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:
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