Authors: Margot Cronin-Furman, Vikki Wachino, Kari Pedersen, Silicia Lomax, & John Sawyer
People with mental health conditions and substance use disorder (SUD) are more likely to be in the criminal justice system than are other people and they may have experienced significant gaps in access to treatment before, during, or after incarceration. Allowing access to targeted, Medicaid-covered health care services during the transition out of incarceration for those who are Medicaid beneficiaries carries significant potential to make successful reentry more likely.
People who are incarcerated in jails and prisons are disproportionately affected by chronic health conditions as well as behavioral health conditions. Common mental health diagnoses for incarcerated adults include major depressive disorder, bipolar disorder, psychotic disorders such as schizophrenia, and post-traumatic stress disorder. Too often, these conditions are associated with poor health outcomes post-release. Studies show that people leaving incarceration are over 12 times more likely to die than the general population in the two weeks following release, from causes that include opioid overdoses, homicide, suicide, heart disease, and cancer.
Improving access to mental health and substance use disorder treatment at reentry can support better health outcomes, reduce the risk of reincarceration, and improve individuals’ long term outcomes following incarceration. Medicaid policies that connect people to targeted pre-release services that promote access to and continuity of care hold the potential to improve public health and public safety. A major vehicle for these policies are Medicaid section 1115 demonstration waivers, or “Medicaid reentry waivers.” These waivers allow Medicaid to cover a targeted set of services for individuals starting in the period before they are released from incarceration.
Primary elements of the Medicaid waiver policy are:
- Coverage period and Medicaid enrollment requirements. States may provide services during a period of up to 90 days before a person’s release from incarceration, and help eligible, interested people apply for Medicaid.
- Eligibility for pre-release services. States can define what groups of Medicaid or the Children’s Health Insurance Program (CHIP) beneficiaries are eligible for services, ranging from all eligible people to a specific population, such as people with certain chronic conditions or people with SUD.
- Pre-release services. The Centers for Medicare and Medicaid Services (CMS) set the minimum pre-release services as case management for reentry, medication-assisted treatment (MAT), and 30 days of medication, but many states have chosen to provide some targeted additional services to meet the needs of their states’ incarcerated population.
- Reinvestment plan and implementation support. States submit a plan to CMS that explains how any federal funding that replaces existing state and local funding for carceral services will be reinvested to increase access to care.
The potential benefits of offering these services include supporting people’s ability to maintain continuous care, adhere to treatments, manage chronic health conditions, access other needs such as housing and employment, and increase the overall probability of successful long-term stability.