Medicaid and Corrections
Recent Medicaid guidance and legislative developments offer new opportunities for correctional leaders to leverage Medicaid to enhance outcomes for people who are incarcerated. With the passage of the SUPPORT Act, the Consolidated Appropriations Acts of 2023 and 2024, and new guidance around the Medicaid Section 1115 Reentry Demonstration Opportunity, prisons and jails have more opportunities to work with their state Medicaid agencies to support individuals not only during incarceration but also during the critical transition from incarceration to the community.
This webpage provides a curated list of resources to support correctional leaders in taking full advantage of these new opportunities.
Medicaid Section 1115 Reentry Demonstration Opportunities
CMS released guidance in April 2023 for Medicaid Section 1115 Reentry Demonstration Opportunities aimed at improving health care transitions for individuals returning to the community after incarceration. Through this demonstration project, states can apply to leverage Medicaid to provide physical and behavioral health care in corrections settings for up to 90 days before release and for pre- and post-release care management to promote individuals’ seamless transitions into the community. The guidance is designed to support state Medicaid agencies to develop applications to address the health care needs of individuals prior to their release from correctional facilities, increasing the likelihood of successful reentry and reducing the risk of recidivism.
- Coverage for Pre-Release Services: If approved for this opportunity, states can provide reimbursement for certain pre-release services up to 90 days before release, including required services case management, medications to treat substance use disorders (also known as medication-assisted treatment, or MAT), and a 30-day supply of all prescription medications upon release. States can choose to provide additional benefits.
- Target Populations: States have flexibility in defining eligible populations but are encouraged to target broadly defined groups of soon-to-be-released individuals who are Medicaid-eligible. Some states have chosen to more narrowly define to people with chronic health conditions or substance use disorders.
- Provider Flexibility: States can use community-based providers, in-reach providers, correctional staff, or embedded carceral health providers to deliver pre-release services. Embedded carceral health providers must comply with state Medicaid participation policies and ensure proper handoff to community-based providers.
- Eligibility and Enrollment: States must suspend, rather than terminate, Medicaid eligibility when an individual is incarcerated. In addition, states must also establish processes to enroll individuals in Medicaid upon incarceration or at least 45 days before release. States can use presumptive eligibility for those with short incarceration periods.
- Capacity Building and IT Support: States may request time-limited federal matching funds to develop health IT systems, train staff, and enhance operations to support the waiver’s implementation.
- Reinvestment Requirements: States must reinvest federal matching funds received for previously funded carceral health care services into community-based health care services or other activities that enhance health care access and quality for people involved in the justice system.
- State Medicaid Director Letter, CMS, April 17, 2023
- Outlines CMS guidance for states to develop demonstration projects under Section 1115 of the Social Security Act to provide Medicaid-funded pre-release services.
- Explainer: Section 1115 Waiver Watch: Medicaid Pre-Release Services for People Who Are Incarcerated, Kaiser Family Foundation, April 16, 2024
- Details the CMS guidance and the status of approved and pending waivers.
- Article: Medicaid Section 1115 Demonstration Waivers for Reentry After Incarceration, Georgetown Law O’Neill Institute for National and Global Health Law, February 20, 2024
- Highlights the goals of the guidance and the need for a permanent legislative solution to address health care gaps for people who are incarcerated.
- Policy Cheat Sheet: Understanding New Federal Guidance on Medicaid Coverage of Health-Related Social Needs Services, Center for Health Care Strategies, January 2024
- Explains federal guidance on how Medicaid can be used to cover services addressing health-related social needs, such as housing and nutrition, with the aim of enhancing health outcomes.
- Informational Bulletin: Coverage of Services and Supports to Address Health-Related Social Needs in Medicaid and the Children’s Health Insurance Program, CMS, November 16, 2023
- Outlines guidance on how Medicaid and CHIP programs can cover services and supports that address social determinants of health to improve overall health outcomes.
- Webinar: CMS Opens Door for Pre-Release Services for Justice-Involved Populations: Health Care and Justice System Implications, Center for Health Care Strategies, March 27, 2023
- Discusses CMS guidance allowing Medicaid to cover health care services for individuals prior to release, highlighting the potential benefits for health care continuity and justice system outcomes.
- Article: CMS Issues Guidance on Section 1115 Demonstration Opportunity to Support Reentry for Justice-Involved Populations, State Health and Value Strategies, April 19, 2023
- Outlines goals of guidance on Section 1115 reentry demonstration waivers, eligible facilities and individuals, minimum covered services, and implementation requirements for states seeking to adopt these demonstrations.
- Outlines goals of guidance on Section 1115 reentry demonstration waivers, eligible facilities and individuals, minimum covered services, and implementation requirements for states seeking to adopt these demonstrations.
- What Correctional Agencies Need to Know about the Medicaid Section 1115 Reentry Demonstration Opportunity, CSG Justice Center, October 4, 2024
- Dives into the Medicaid Section 1115 Reentry Demonstration Opportunity, which empowers states to enhance pre- and post-release care for people returning from incarceration.
- Frequently Asked Questions on Medicaid and Reentry, Legal Action Center, January 2024
- Discusses recent policy advancements, provides guidance on implementing relevant policies, and highlights ongoing efforts at the federal and state levels to enhance Medicaid reentry services.
- Webinar: From Corrections to Community: Navigating the New Medicaid Section 1115 Demonstration Opportunity, Part 2, CSG Justice Center, September 14, 2023
- Leaders from two states discuss how they have developed Medicaid Reentry Section 1115 demonstration proposals, including their experience engaging stakeholders, designing their demonstrations’ scope and services, and planning for implementation.
- Webinar: From Corrections to Community: Navigating the New Medicaid Section 1115 Demonstration Opportunity, Part 1, CSG Justice Center, July 19, 2023
- Introduces correctional leaders to opportunities under Medicaid Section 1115 waiver demonstrations, including opportunities to support individuals with health care services before release.
- Webinar: Medicaid 1115 Justice Waiver Opportunities: Improving Carceral Healthcare Delivery Information, Health Management Associates, May 18, 2023
- Explores methods to use Medicaid to improve transitions in care in carceral facilities and discusses health risk assessments and continuity of care.