New Policy Advances for Medicaid at Reentry

On April 17, 2023 Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), announced a groundbreaking new guidance offering states the opportunity to strengthen health care access at the point of reentry to improve people’s health and wellbeing as they return to our communities after incarceration.

The “Medicaid Reentry Section 1115 Demonstration Opportunity” waiver opportunity would grant state Medicaid programs the ability to cover health services for people leaving carceral settings and returning to communities, thus improving access to healthcare services and continuity of care. 

This landmark reentry policy is a monumental win, first and foremost, for the individuals and communities directly impacted by incarceration. The policy was informed directly by input from health and justice leaders and advocates, including the Health and Reentry Project, formed in 2022 as a collaboration between the Council on Criminal Justice, former CMS Deputy Administrator Vikki Wachino, and Waxman Strategies. The goal of the Health and Reentry Project (HARP) is to “promote continuity of care between correctional and community settings and maximize the benefits of Medicaid policy changes for public health and public safety”.

This is the first time that Medicaid will cover services while people are incarcerated, up to 90 days prior to release. As stated in CMS’ press release, “The Medicaid Reentry Section 1115 Demonstration Opportunity will allow states to cover a package of pre-release services for up to 90 days prior to the individual’s expected release date that could not otherwise be covered by Medicaid due to a longstanding statutory exclusion that prohibits Medicaid payment for most services provided to most people in the care of a state or county carceral facility.” Services that can now be covered are related to physical and behavioral health, and health-related social needs.

To implement this continuity of care coverage, states must negotiate 1115 demonstration waiver proposals with CMS. So far, CMS has approved the state of California’s proposal. Under the waiver, California will provide case management services, prescriptions and over-the-counter drugs, and engage community health workers with lived experience of incarceration to care for incarcerated people starting 90 days prior to their release. There are 14 other states who have pending proposals (AZ, KY, MA, MT, NH, NJ, NM, NY, OR, RI, UT, VT, WA, WV).

To make sense of the Medicaid Reentry Section 1115 Demonstration Opportunity, HARP is hosting a webinar on the new policy on Thursday, April 27th at 3-4pm ET. During the webinar, the panel will explain the new policy, its impact, and how stakeholders can “help advance policies that improve the health of people as they leave incarceration”.

Upcoming Webinar

Medicaid and Reentry: New Policy Advances

Thursday, April 27 · 3 – 4pm EDT

For the first time, new federal and state policies will allow for Medicaid coverage of services in the period before individuals are released from prison or jail to help them successfully transition to the community – a change that carries enormous potential for public health and public safety. Specifically:

The Centers for Medicare and Medicaid Services recently issued new national guidance to states on how to provide Medicaid covered services at reentry through demonstration waivers. The guidance builds on the federal approval in January of California’s plan to cover some services for 90 days pre-release, a first-of-its kind policy change. Fourteen additional states have proposed to make similar changes.

By promoting continuity of care, these changes hold the potential to improve the life and health of people who have experienced incarceration, and positively impact their families and the communities in which they live. They can address chronic physical conditions like diabetes and asthma and make progress on national crises of mental health and overdoses due to substance use.

Please join us Thursday, April 27, from 3-4 pm ET to hear from two federal officials who developed the landmark Medicaid policy, along with health and justice leaders working to translate it into meaningful improvements in people’s lives: 

Daniel Tsai, CMS Deputy Administrator and Director of the Center for Medicaid and CHIP Services

Amy Solomon, Assistant Attorney General Designate at the U.S. Department of Justice

Juliana Stratton, Lieutenant Governor of Illinois

Khalil Cumberbatch, Director of Strategic Partnerships at the Council on Criminal Justice

Successful implementation of these policies can drive health goals and justice reform goals alike by facilitating continuity of care, access to needed treatment, and connections to community-based services and care providers.

We want to uplift and celebrate the efforts of HARP, whose efforts to inform and advance policy in this area were critical for achieving this potentially life changing policy win for people who have experienced incarceration.  “We applaud this landmark new federal policy, which gives states unprecedented new tools to advance the health and well being of people who are leaving incarceration,” HARP Executive Director Vikki Wachino said.  

Photo: Lynsey Addario via Getty Images | Source: The Commonwealth Fund blog

Undoubtedly, improved access to high-quality healthcare services will yield better health outcomes for individuals returning to their communities who are eligible for Medicaid. As CMS wrote in its press release, this is a “group of individuals who have been historically underserved and adversely affected by persistent poverty and inequality. Improving health care transitions and addressing social determinants of health – from case management to medication-assisted treatment – for individuals after they have been released from carceral settings increases the likelihood that they may continue to receive crucial substance-use disorder, mental health, and other health care treatment during this vital period. It also holds promise for reducing emergency department visits, inpatient hospital admissions, overdose, and overdose-related issues, including death, and improving health outcomes overall. Moreover, addressing people’s underlying health needs enhances their ability to succeed and thrive during reentry, thereby lowering the risk of recidivism, helping make our communities healthier and safer”.

The Rx Foundation co-funded the Health and Reentry Project (HARP), led by the Council on Criminal Justice, to translate anticipated policy changes allowing Medicaid coverage prior to release from prison or jail into tangible, positive impact on public health and public safety. The Commonwealth FundThe California Health Care Foundation, and the Charles and Lynn Schusterman Family Foundation also supported this work.

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