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HHS Authorizes Five States to Provide Historic Health Care Coverage for People Transitioning out of Incarceration

Adults and youth transitioning out of incarceration can experience delays in getting access to Medicaid or CHIP coverage upon return to their communities — harming public health and public safety. The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved the latest in a series of groundbreaking Medicaid and Children’s Health Insurance Programs (CHIP) demonstrations that will allow Illinois, Kentucky, Oregon, Utah, and Vermont to provide coverage before release, creating a seamless transition and avoiding gaps in coverage. These states join California, Massachusetts, Montana, and Washington in pursuing an innovative option for expanding access to high-quality, affordable health care.

“The Biden-Harris Administration is working to ensure every American has access to high-quality, affordable health care. This is an essential step for advancing health equity in our nation,” said HHS Secretary Xavier Becerra. “For people involved in the justice system, ensuring a successful transition back into the community includes having the health care supports and services they need. I’m pleased to see more and more states putting resources behind efforts that will ensure these individuals have what they need to thrive.” 

“For the first time ever, thousands of incarcerated people in Illinois, Kentucky, Oregon, Utah, and Vermont will have critical supports during their transition out of a carceral setting, thanks to this important health care coverage,” said CMS Administrator Chiquita Brooks-LaSure. “At the heart of that work are Medicaid and CHIP — programs that continue to bring states and the federal government together to meet the needs of our communities. Under the Biden-Harris Administration, that’s meant more innovation than ever before to enhance public health and public safety.”

“Expanding access to life-saving treatment and recovery supports for incarcerated people is a critical part of our bipartisan efforts to beat the overdose epidemic and save lives,” said White House Office of National Drug Control Policy (ONDCP) Director Dr. Rahul Gupta. “President Biden made addressing the overdose epidemic part of his Unity Agenda for the nation because it is an issue that affects every community across the country and requires members of both parties to deliver progress for the American people. Under this important action today, the Biden-Harris Administration is providing a groundbreaking opportunity for these states to increase access to health care, including care for substance use disorder, in jails and prisons, and provide historically underserved and marginalized individuals with the tools and resources they need to succeed upon reentry. I am grateful to these states — red and blue, from coast to coast — for joining our whole-of-society response to strengthen public health, enhance public safety, and save lives.”

The Medicaid Reentry Section 1115 Demonstration Opportunity allows a state to cover certain services not otherwise coverable in Medicaid and CHIP up to 90 days before an eligible person’s expected release from incarceration. This includes coverage of substance-use disorder (SUD) treatment before a Medicaid or CHIP beneficiary is released from jail, prison, or a youth correctional facility. Additionally, states will be able to help connect the person to community-based Medicaid and CHIP providers up to 90 days prior to their release to ensure they can continue their treatment after they return to the community. 

For incarcerated people — who often live with higher rates of SUDs, chronic physical health conditions, poor health care coordination, and other health concerns that can impact public health and public safety — these demonstrations mean:

  • Increased coverage, continuity of care, and appropriate service uptake through assessment of eligibility and availability of coverage for benefits in carceral settings just prior to release.
  • Improved access to services prior to release, and improved transitions into the community upon release.
  • Improved coordination and communication among correctional facilities, Medicaid programs and CHIPs, including managed care plans, and community-based providers.
  • Increased investments in health care and related services aimed at improving the quality of care for people in carceral settings.
  • Improved connections between carceral settings and community services to address physical health, behavioral health, and health-related social needs.
  • Better interventions for certain behavioral health conditions and increased use of stabilizing medications like long-acting injectable anti-psychotics and medications targeting SUDs, with the goal of reducing decompensation, suicide-related deaths, overdoses, and overdose-related deaths in the near-term post-release; and
  • Improved use of health care resources post-release, which can reduce unnecessary emergency department visits, inpatient hospitalizations, and all-cause deaths among recently incarcerated people with Medicaid and individuals otherwise eligible for CHIP if not for their incarceration status. 

As highlighted in a previously released report from HHS Assistant Secretary for Planning and Evaluation, there are significant health coverage and continuity-of-care needs that justice-involved individuals face when returning to the community. These include disproportionately high rates of SUD, opioid overdose and overdose deaths, serious mental illness, and infectious and other chronic physical health conditions. Opportunities like the Medicaid and CHIP reentry demonstrations have a track record for improving health and health care transitions.

CMS continues to work with a range of other states on Medicaid reentry section 1115 demonstration requests. The agency has developed a standard demonstration application and special terms and conditions to expedite the approval of these requests. CMS continues to review these applications as quickly as possible under this streamlined approach, which balances increased efficiency with the Biden-Harris Administration’s priority to advance high-quality, affordable, person-centered health care coverage wherever possible. CMS hopes to adopt this approach for other section 1115 demonstration initiatives.