Authors: Margot Cronin-Furman, Vikki Wachino, John Sawyer, and Silicia Lomax
California is the first state to receive federal approval to cover some services for people returning to communities after incarceration through a Medicaid section 1115 demonstration waiver. The goal of providing these pre-release services is to increase service continuity, access to care, and improve health outcomes and public safety following release. California’s approach can inform decisions by other states about how to strengthen access to care through Medicaid for people leaving incarceration.
California’s Justice Involved Initiative is part of a larger statewide effort to strengthen Medicaid, called California Advancing and Innovating Medi-Cal (CalAIM). By serving individuals leaving prison, jail, and juvenile justice centers, CalAIM’s Justice Involved Initiative (JI Initiative) aims to meet the health needs of incarcerated people, who disproportionately experience chronic illness and mental health and substance use disorders.
Key aspects of California’s reentry waiver include:
- Enrolling eligible people in Medi-Cal prior to release from prison, jail, or youth correctional facility
- Coverage of pre-release services for youth and eligible adults
- Coordination with and connection to health, behavioral health, and other community-based services post- release
As the state implements the waiver, some of the significant issues that it is tackling are:
- Achieving continuity and access to primary care, behavioral health, and other services post-release.
- Establishing a beneficiary-specific 90-day pre-release service period.
- Ensuring consistency in implementation across facilities.
- Developing the workforce to meet the need for services.
- Ensuring accountability for services provided prior to release.
Health and criminal justice policymakers in other states and at the national level can look to California to inform ongoing efforts to address national priorities related to public safety, public health, and behavioral health. Some key considerations as states seek to assess the implications of California’s approach for their efforts to develop pre-release services are:
- California’s pre-release services program is part of its ongoing, broader Medicaid delivery system reforms.
- The pre-release program also builds on past efforts in California to advance Medicaid’s ability to meet the needs of people who have been incarcerated.
- Key Medicaid pre-release program design choices will vary by state.
- Successful implementation relies on stakeholder engagement and resources.