New guidelines can help people at high risk for substance use disorders and other health conditions get the care they need, especially as they transition from incarceration to the community.

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announces a new opportunity for states to help increase care for incarcerated people in the run up to their release immediately to help them succeed and thrive upon re-entry. The new Medicaid Reentry Section 1115 demonstration opportunity would allow state Medicaid programs to cover services that address a variety of health conditions, including substance use disorders and other chronic conditions.

“The Biden-Harris administration has made expanding access to affordable, high-quality health care a top priority,” HHS Secretary Xavier Becerra said. “We are committed to ensuring that all Americans have the peace of mind they deserve knowing they have access to lifesaving health care, whether it’s drug treatment for the use of substances or prescription drugs to treat other chronic health conditions. Through this historic new effort, we are working to ensure that people who were previously incarcerated can successfully reintegrate into the community with the health supports and services they need. This is an essential step in advancing health equity in our country, and we encourage all states to take advantage of this new opportunity.

“Today marks an important milestone in expanding access to health care through the Medicaid program,” said CMS Administrator Chiquita Brooks-LaSure. “These guidance outlines a pathway to implement historic changes for those incarcerated and eligible for Medicaid. By improving care and coordination prior to release from the justice system, we can help bridge the community and improve individual and collective public health and public safety outcomes.

The goal of this demonstration opportunity is to help Medicaid enrollees connect with community providers to better ensure their health care needs are met during their reintegration process. In January, California became the first state to cover certain health care services for people returning to the community. CMS action today builds on the priorities established by the Substance Use Disorder Prevention Act that promotes opioid recovery and treatment for patients and communities (SUPPORT), and supports President Biden’s comprehensive, evidence-based public safety strategy, the Safer America Plan, as well as the President’s Unity Agenda to address the mental health crisis and the opioid epidemic.

The Medicaid Reentry Section 1115 Demonstration Opportunity will allow states to cover a set of pre-release services up to 90 days prior to the individual’s scheduled discharge date that may not otherwise be covered by Medicaid due to a long-standing statutory exclusion that prohibits Medicaid payment for most services provided to most people in the care of a state or county prison.

According to the US Department of Justice, from 2011 to 2012, approximately 37% of those incarcerated in state/federal prisons and 44% of those incarcerated had a history of mental illness. The National Institute on Drug Abuse (NIDA) estimates that the rate of substance use disorders among incarcerated people can be as high as 65%. The NIDA report also indicates that, without treatment, formerly incarcerated individuals are at increased risk of overdose in the first weeks after re-entry.

The Medicaid Reentry Section 1115 Demonstration Opportunity focuses on providing high-quality service coverage for incarcerated, Medicaid-eligible, returning people to their communities – a group of people who have been historically underserved and affected by poverty and persistent inequalities. Improving health care transitions and addressing the social determinants of health – from case management to drug treatment – ​​for people after leaving prison increases the likelihood that they will continue to receive critical disorders related to substance use, mental health and other health issues. care treatment during this vital period. It also shows promise for reducing emergency department visits, hospitalizations, overdoses and overdose-related problems, including deaths, and improving overall health outcomes. Additionally, addressing people’s underlying health needs improves their ability to succeed and thrive during reintegration, thereby reducing the risk of recidivism, helping to make our communities healthier and safer.

In addition to improving health and well-being and saving lives, the demonstration aims to achieve several other critical goals, including improving coordination and communication between correctional systems, Medicaid systems, plans managed care and community providers, as well as increased investment. in health care and related services.

To learn more, read the full State Medicaid Direct letter on Medicaid.gov.

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