The Centers for Medicare and Medicaid Services (CMS) has made important changes to Medicare rules that will help older adults leaving incarceration access health care. These changes were finalized as part of the 2025 Hospital Outpatient Prospective Payment rule.  

CMS narrowed the description of custody used to determine if Medicare will pay for services. The new description makes clear that individuals who are released to the community pending trial (including those in pretrial community supervision and those released pursuant to cash bail), on parole, probation, or home detention, or required to reside in halfway houses are not considered to be in “custody.” This change means that individuals who are released from physical confinement, including those under community supervision, will be able to use Medicare coverage. 

CMS also made it easier to enroll in Medicare at re-entry. Beginning on January 1, 2025, eligibility for the Medicare Special Enrollment Period (SEP) for formerly incarcerated individuals will be linked to the Social Security Administration’s determination that they are no longer incarcerated. In line with the new custody definition, people residing in halfway houses will also be eligible for the SEP.  

Justice in Aging, along with the Legal Action Center, Medicare Rights Center, and the Health and Reentry Project (HARP), led the advocacy effort to secure these changes. We are grateful for the wide-ranging stakeholders from law enforcement to reentry advocates to healthcare providers who wrote to CMS in support of these changes.  

Justice in Aging will provide additional analysis and resources in the coming weeks.  

Read Justice in Aging’s comments on the proposed custody and SEP rule changes and sign on letter signed by 117 organizations.