I 
112TH CONGRESS 
1ST SESSION H. R. 2704 
To reduce the spread of sexually transmitted infections in correctional 
facilities, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 29, 2011 
Ms. LEE of California introduced the following bill; which was referred to the 
Committee on the Judiciary, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To reduce the spread of sexually transmitted infections in 
correctional facilities, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Justice for the Unpro-
tected Against Sexually Transmitted Infections among the 
Confined and Exposed Act’’ or the ‘‘JUSTICE Act’’. 
SEC. 2. FINDINGS. 
The Congress makes the following findings: 
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(1) According to the Bureau of Justice Statis-
tics (BJS), 2,292,133 persons were incarcerated in 
the United States as of the end of 2009. Between 
1998 and 2008, the number of persons incarcerated 
in Federal or State correctional facilities increased 
by an average of 2.4 percent per year. One in every 
32 United States residents was on probation, in jail 
or prison, or on parole at the end of 2009. 
(2) As of 2009, 66.8 percent of incarcerated 
persons were racial or ethnic minorities. Based on 
current incarceration rates, BJS estimates that Afri-
can-American males are 6 times more likely to be 
held in custody than White males, while Hispanic 
males are a little more than 2 times more likely to 
be held in custody. Across all age categories, Afri-
can-American males were incarcerated at higher 
rates than Hispanic or White males. 
(3) There is a disproportionately high rate of 
HIV/AIDS among incarcerated persons, especially 
among minorities. Approximately 25 percent of the 
HIV-positive population of the United States passes 
through correctional facilities each year. BJS has 
determined that the rate of confirmed AIDS cases is 
2.4 times higher among incarcerated persons than in 
the general population. Minorities account for the 
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majority of AIDS-related deaths among incarcerated 
persons, with African-American incarcerated persons 
2.8 times more likely than White incarcerated per-
sons and 1.4 times more likely than Hispanic incar-
cerated persons to die from AIDS-related causes. 
Nearly two-thirds of AIDS-related deaths are among 
Black, non-Hispanic males. 
(4) Studies suggest that other sexually trans-
mitted 
infections 
(STIs), 
such 
as 
gonorrhea, 
chlamydia, syphilis, genital herpes, viral hepatitis, 
and human papillomavirus, also exist at a higher 
rate among incarcerated persons than in the general 
population. For instance, researchers have estimated 
that the rate of hepatitis C (HCV) infection among 
incarcerated persons is somewhere between 8 and 20 
times higher than that of the general population. 
(5) Correctional facilities lack a uniform system 
of STI testing and reporting. Establishing a uniform 
data collection system would assist in developing and 
targeting counseling and treatment programs for in-
carcerated persons. Better developed and targeted 
programs may reduce the spread of STIs. 
(6) Although Congress has acted to reduce the 
spread of sexual violence in correctional facilities by 
enacting the National Prison Rape Elimination Act 
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(PREA) of 2003, BJS reported that approximately 
4.4 percent of incarcerated persons in prisons and 
3.1 percent of persons in jail reported experiencing 
one or more incidents of sexual victimization by an-
other incarcerated person or correctional facility 
staff in the previous year. 
(7) Approximately 95 percent of all incarcer-
ated persons eventually return to society. According 
to one study, every year approximately 100,000 per-
sons infected with both HIV and HCV are released 
from correctional facilities. These individuals com-
prise approximately 50 percent of all persons with 
both infections in the United States. 
(8) According to the Centers for Disease Con-
trol and Prevention (CDC), latex condoms, when 
used consistently and correctly, are highly effective 
in preventing the transmission of HIV. Latex 
condoms also reduce the risk of other STIs. Despite 
the effectiveness of condoms in reducing the spread 
of STIs, the Bureau of Prisons does not recommend 
their use in correctional facilities. 
(9) The distribution of condoms in correctional 
facilities is currently legal in certain parts of the 
United States and the world. The States of Vermont 
and Mississippi and the District of Columbia allow 
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more, the researchers determined that the program 
had not caused any major security infractions. In 
Canada, the Expert Committee on AIDS and Pris-
ons surveyed more than 400 correctional officers in 
the Federal prison system of Canada in 1995 and 
reported that 82 percent of those responding indi-
cated that the availability of condoms had created no 
problems at their facility. 
(12) The American Public Health Association, 
the United Nations Joint Program on HIV/AIDS, 
and the World Health Organization have endorsed 
the effectiveness of condom distribution programs in 
correctional facilities. 
(13) Many correctional facilities in the United 
States do not provide comprehensive testing and 
treatment programs to reduce the spread of STIs. 
According to BJS surveys from 2005, only 996 of 
the 1,821 Federal and State correctional facilities 
(i.e. 54.7 percent) provided HIV/AIDS counseling 
programs. 
(14) Individuals who are enrolled in Medicaid 
prior to incarceration face a suspension of their ben-
efits upon incarceration, and in some States a termi-
nation of their Medicaid eligibility. The Federal Gov-
ernment encourages States to automatically re-enroll 
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incarcerated persons on Medicaid upon their release 
from a correctional facility, unless the State reaches 
a determination that the individual is no longer eligi-
ble for reasons other than their prior incarceration. 
(15) Formerly incarcerated individuals who are 
newly released from correctional facilities often face 
delays in the resumption of their Medicaid benefits 
which may exacerbate any health issues which they 
face. 
(16) Incarcerated individuals living with HIV/ 
AIDS who are eligible for Medicaid would benefit 
from prompt and automatic enrollment upon their 
release in order to ensure their continued ability to 
access health services, including antiretroviral treat-
ment. 
SEC. 3. AUTHORITY TO ALLOW COMMUNITY ORGANIZA-
TIONS TO PROVIDE STI COUNSELING, STI 
PREVENTION EDUCATION, AND SEXUAL BAR-
RIER PROTECTION DEVICES IN FEDERAL 
CORRECTIONAL FACILITIES. 
(a) DIRECTIVE TO ATTORNEY GENERAL.—Not later 
than 30 days after the date of enactment of this Act, the 
Attorney General shall direct the Bureau of Prisons to 
allow community organizations to distribute sexual barrier 
protection devices and to engage in STI counseling and 
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STI prevention education in Federal correctional facilities. 
These activities shall be subject to all relevant Federal 
laws and regulations which govern visitation in correc-
tional facilities. 
(b) INFORMATION REQUIREMENT.—Any community 
organization permitted to distribute sexual barrier protec-
tion devices under subsection (a) must ensure that the 
persons to whom the devices are distributed are informed 
about the proper use and disposal of sexual barrier protec-
tion devices in accordance with established public health 
practices. Any community organization conducting STI 
counseling or STI prevention education under subsection 
(a) must offer comprehensive sexuality education. 
(c) POSSESSION OF DEVICE PROTECTED.—No Fed-
eral correctional facility may, because of the possession or 
use of a sexual barrier protection device— 
(1) take adverse action against an incarcerated 
person; or 
(2) consider possession or use as evidence of 
prohibited activity for the purpose of any Federal 
correctional facility administrative proceeding. 
(d) IMPLEMENTATION.—The Attorney General and 
Bureau of Prisons shall implement this section according 
to established public health practices in a manner that 
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protects the health, safety, and privacy of incarcerated 
persons and of correctional facility staff. 
SEC. 4. SENSE OF CONGRESS REGARDING DISTRIBUTION 
OF SEXUAL BARRIER PROTECTION DEVICES 
IN STATE PRISON SYSTEMS. 
It is the sense of Congress that States should allow 
for the legal distribution of sexual barrier protection de-
vices in State correctional facilities to reduce the preva-
lence and spread of STIs in those facilities. 
SEC. 5. AUTOMATIC REINSTATEMENT OF MEDICAID BENE-
FITS. 
(a) IN GENERAL.—Section 1902(e) of the Social Se-
curity Act (42 U.S.C. 1396a(e)) is amended by adding at 
the end the following: 
‘‘(15) ENROLLMENT OF EX-OFFENDERS.— 
‘‘(A) AUTOMATIC ENROLLMENT OR REIN-
STATEMENT.— 
‘‘(i) IN
GENERAL.—The State plan 
shall provide for the automatic enrollment 
or reinstatement of enrollment of an eligi-
ble individual— 
‘‘(I) if such individual is sched-
uled to be released from a public insti-
tution due to the completion of sen-
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tence, not less than 30 days prior to 
the scheduled date of the release; and 
‘‘(II) if such individual is to be 
released from a public institution on 
parole or on probation, as soon as 
possible after the date on which the 
determination to release such indi-
vidual was made, and before the date 
such individual is released. 
‘‘(ii) EXCEPTION.—If a State makes a 
determination that an individual is not eli-
gible to be enrolled under the State plan— 
‘‘(I) on or before the date by 
which the individual would be enrolled 
under clause (i), such clause shall not 
apply to such individual; or 
‘‘(II) after such date, the State 
may terminate the enrollment of such 
individual. 
‘‘(B) RELATIONSHIP OF ENROLLMENT TO 
PAYMENT FOR SERVICES.— 
‘‘(i) IN
GENERAL.—Subject to sub-
paragraph (A)(ii), an eligible individual 
who is enrolled, or whose enrollment is re-
instated, under subparagraph (A) shall be 
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eligible for medical assistance that is pro-
vided after the date that the eligible indi-
vidual is released from the public institu-
tion 
‘‘(ii) RELATIONSHIP
TO
PAYMENT 
PROHIBITION FOR INMATES.—No provision 
of this paragraph may be construed to per-
mit payment for care or services for which 
payment is excluded under subparagraph 
(A), following paragraph (29), in section 
1905(a). 
‘‘(C) TREATMENT OF CONTINUOUS ELIGI-
BILITY.— 
‘‘(i) SUSPENSION FOR INMATES.—Any 
period of continuous eligibility under this 
title shall be suspended on the date an in-
dividual enrolled under this title becomes 
an inmate of a public institution (except as 
a patient of a medical institution). 
‘‘(ii) DETERMINATION OF REMAINING 
PERIOD.—Notwithstanding any changes to 
State law related to continuous eligibility 
during the time that an individual is an in-
mate of a public institution (except as a 
patient of a medical institution), subject to 
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clause (iii), with respect to an eligible indi-
vidual who was subject to a suspension 
under subclause (I), on the date that such 
individual is released from a public institu-
tion the suspension of continuous eligibility 
under such subclause shall be lifted for a 
period that is equal to the time remaining 
in the period of continuous eligibility for 
such individual on the date that such pe-
riod was suspended under such subclause. 
‘‘(iii) EXCEPTION.—If a State makes 
a determination that an individual is not 
eligible to be enrolled under the State 
plan— 
‘‘(I) on or before the date that 
the suspension of continuous eligibility 
is lifted under clause (ii), such clause 
shall not apply to such individual; or 
‘‘(II) after such date, the State 
may terminate the enrollment of such 
individual. 
‘‘(D) AUTOMATIC ENROLLMENT OR REIN-
STATEMENT OF ENROLLMENT DEFINED.—For 
purposes of this paragraph, the term ‘automatic 
enrollment or reinstatement of enrollment’ 
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means that the State determines eligibility for 
medical assistance under the State plan without 
a program application from, or on behalf of, the 
eligible individual, but an individual can only be 
automatically enrolled in the State Medicaid 
plan if the individual affirmatively consents to 
being enrolled through affirmation in writing, 
by telephone, orally, through electronic signa-
ture, or through any other means specified by 
the Secretary. 
‘‘(E) ELIGIBLE
INDIVIDUAL
DEFINED.— 
For purposes of this paragraph, the term ‘eligi-
ble individual’ means an individual who is an 
inmate of a public institution (except as a pa-
tient in a medical institution)— 
‘‘(i) who was enrolled under the State 
plan for medical assistance immediately be-
fore becoming an inmate of such an insti-
tution; or 
‘‘(ii) is diagnosed with human im-
munodeficiency virus.’’. 
(b) SUPPLEMENTAL FUNDING FOR STATE IMPLE-
MENTATION OF AUTOMATIC REINSTATEMENT OF MED-
ICAID BENEFITS.— 
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(1) IN GENERAL.—Subject to paragraph (6), 
for each State for which the Secretary of Health and 
Human Services has approved an application under 
paragraph (3), the Federal matching payments (in-
cluding payments based on the Federal medical as-
sistance percentage) made to such State under sec-
tion 1903 of the Social Security Act (42 U.S.C. 
1396b) (excluding any increase resulting from the 
application of section 5001 of Public Law 111–5) 
shall be increased by 5.0 percentage points for pay-
ments to the State for the activities permitted under 
paragraph (2) for a period of one year. 
(2) USE OF FUNDS.—A State may only use in-
creased matching payments authorized under para-
graph (1)— 
(A) to strengthen the State’s enrollment 
and administrative resources for the purpose of 
improving processes for enrolling (or reinstating 
the enrollment of) eligible individuals (as such 
term is defined in section 1902(e)(15)(E) of the 
Social Security Act); and 
(B) for medical assistance (as such term is 
defined in section 1905(a) of the Social Secu-
rity Act) provided to such eligible individuals. 
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(3) APPLICATION AND AGREEMENT.—The Sec-
retary may only make payments to a State in the in-
creased amount if— 
(A) the State has amended the State plan 
under section 1902 of the Social Security Act 
to incorporate the requirements of subsection 
(e)(15) of such section; 
(B) the State has submitted an application 
to the Secretary that includes a plan for imple-
menting 
the 
requirements 
of 
section 
1902(e)(15) of the Social Security Act under 
the State’s amended State plan before the end 
of the 90-day period beginning on the date that 
the State receives increased matching payments 
under paragraph (1); 
(C) the State’s application meets the satis-
faction of the Secretary; and 
(D) the State enters an agreement with 
the Secretary that states that— 
(i) the State will only use the in-
creased matching funds for the uses per-
mitted under paragraph (2); and 
(ii) at the end of the period under 
paragraph (1), the State will submit to the 
Secretary, and make publicly available, a 
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report that contains the information re-
quired under paragraph (4). 
(4) REQUIRED REPORT INFORMATION.—The in-
formation that is required in the report under para-
graph (3)(D)(ii) includes— 
(A) the results of an evaluation of the im-
pact of the implementation of the requirements 
of section 1902(e)(15) of the Social Security 
Act on improving the State’s processes for en-
rolling of individuals who are released for public 
institutions into the Medicaid program; 
(B) the number of individuals who were 
automatically enrolled (or whose enrollment is 
reinstated) under such section 1902(e)(15) dur-
ing the period under paragraph (1); and 
(C) any other information that is required 
by the Secretary. 
(5) INCREASE IN CAP ON MEDICAID PAYMENTS 
TO
TERRITORIES.—Subject to paragraph (6), the 
amounts otherwise determined for Puerto Rico, the 
United States Virgin Islands, Guam, the Northern 
Mariana Islands, and American Samoa under sub-
sections (f) and (g) of section 1108 of the Social Se-
curity Act (42 6 U.S.C. 1308) shall each be in-
creased by the necessary amount to allow for the in-
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crease in the Federal matching payments under 
paragraph (1), but only for the period under such 
paragraph for such State. In the case of such an in-
crease for a territory, subsection (a)(1) of such sec-
tion 1108 shall be applied without regard to any in-
crease in payment made to the territory under part 
E of title IV of such Act that is attributable to the 
increase in Federal medical assistance percentage ef-
fected under paragraph (1) for the territory. 
(6) LIMITATIONS.— 
(A) TIMING.—With respect to a State, at 
the end of the period under paragraph (1), no 
increased matching payments may be made to 
such State under this subsection. 
(B) MAINTENANCE OF ELIGIBILITY.— 
(i) IN
GENERAL.—Subject to clause 
(ii), a State is not eligible for an increase 
in its Federal matching payments under 
paragraph (1), or an increase in a cap 
amount under paragraph (5), if eligibility 
standards, methodologies, or procedures 
under its State plan under title XIX of the 
Social Security Act (including any waiver 
under such title or under section 1115 of 
such Act (42 U.S.C. 1315)) are more re-
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strictive than the eligibility standards, 
methodologies, or procedures, respectively, 
under such plan (or waiver) as in effect on 
the date of enactment of this Act. 
(ii) STATE REINSTATEMENT OF ELIGI-
BILITY PERMITTED.—A State that has re-
stricted eligibility standards, methodolo-
gies, or procedures under its State plan 
under title XIX of the Social Security Act 
(including any waiver under such title or 
under section 1115 of such Act (42 U.S.C. 
1315)) after the date of enactment of this 
Act, is no longer ineligible under clause (i) 
beginning with the first calendar quarter 
in which the State has reinstated eligibility 
standards, methodologies, or procedures 
that are no more restrictive than the eligi-
bility standards, methodologies, or proce-
dures, respectively, under such plan (or 
waiver) as in effect on such date. 
(C) NO
WAIVER
AUTHORITY.—The Sec-
retary may not waive the application of this 
subsection under section 1115 of the Social Se-
curity Act or otherwise. 
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