Whereas, county governments bear, apart from narrow inpatient exceptions, 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, freeing recovered funds for 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 leaves no room for the self-attested identities that drive 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 supports reentry; and
Whereas, state-based marketplace enrollment procedures and agent-of-record workflows for correctional environments are in active development, demonstrating that this pathway is operationally practicable now; 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 National Sheriffs' Association and the National Association of Counties — together with their counterpart associations in every state — formalize letters of support and transmit this resolution to their memberships.
In witness whereof, the undersigned present this Resolution, under the seal affixed below, this 24th day of July, two thousand twenty-six, in the year of the two hundred fiftieth anniversary of American independence, and respectfully submit it for adoption and transmittal.
