I 

118TH CONGRESS 

1ST SESSION H. R. 6675 

To amend titles XIX and XXI of the Social Security Act to provide mental 

health and substance use services to incarcerated individuals, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 7, 2023 

Ms. KUSTER (for herself and Mr. BACON) introduced the following bill; which 

was referred to the Committee on Energy and Commerce 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to provide mental health and substance use services to 

incarcerated individuals, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Rehabilitation and Re5 covery During Incarceration Act’’. 


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1 SEC. 2. MODIFYING MEDICAID AND CHIP EXCLUSIONS RE2 LATING TO INCARCERATED INDIVIDUALS TO 

3 ALLOW FOR PROVISION OF MENTAL HEALTH 

4 AND SUBSTANCE USE SERVICES. 

5 (a) MEDICAID OPTION.— 

6 (1) IN GENERAL.—Section 1905(a) of the So7 cial Security Act (42 U.S.C. 1396d(a)) is amended, 

8 in the subdivision (A) following paragraph (31), by 

9 inserting ‘‘, or, at the option of the State, in the 

10 case of an eligible inmate (as defined in paragraph 

11 (4) of section 1902(nn)), with respect to mental 

12 health and substance use services described in para13 graph (5) of such section’’ before ‘‘); or’’. 

14 (2) ELIGIBLE INMATE AND MENTAL HEALTH

15 AND SUBSTANCE USE SERVICES DEFINED.—Section 

16 1902(nn) of the Social Security Act (42 U.S.C. 

17 1396a(nn)) is amended— 

18 (A) in the subsection header, by inserting 

19 ‘‘; ELIGIBLE INMATE; MENTAL HEALTH AND

20 SUBSTANCE USE SERVICES’’ after ‘‘PUBLIC IN21 STITUTION’’; 

22 (B) in the matter preceding paragraph (1), 

23 by striking ‘‘and this subsection’’ and inserting 

24 ‘‘, this subsection, and the subdivision (A) fol25 lowing the last numbered paragraph of section 

26 1905(a)’’; and 


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1 (C) by adding at the end the following new 

2 paragraphs: 

3 ‘‘(4) ELIGIBLE INMATE.—The term ‘eligible in4 mate’ means an individual of any age who is an in5 mate of a public institution and who— 

6 ‘‘(A) was determined eligible for medical 

7 assistance under the State plan immediately be8 fore becoming an inmate of such a public insti9 tution; or 

10 ‘‘(B) is determined eligible for such med11 ical assistance while an inmate of a public insti12 tution. 

13 ‘‘(5) MENTAL HEALTH AND SUBSTANCE USE

14 SERVICES.—The term ‘mental health and substance 

15 use services’ means such services for the treatment 

16 of a mental health condition or substance use dis17 order as the Secretary shall specify by regulation.’’. 

18 (b) CHIP OPTION.— 

19 (1) IN GENERAL.—Section 2110(b)(7) of the 

20 Social Security Act (42 U.S.C. 1397jj(b)(7)) is 

21 amended— 

22 (A) in the paragraph header, by striking 

23 ‘‘EXCEPTION’’ and inserting ‘‘EXCEPTIONS’’; 

24 (B) by striking ‘‘In the case of’’ and in25 serting the following: 


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1 ‘‘(A) PROVISION OF SCREENING, DIAG2 NOSTIC, REFERRAL, AND CASE MANAGEMENT

3 SERVICES PRE-RELEASE.—In the case of’’; and 

4 (C) by adding at the end the following new 

5 subparagraph: 

6 ‘‘(B) PROVISION OF MENTAL HEALTH AND

7 SUBSTANCE USE DISORDER SERVICES WHILE

8 AN INMATE.— 

9 ‘‘(i) IN GENERAL.—In the case of a 

10 child who is an eligible inmate, the child 

11 shall not be considered to be described in 

12 paragraph (2)(A) with respect to mental 

13 health services and substance use disorder 

14 services otherwise covered under the State 

15 child health plan (or waiver of such plan). 

16 ‘‘(ii) ELIGIBLE INMATE DEFINED.— 

17 For purposes of this subparagraph, the 

18 term ‘eligible inmate’ has the meaning 

19 given that term in section 1902(nn)(4), ex20 cept that such section shall be applied 

21 by— 

22 ‘‘(I) substituting ‘child health as23 sistance’ for ‘medical assistance’ each 

24 place it appears; and 


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1 ‘‘(II) by substituting ‘State child 

2 health plan under title XXI’ for ‘State 

3 plan’.’’. 

4 (2) TECHNICAL AMENDMENT.— 

5 (A) IN GENERAL.—Section 5122(b) of divi6 sion FF of the Consolidated Appropriations 

7 Act, 2023 (Public Law 117–328) is amended by 

8 striking paragraph (1). 

9 (B) EFFECTIVE DATE.—The amendment 

10 made by this paragraph shall take effect as if 

11 included in the enactment of the Consolidated 

12 Appropriations Act, 2023 (Public Law 117– 

13 328). 

14 (c) INCREASED FEDERAL MATCH FOR MENTAL

15 HEALTH AND SUBSTANCE USE DISORDER SERVICES

16 FURNISHED TO INCARCERATED INDIVIDUALS.— 

17 (1) MEDICAID.—Section 1905 of the Social Se18 curity Act (42 U.S.C. 1396d) is amended— 

19 (A) in subsection (b), by striking ‘‘and 

20 (ii)’’ and inserting ‘‘(ii), and (jj)’’; and 

21 (B) by adding at the end the following new 

22 subsection: 

23 ‘‘(jj) INCREASED FMAP FOR MENTAL HEALTH AND

24 SUBSTANCE USE SERVICES FURNISHED TO INMATES.— 


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1 ‘‘(1) IN GENERAL.—Notwithstanding any other 

2 provision of this title except for paragraph (3), the 

3 Federal medical assistance percentage for a State, 

4 with respect to amounts expended by the State for 

5 medical assistance for mental health and substance 

6 use disorder services furnished to an eligible inmate 

7 (as such terms are defined in section 1902(nn)) 

8 shall be equal to 100 percent. 

9 ‘‘(2) EXCLUSION OF EXPENDITURES FROM TER10 RITORIAL CAPS.—Any payment made to a territory 

11 for expenditures for medical assistance that are sub12 ject to the Federal medical assistance percentage 

13 specified under paragraph (1) shall not be taken into 

14 account for purposes of applying payment limits 

15 under subsections (f) and (g) of section 1108. 

16 ‘‘(3) REQUIREMENT TO REINVEST ADDITIONAL

17 FUNDS.—As a condition for the receipt of the in18 crease under paragraph (1) to the Federal medical 

19 assistance percentage of a State, the State shall 

20 demonstrate to the satisfaction of the Secretary that 

21 the State will use the Federal funds attributable to 

22 such increase only for the following purposes: 

23 ‘‘(A) To improve health information tech24 nology and data sharing between State MedVerDate Sep 11 2014 00:37 Dec 28, 2023 Jkt 049200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6675.IH H6675

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1 icaid programs, jails and prisons, and commu2 nity-based providers and support organizations. 

3 ‘‘(B) To increase the treatment capacity of 

4 community-based providers who are particularly 

5 attuned to, and able to serve, the specific needs 

6 of individuals who are involved with the justice 

7 system or at risk of becoming involved in the 

8 justice system. 

9 ‘‘(C) To expand or enhance community10 based reentry services and supports provided by 

11 the State to incarcerated and formerly incarcer12 ated individuals, including services and supports 

13 designed to meet the health-related social needs 

14 of such individuals.’’. 

15 (2) CHIP.— 

16 (A) IN GENERAL.—Section 2105 of the So17 cial Security Act (42 U.S.C. 1397ee) is amend18 ed— 

19 (i) in subsection (b), by striking 

20 ‘‘(11)’’ and inserting ‘‘(11), (12), and 

21 (13)’’; and 

22 (ii) in subsection (c), by adding at the 

23 end the following new paragraph: 


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1 ‘‘(13) ENHANCED PAYMENT FOR COVERAGE OF

2 MENTAL HEALTH AND SUBSTANCE USE DISORDER

3 SERVICES.— 

4 ‘‘(A) IN GENERAL.—Notwithstanding sub5 section (b) and subject to subparagraph (B), 

6 the enhanced FMAP for a State with respect to 

7 payments under subsection (a) for expenditures 

8 under the State child health plan (or a waiver 

9 of such plan) for mental health or substance 

10 use disorder services furnished to a targeted 

11 low-income child or a targeted low-income preg12 nant woman who is an eligible inmate (as such 

13 term is defined in section 2110(b)(7)(B)(ii)) 

14 shall be equal to 100 percent. 

15 ‘‘(B) REQUIREMENT TO REINVEST ADDI16 TIONAL FUNDS.—The requirement described in 

17 paragraph (3) of section 1905(jj) shall apply to 

18 Federal funds attributable to an increase in the 

19 enhanced Federal medical assistance percentage 

20 of a State under subparagraph (A) in the same 

21 manner as such requirement applies to Federal 

22 funds attributable to an increase to the Federal 

23 medical assistance percentage of a State under 

24 paragraph (1) of such section.’’. 


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1 (B) ADJUSTING STATE CHIP ALLOTMENTS

2 TO ACCOUNT FOR INCREASED PAYMENTS FOR

3 COVERAGE OF MENTAL HEALTH AND SUB4 STANCE USE SERVICES FURNISHED TO ELIGI5 BLE INMATES.—Section 2104(m) of the Social 

6 Security Act (42 U.S.C. 1397dd(m)) is amend7 ed— 

8 (i) in paragraph (2)(B), in the matter 

9 preceding clause (i), by striking ‘‘and 

10 (12)’’ and inserting ‘‘(12), and (13)’’; and 

11 (ii) by adding at the end the following 

12 new paragraph: 

13 ‘‘(13) ADJUSTING ALLOTMENTS TO ACCOUNT

14 FOR INCREASED FEDERAL PAYMENTS FOR COV15 ERAGE OF MENTAL HEALTH AND SUBSTANCE USE

16 SERVICES FOR ELIGIBLE INMATES.—If a State, com17 monwealth, or territory receives payment for a fiscal 

18 year under subsection (a) of section 2105 for ex19 penditures that are subject to the enhanced FMAP 

20 specified under subsection (c)(13) of such section, 

21 the amount of the allotment determined for the 

22 State, commonwealth, or territory under this sub23 section— 

24 ‘‘(A) for such fiscal year shall be increased 

25 by the projected expenditures for such year by 


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1 the State, commonwealth, or territory under the 

2 State child health plan (or a waiver of such 

3 plan) for mental health and substance use dis4 order services furnished to eligible inmates (as 

5 defined in section 2110(b)(7)(B)(ii)); and 

6 ‘‘(B) once actual expenditures are available 

7 in the subsequent fiscal year, the fiscal year al8 lotment that was adjusted by the amount de9 scribed in subparagraph (A) shall be adjusted 

10 on the basis of the difference between— 

11 ‘‘(i) such projected amount of expend12 itures described in subparagraph (A) for 

13 such fiscal year described in such subpara14 graph by the State, commonwealth, or ter15 ritory; and 

16 ‘‘(ii) the actual amount of expendi17 tures for such fiscal year described in sub18 paragraph (A) by the State, common19 wealth, or territory under the State child 

20 health plan (or waiver of such plan) for 

21 mental health and substance use disorder 

22 services furnished to eligible inmates (as 

23 defined in section 2110(b)(7)(B)(ii)).’’. 

24 (d) CONFORMING AMENDMENTS.— 


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1 (1) Section 1905(a) of the Social Security Act 

2 (42 U.S.C. 1396d(a)), as amended by subsection (a), 

3 is amended, in the matter following paragraph (31), 

4 by striking ‘‘set forth in the subdivision (B) fol5 lowing paragraph (30) of the first sentence of this 

6 subsection’’ and inserting ‘‘set forth in the portion 

7 of the first sentence of this subsection that follows 

8 the last numbered paragraph of this subsection’’. 

9 (2) Section 5122(a)(1) of division FF of the 

10 Consolidated Appropriations Act, 2023 (Public Law 

11 117–328) is amended by striking ‘‘case manage12 ment’’ and inserting ‘‘targeted case management 

13 services’’. 

14 (e) EFFECTIVE DATE.— 

15 (1) IN GENERAL.—Except as provided in para16 graph (2), the amendments made by this section 

17 shall apply with respect to medical assistance, child 

18 health assistance, and pregnancy-related assistance 

19 provided on or after January 1, 2023. 

20 (2) EFFECTIVE DATE OF CONFORMING AMEND21 MENT.—The amendment made by paragraph (2) of 

22 subsection (d) shall take effect as if included in the 

23 enactment of the Consolidated Appropriations Act, 

24 2023 (Public Law 117–328). 


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1 SEC. 3. REPORT BY COMPTROLLER GENERAL. 

2 Not later than the date that is 5 years after the date 

3 of enactment of this Act, the Comptroller General of the 

4 United States shall submit to Congress a report con5 taining available information regarding incarcerated indi6 viduals that receive medical assistance or child health as7 sistance under a State plan under title XIX or XXI of 

8 the Social Security Act (42 U.S.C. 1396 et seq., 1397aa 

9 et seq.) (as applicable) as a result of a State electing to 

10 provide coverage to eligible inmates pursuant to the 

11 amendments to such titles made by section 2. The infor12 mation contained in the report may include information 

13 such as the following: 

14 (1) The number of such incarcerated individ15 uals. 

16 (2) The access of such incarcerated individuals 

17 to health care services, including specialty care, and 

18 health care providers. 

19 (3) The quality of health care services provided 

20 to incarcerated individuals. 

21 (4) Any impact of coverage under such a State 

22 plan on recidivism. 

23 (5) The percentage of such incarcerated individ24 uals who, upon release, are— 

25 (A) enrolled under such a State plan; 


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1 (B) connected to a provider in their com2 munity of mental health, substance use dis3 order, or primary care services; and 

4 (C) receiving medication-assisted treatment 

5 for the treatment of a substance use disorder. 

6 (6) Any other information the Comptroller Gen7 eral determines necessary regarding the health of in8 carcerated individuals. 

Æ 


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