in jail not because they’re dangerous, but because they’re living with untreated mental health challenges or deep in addiction and haven’t gotten the help they need. And the damage doesn’t stop at the jail door.
When people are released, often without any plan to restart their medical benefits or reconnect to care, they walk right back into the same instability, only now with deeper trauma and fewer resources. It’s no surprise that the risk of overdose skyrockets after release. Studies show people are up to 129 times more likely to die of a drug overdose in the first two weeks after leaving jail or prison.
I’ve seen firsthand the deadly consequences when someone is locked up pretrial and loses access to their medications, therapy or support systems. People are in withdrawal. They suffer in silence and spiral without the care they relied on outside those walls. Our jails, already under-resourced and overwhelmed, have become the frontlines of a behavioral health crisis they were never built to manage. They’re acting as detox centers and psychiatric hospitals by default, and that’s not just unsustainable, it’s inhumane.
Keeping health care coverage active during pretrial incarceration isn’t just the right thing to do morally, it’s smart policy. It prevents needless suffering, reduces recidivism, and eases the burden on emergency services and hospitals. It helps people transition from jail back into their communities with the support they need to stay healthy and free. And ultimately, it saves money by keeping people out of crisis and out of the revolving door of the criminal legal system.
Let’s be clear: taking health care away from someone who hasn’t yet been convicted of a crime is not justice. It’s a systemic failure. If we truly believe in second chances, if we believe in treating addiction and mental illness as health issues, not criminal ones, then we have to make sure that care doesn’t stop at the jailhouse door.
Health care is a lifeline. Let’s stop cutting that lifeline when people need it most.
John Bowman is Dream.Org’s Kentucky senior campaign organizer.
