Federal law keeps Marketplace coverage open to people detained pending the disposition of charges. This petition asks federal regulators to keep that door open — and to recognize the jailhouse booking record for what it is: the most rigorous identity verification in American healthcare.
Signatures to date: — · Open to sheriffs, jail administrators, county officials, correctional professionals, and the public.
The Medicaid Inmate Exclusion (Social Security Act §1905(a)) has barred federal Medicaid participation for inmates of public institutions since 1965 — conviction or no conviction. Marketplace coverage for non-sentenced detainees is the only lawful federal cost-recovery channel a county jail has. Recovered dollars fund deputies, correctional staff, and communications officers — not deficits.
The Affordable Care Act excludes incarcerated individuals from the Marketplace — except those held "pending the disposition of charges." Pre-trial detainees are not "incarcerated" for Marketplace purposes, and release from custody is a qualifying event for enrollment. That is the statute as written, not a workaround.
Since 2025, federal rulemaking has raised verification standards across every consumer enrollment channel. Yet current guidance is silent on the correctional environment — where the detaining agency verifies every identity at booking, in person, against government records. That silence is the gap this petition closes.
Whereas, county governments bear the full cost of medical care for individuals held in county jails, the majority of whom are detained pre-trial and have not been convicted of any crime; and
Whereas, the Medicaid Inmate Exclusion, Social Security Act §1905(a), has barred federal Medicaid participation for inmates of public institutions since 1965, without regard to conviction status; and
Whereas, the Affordable Care Act, at §1312(f)(1)(B), excludes from Marketplace eligibility only individuals incarcerated "other than incarceration pending the disposition of charges," such that pre-trial, non-sentenced detainees remain eligible for qualified health plans, and release from custody constitutes a qualifying event for enrollment; and
Whereas, enrollment of eligible non-sentenced detainees permits counties to recover the cost of medical services from qualified health plans, and recovered funds are returned to correctional staffing, deputy hiring, and the core public-safety mission of local government; and
Whereas, the identity of every detainee is verified by the detaining agency at booking — in person, against government records — a standard of verification more rigorous than any consumer enrollment channel, and enrollment through a county-managed process eliminates fraudulent applications; and
Whereas, the National Association of Counties and the National Sheriffs' Association have jointly urged relief from the fiscal burden of detainee healthcare and continuity of coverage that reduces recidivism; and
Whereas, the Marketplace Integrity and Affordability Final Rule (June 2025), the 2027 Payment Notice (CMS-9883-F, effective July 20, 2026), and Public Law 119-21 §71303 (plan year 2028) together raise verification standards that Marketplace guidance does not yet address for the correctional environment;
Now, therefore, the undersigned sheriffs, jail administrators, county commissioners, correctional healthcare professionals, and residents respectfully petition and resolve:
FIRST — that CMS and the Center for Consumer Information and Insurance Oversight adopt, in Plan Year 2027 guidance, a correctional-environment verification pathway recognizing booking-time identity verification performed by detaining agencies as satisfying Marketplace verification requirements;
SECOND — that the Congress and CMS preserve Marketplace eligibility for pre-trial, non-sentenced detainees under ACA §1312(f)(1)(B), and the release-based special enrollment pathway, in all future rulemaking and legislation; and
THIRD — that the Florida Sheriffs Association, the Florida Association of Counties, the National Sheriffs' Association, and the National Association of Counties formalize letters of support and transmit this resolution to their memberships.
CMS's Marketplace Integrity and Affordability Final Rule ends income-based special enrollment and tightens the front door of the Marketplace. Enrollment anchored to a verified custody event — booking and release — is precisely the model the new era rewards.
CMS-9883-F is now in force, and the Plan Year 2027 guidance window is open. This is the moment to place a correctional-environment verification pathway into guidance — not after the rules harden.
Public Law 119-21 §71303 sets a hard verification deadline. Without a recognized pathway for facility-verified identity, eligible non-sentenced detainees — the most rigorously identified applicants in the system — fall through on a technicality.
NCCHC Standard E-10 (2026) makes discharge planning with coverage linkage the professional standard of care in correctional health. Policy should not lag the standard of care.
Every recovered medical dollar is a dollar available to hire and equip correctional staff, deputy sheriffs, and communications officers — so the primary duty of local government, public safety, is carried out efficiently and effectively.
Identity is established by the detaining agency at booking — never by an enrollment vendor, never by self-attestation. A county-managed process doesn't just resist fraudulent applications; it eliminates the channel they come through.
NACo and the NSA have long held that stripping coverage at the jailhouse door — before any conviction — worsens mental health and substance-use outcomes and drives people back. Coverage at release is reentry infrastructure.
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Thank you, . Your name has been added to the petition record and will be included in the next transmittal to the offices named in the resolution.
DRAFT MODE — submissions are not yet connected to the live record