Authors: Naba Husain, Vikki Wachino, John Sawyer, and David Ryan
The “One Big Beautiful Bill Act” (OBBBA), which was enacted in July 2025, includes several provisions that will impact state Medicaid agencies and correctional leaders who are working to strengthen access to services and continuity of care for people who are leaving prison and jail. To support states in navigating these changes, HARP analyzed the new law closely and now offers a comprehensive analysis of relevant Medicaid provisions and their potential impact on continuity of care and public safety.
Importantly, OBBBA leaves intact recent policy gains linking Medicaid to reentry through the 1115 Reentry Waiver Opportunity. However, the law includes significant changes to eligibility for beneficiaries.
Specifically, the law conditions Medicaid eligibility to a new “community engagement requirement” and includes provisions for more frequent coverage renewals for beneficiaries. Independent analysts have estimated these changes will ultimately reduce the number of covered individuals over the next decade. OBBBA is also projected to result in large federal funding reductions to Medicaid.
The changes contained in OBBBA add complexity to Medicaid, posing a significant implementation challenge to state Medicaid programs and stakeholders. HARP’s analysis examines the impact of this new complexity on work underway across the nation to establish continuity of care as people leave prison and jail, including Medicaid reentry waivers and new national requirements that connect youth and young adults to services as they leave incarceration.
Understanding these changes is essential because they stand to affect a significant number of people. Every year, there are more than seven million releases of people from jails and nearly half a million releases of people from prisons. Individuals returning to their communities from incarceration often experience significant health and behavioral health needs, including high rates of mental illness, substance use disorders, and chronic conditions. The reentry period is also often marked by multiple forms of instability—gaps in housing, employment, food, and transportation—that can complicate and compound challenges in securing access to health care.
The public safety implications are real. Correctional administrators know the first 72-hours post-release can be the most challenging, and potential interruptions in coverage and care in the community can exacerbate these challenges.
Medicaid agencies, corrections and public safety agencies that are working to strengthen continuity of care at reentry can continue to advance these changes as they operationalize the OBBBA’s exemption from community engagement requirements for people who are incarcerated and newly released individuals. Continuing to strengthen data sharing across corrections and Medicaid will be key to implementing these exemptions, as well as connecting people who are returning to services. Strong partnerships between Medicaid agencies and correctional partners and prioritizing continued progress to ensure access to care upon release will be key to achieving continuity of care going forward.
HARP offers technical assistance to help states and local governments effectively implement health and reentry policies. We will continue to conduct analysis of the OBBBA’s impact on the reentry landscape, and invite you to reach out to us if you are interested in learning more about how we can support the work in your state. To stay informed, we also invite you to join our email list, follow us on LinkedIn, and visit our website for the latest updates and insights.