Medicaid Reentry Waiver Map
For the first time, states, local governments, and the federal government are advancing policies that build access and continuity of services, starting prior to release. A major vehicle for these changes 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. The services under these waivers have the potential to improve a range of health and public safety outcomes, including reducing mortality, rates of reincarceration, and unnecessary emergency room visits and hospitalizations. These changes also hold promise to reduce costs for prisons and jails, and for the health care system more broadly, through improved continuity of care. Waivers are initiated at states’ discretion, meaning that individual states develop waiver proposals, which the federal government must approve for the proposal to take effect. There are currently 18 states with approved reentry waivers and 8 additional states, plus Washington DC, with proposed waivers awaiting federal consideration.
Click on a state on the map below to find out about its reentry waiver.
- No Waiver
- Pending
- Approved
Source: Health and Reentry Project (HARP) tracking and analysis of state and CMS actions related to 1115 reentry waivers (download image).
Youth and Young Adults Continuity State Plan Amendments
States nationwide are also implementing new Medicaid and Children’s Health Insurance Program (CHIP) continuity of care policies for youth and young adults who are leaving state prisons, local jails, tribal jails, juvenile detention, or youth correctional facilities. All states are required to provide targeted case management services in the 30 days before and after release and necessary screening, diagnostic, and referral services 30 days before release or shortly after release. These services are available to all post-adjudicated youth who are under age 21 as well as former foster care youth (who remain eligible for Medicaid until they reach age 26). These requirements were established in section 5121 of the Consolidated Appropriations Act of 2023. In addition, under section 5122 of that Act, states may at their option offer comprehensive Medicaid-covered services to youth who are incarcerated pending disposition of charges.
As part of implementing these changes, states must pursue a State Plan Amendment (SPA) to authorize the services. Each state has a federally approved state plan that governs its Medicaid and CHIP programs and describes how the state will meet federal requirements and which optional policies it is implementing. When states make a change in their Medicaid or CHIP programs, including adopting new federal policies, they submit a SPA for CMS to review and approve. Approved state plans are necessary for a state to obtain federal Medicaid and CHIP matching payments for services and administration. This map identifies which states have approved SPAs for the new CAA services.
There are currently 32 states with SPAs covering 5121 services and 1 state with a SPA covering 5122 services.
Click on a state on the map below to find out about its SPA(s).
- No finalized CAA SPA approval at this time
- Approved SPA
Source: Health and Reentry Project (HARP) tracking and analysis of state and CMS actions related to State Plan Amendments (SPAS) (download image).
