HHS Releases New Medicaid Reentry 1115 Demonstration Opportunity to Increase Access to Care for Individuals Leaving Prison and Jail

On April 17, 2023, the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), released new guidance that allows states to utilize Medicaid funds to provide health care services to incarcerated individuals, including substance use disorder treatment. The new Medicaid Reentry Section 1115 Demonstration Opportunity would provide states with an additional opportunity to modify Medicaid programs to improve continuity, coordination, and access to care and health outcomes for people returning to communities. 


In January 2023, CMS approved California’s Section 1115 request to expand Medicaid eligibility to justice-involved individuals. This first-of-its-kind section 1115 demonstration amendment waives the federal Medicaid inmate exclusion policy, which prohibits Medicaid from paying for services to individuals that are incarcerated, and improves access to treatment services and connections to community-based providers 90 days prior to release. 


The Medicaid Reentry Section 1115 Demonstration Opportunity builds on the success in California as well as priorities established by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, and guidance from President Biden’s comprehensive, evidenced-based public safety strategy, the Safer America Plan, and President’s Unity Agenda to address the mental health crisis and the opioid epidemic.


The main goals of the Medicaid Reentry Section 1115 Demonstration Opportunity are to increase coverage for eligible individuals, improve access to quality care and treatment services in carceral settings, and enhance coordination with community providers to ensure seamless access to services for individuals with substance use disorders as they prepare to reenter the community. States will be allowed to provide a package of pre-release services for up to 90 days prior to the individual’s expected release date. States have the ability to provide an array of pre-release services but are required to include the following benefits in their proposed demonstration projects:

  • 1 Case Management to Assess and Address Physical and Behavioral Health Needs, and Health-related social needs – using comprehensive assessments to identify medical and social needs and services; develop care plans that are informed by the assessments; and referrals activities that connect individuals to medical, social, and educational providers, programs, and services.
  • 2 Medications for Addiction Treatment (MAT) – providing FDA-approved medications to treat substance use disorders in combination with behavioral therapies, such as counseling. CMS encourages states to use all available approved medications for opioid use disorder (MOUD), including methadone, buprenorphine, and naltrexone, and acamprosate and naltrexone for alcohol use disorder (AUD).
  • 3 30-Day Supply of all Prescription Medications Provided to the Beneficiary Immediately Upon Release from the Correctional Facility – providing a 30-day supply of any prescription medication, including medications to treat OUD and AUD.


Using Medicaid coverage to improve the continuity of health care between carceral and community settings can help ensure that people have the resources they need to return to their communities healthy and whole. 


To learn more about the Medicaid Reentry Section 1115 Demonstration Opportunity, visit: https://www.cms.gov/newsroom/press-releases/hhs-releases-new-guidance-encourage-states-apply-new-medicaid-reentry-section-1115-demonstration