In January 2023, California became the first state in the country to gain approval to provide a suite of pre-release health care services and improve access to care for people returning home from jails and prisons. Many other states are developing Medicaid reentry waiver proposals following guidance from the Centers for Medicare and Medicaid Services.
With approval from CMS, Washington State will offer some Medicaid coverage to youth and adults in correctional facilities up to 90 days before release, beginning July 1, 2025.
Six states (Illinois, Kentucky, Massachusetts, Rhode Island, Utah, and West Virginia) have pending Medicaid reentry demonstration waivers. Several other states, including Arizona, Montana, New Hampshire, New Jersey, New Mexico, New York, Oregon and Vermont, are reportedly developing waiver proposals.
During a Nov. 14 event hosted by KFF, Jennifer Strohecker, Pharm.D., director of Medicaid in Utah, spoke about efforts in her state. “Like many other states, Utah is very interested in justice-related reentry initiatives. As we have now received more guidance from CMS, we are very excited about the opportunities this allows to improve care connection and continuity of care across pre-release services,” she said.
“Given that the rate of mental illness in Utah prisons is six times that of the general public, what we are seeing are substantial gaps in care. “Incarcerated people who may have a substance use disorder, who have untreated mental illness, move through the system and have gaps,” Strohecker added. “They are not receiving the level of care we want. We are working with our prisons and jails to really advocate for the infrastructure for this, anticipating that these conversations with CMS will move toward approving this essential service soon. Without a doubt, this is a high priority point for us.”
In June 2022, Jami Snyder, who then oversaw Arizona’s Medicaid and CHIP program, said: “We want to be able to reimburse for services when a person is preparing to leave a correctional setting. “We want to be able to reimburse for those care coordination and case management services, so we can connect people to care quickly when they leave that correctional setting through a variety of providers, including our justice clinic sites.”
The country most advanced on this path is California, which has taken several steps to establish its Justice-Involved initiative.
The state is taking steps to address poor health outcomes in this population by establishing pre-release Medi-Cal enrollment strategies to ensure individuals have continuity of coverage upon release as well as access to services. key to helping them successfully return to their communities.
The Justice-Involved Initiative allows eligible Californians who are incarcerated to enroll in Medi-Cal and receive a specific set of services in the 90 days prior to their release. This initiative aims to ensure continuity of health coverage and services between the time of your incarceration and your release. It also provides people returning to the community with the prescription medications and durable medical equipment they need, and access to programs and services to support this transition.
Several initiatives that focus efforts on ensuring Medi-Cal enrollment and benefits upon release from correctional facilities include the following:
• Since 2015, state prisons must use a standardized process to collect and process pre-release applications to ensure JI individuals are enrolled in Medi-Cal prior to their return to the community.
• From 2016 to 2021, 17 counties offered comprehensive care (WPC) pilot programs dedicated to serving individuals reentering the community after incarceration and have designed programs to directly involve local jails and/or probation departments. These programs have become Community Support/Enhanced Care Management (ECM) programs at CalAIM.
• Beginning January 1, 2023, all counties are mandated to implement pre-release Medi-Cal application processes in county jails and youth correctional facilities.
• Beginning January 1, 2023, and as authorized by SB 184, Medi-Cal benefits for youth and adults may remain in suspended status until the individual is no longer an inmate of a public institution.
• A 2021 state law (AB 133) requires correctional services to implement a process to facilitate referrals to county Specialized Mental Health Services (SMHS), Drug Medi-Cal (DMC), the Organized Drug Delivery System Medi-Cal (DMC-ODS). and/or Medi-Cal MCP for incarcerated individuals who received behavioral health services while incarcerated, to allow for continuation of behavioral health treatment. These referrals are called behavioral health links.
• Managed care plans must offer intensive community-based care management for individuals transitioning to the community through the state ECM and Community Supports benefit. All individuals who are eligible for pre-release Medi-Cal services and who are enrolled in managed care will also be eligible to receive ECM upon release to the community.
CMS requires state Medicaid programs to evaluate whether these interventions are having positive impacts on health outcomes and costs.
For example, in its letter approving Washington state’s waiver, CMS said that “by allowing early interventions to occur in the full 90-day period immediately prior to expected release, such as for certain behavioral health conditions and including stabilizing medications such as long-acting injectable antipsychotics and addiction treatment medications for SUDs, Washington hopes to reduce decompensation, suicide-related deaths, overdoses, and overdose-related deaths in the short term following release. The state will thoroughly test and evaluate through robust hypothesis testing, the effectiveness of the extended 90-day full coverage period prior to the beneficiary’s anticipated release date in achieving these articulated goals of the initiative.”
