Around 19 US states have been developing bipartisan programmes to provide Medicaid coverage to people in prisons and jails before their release, aiming to give them access to substance use treatment, medications and mental health care while incarcerated, and to maintain that care once they return to the community. The approach is intended to cut recidivism and reduce the sharply elevated risk of death, particularly from overdose, that people face in the weeks after leaving custody. However, President Trump's "One Big Beautiful Bill" is now making these schemes considerably harder to implement, introducing new work requirements, stricter eligibility checks and funding cuts that are straining state Medicaid budgets and administrative capacity.

Four states—California, Washington, Montana and New Hampshire—have already launched such programmes, together covering tens of thousands of people, while at least three others, Oregon, Rhode Island and Michigan, have paused their efforts, citing insufficient time and resources under the new federal rules. Louisiana became the first state approved for a scheme under the current administration, but only after what officials described as an "intensive delete process" that narrowed its scope to mental health care, addiction medication, infectious disease screening and medical equipment, cutting planned primary care services. Experts, including Duke University researcher Lauren Brinkley-Rubinstein, warn that such scaled-back programmes may prove less effective, leaving newly released people to manage multiple chronic conditions alone while also trying to secure housing, employment and food.