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HARP Materials

The HARP Team has developed and contributed to the following materials providing background on Medicaid, reentry, and related issues. Please check back frequently as we will continue to add briefs, reports, blogs, and other information from the HARP network.

NEW UPDATE: Fact Sheet: Medicaid’s New Role in Advancing Reentry: Key Policy Changes (October 2024)

This 2-page fact sheet provides an overview of groundbreaking new reentry policies that are taking place nationally through statutory changes made by Congress and in individual states through Medicaid 1115 demonstration waivers.

NEW: FAQ: Engaging People with Lived Experience of Incarceration (October 2024)

As a part of our Learning and Action Network, HARP and National Academy of State Health Policy (NASHP) teams recently sat down with DeAnna Hoskins, President and CEO of Just Leadership USA (JLUSA), to discuss how states can effectively collaborate with people affected by incarceration in reentry policy development, decision-making, and program implementation. We synthesized the conversation into an FAQ for state leaders who are looking for ways to develop and implement approaches that are responsive to the needs of people affected by incarceration.

NEW: Implementing the Medicaid Reentry Waiver in California: Key Policy and Operational Insights from 11 Counties  (October 2024)

In January 2023, California became the first state in the nation to receive approval from CMS for a Medicaid Section 1115 demonstration request to amend Medicaid’s inmate exclusion. California’s waiver, called California’s Advancing and Innovating Medi-Cal (CalAIM), and the specific component focused on individuals who are transitioning out of the criminal justice system, the Justice Involved (JI) initiative, will for the first time provide a targeted set of Medicaid-covered services right before someone is released from prison or jail. This paper highlights California’s implementation approach, focusing on the county-level impacts on jails, health care providers, and reentry processes. It also explores several implementation challenges and the steps the state and the counties have taken thus far to implement this change.

Statement from HARP on CMS’ Approval of Five New Medicaid Reentry Waivers (July 2024)

On 7/2/24 CMS announced the approval of five states’ proposals to strengthen access to health care as people return to their communities following incarceration. These states—Illinois, Kentucky, Oregon, Utah, and Vermont—will each use Medicaid section 1115 demonstration waivers to use Medicaid to cover some services prior to release, increasing access to and continuity of care for returning citizens.

Eight Key Considerations for Successful Implementation of New Medicaid Reentry Policies (June 2024)

This short fact sheet describes eight success factors that states and local governments will need to address to effectively implement new Medicaid reentry policies. These considerations identify priority issues for implementers to tackle related to infrastructure, operations, workforce capacity, and more.

Key Elements of Medicaid Reentry Waivers (June 2024)

This chart answers frequently asked questions about the policy and operational expectations laid out in April 2024 federal guidance from CMS and California, Washington, Montana, and Massachusetts’ approved waivers.

HARP Expands Team with Key Hires, Deepening Expertise and Momentum for Transformative Work (April 2024)

HARP has expanded our team with two new hires: David Ryan as Senior Director of Criminal Justice and Melanie Pinkert as Operations Manager. In addition, Mack Jenkins recently signed on to HARP as Strategic Advisor.

“We are thrilled to welcome David, Melanie, and Mack to the HARP team. Their unique experience and deep commitment to the health and safety of individuals and communities impacted by the justice system will help drive meaningful and lasting change,” said Vikki Wachino, Founder and Executive Director of HARP. “Most people who are incarcerated will return to their communities at some point and states across the country are recognizing the role that access to health care plays in building healthier, safer communities. HARP will rely on the expertise and dedication of David, Melanie, and Mack in HARP’s efforts to meet this critical moment.”

NEW: Statement from HARP on the New Community Health Center Funding and Policy to Support Transitions in Care for Justice Involved Individuals (April 2024)

On April 10th, the federal Health Resources and Services Administration (HRSA) announced new funding for Community Health Centers (CHCs) to provide health care for people returning to their communities from incarceration. Alongside the new funding, HRSA released draft policy guidance for CHCs covering activities in this area, which is open for public comment. The new initiative will provide 51 CHCs with two years of resources, which can be used to improve transitions from correctional to community-based health care, including by providing chronic disease, mental health, and substance use disorder care to individuals before and after release.

Interview: How Bolstering Health Care for People Reentering Communities Improves Safety (March 2024)

This interview from Arnold Ventures discusses HARP’s work bridging gaps between the health and criminal justice systems to build safer and healthier communities. In the interview, HARP executive director Vikki Wachino describes how access to health care can help improve health and safety, and how HARP is positioned to seize this moment of opportunity to advance policy and practice that can make meaningful improvements in people’s lives.

Statement from HARP on the Medicaid and Criminal Justice Provisions of the Consolidated Appropriations Act of 2024 (March 2024)

On March 3rd, Congressional leaders released bipartisan, bicameral legislation, the Consolidated Appropriations Act of 2024, that contains multiple provisions related to Medicaid coverage for people who are incarcerated. The bill establishes, for the first time, a uniform national standard that Medicaid eligibility be suspended, not terminated, when people are incarcerated. The bill also provides states with needed resources and tools to meet this standard. Click here to read HARP’s statement in response to the bill and a short summary of the provisions in question.

For additional information: New Bipartisan Legislation Uses Changes to Medicaid Policy to Help Support Healthy Transitions Between Corrections and Community for the Commonwealth Fund’s To the Point Blog (March 2024)

Issue Brief: From Policy to Practice: Seizing the Moment to Transform Health and Reentry –
Convening Summary and Stakeholder Perspectives (February 2024)

HARP hosted a convening in July 2023 to discuss implementation of new Medicaid policies covering services for people leaving incarceration.  The participants included representatives of state and local governments, probation and parole officials, public defenders, Medicaid managed care organizations, community-based service providers, state policy experts, reentry service leaders, and people with lived experience of incarceration. This brief summarizes the convening and provides 10 key implementation takeaways.

Issue Brief: Meeting the Moment: Opportunities to Improve Health and Safety by Changing Medicaid’s Role When People are Incarcerated (February 2024)

States and the federal government have begun making historic changes to the Medicaid program to support the health and well-being of individuals returning to the community from correctional facilities. This brief provides an overview of how and why these policies are changing, the opportunities the changes present to improve health and well-being, and an analysis of essential elements for their implementation.

Issue Brief: Essential Connections: Community Health Centers’ Role in Facilitating Healthy Transitions Out of Incarceration (February 2024)

What role do community health centers (CHCs) play in providing care and services to people as they leave incarceration? How can they play a larger role in bridging the gaps between corrections and community health? This brief explores these questions and provides policy recommendations and best practices that states, correctional partners, and CHCs can build on, especially as Medicaid plays a larger role in covering services at reentry.

Set of Three New Reports Recommend First Approach to Medicaid Coverage of Services for Opioid Use Disorder in Prisons and Jails 

Viaduct Consulting LLC, led by HARP Executive Director Vikki Wachino, released a set of groundbreaking reports recommending approaches states and the federal government can use to expand access to quality, evidence-based treatment for opioid use disorder in prisons and jails by leveraging Medicaid coverage:

Recommendations for Medicaid Coverage of Opioid Use Disorder Services in Jails and Prisons (October 2023), recommends ways to advance quality, evidence-based services for opioid use disorder in state prisons and local jails by allowing Medicaid to cover those services. This report is the first to recommend specific services and standards that Medicaid could cover in a prison or jail setting and comes as groundbreaking new Medicaid policies to cover some services provided in prisons and jails are taking place. Find additional information on this report in a recent press release from HARP and recent blogs from The Pew Charitable Trusts and The Milbank Memorial Fund.

Recommendations for Medicaid Performance Measures for Opioid Use Disorder in Jails and Prisons (November 2023), recommends performance measures for states and the federal government to use assessing efforts to provide OUD services, including MOUD, to Medicaid beneficiaries in jails and prisons and reentering the community. Find additional information on this report in recent blogs by The Pew Charitable Trusts and The Milbank Memorial Fund.

Recommendations for Medicaid Payment Models for Opioid Use Disorder Services in Jails and Prisons (January 2024) recommends payment approaches that states and the federal government can use to advance Medicaid-covered OUD services in prisons and jails.  It also identifies operational considerations in implementing Medicaid-covered OUD services in prisons and jails. Find additional information on this report in recent blogs by The Pew Charitable Trusts and The Milbank Memorial Fund.

This short slide deck provides an overview of the case for MOUD during incarceration and the key findings from all three reports: Recommendations for Medicaid Coverage of OUD Services in Jails and Prisons Slide Deck

Issue Brief: Paving the Path to Healthier Reentry: How New Medicaid Policies Can Improve Mental Health and Substance Use Support as People Return to Communities (October 2023)

New policies that allow Medicaid to cover some services prior to people being released from prison or jail have the potential to improve the health and wellbeing of people with mental health and substance use conditions, who are overrepresented in the criminal justice system. This new brief describes these changes and the opportunities they create to improve care for people with mental health conditions and substance use disorder as they return to communities.

Issue Brief: Breaking Ground: How California is Using Medicaid to Improve the Health of People Leaving Incarceration (May 2023)

CMS’s January 2023 approval of California’s Medicaid Section 1115 Demonstration Waiver represents the first real-world pilot of using Medicaid to cover some services in jails and prisons prior to a person’s release from incarceration. This brief provides an overview of California’s groundbreaking new reentry reforms and examines their potential impacts, anticipated implementation issues, and implications for other states considering similar reforms.

Issue Brief: Redesigning Reentry: How Medicaid Can Improve Health and Safety by Smoothing Transitions from Incarceration to Community (July 2022)

What support helps people successfully navigate release from incarceration so that they can return to their community “healthy and whole”? How can changes to Medicaid’s role at reentry facilitate smoother transitions from carceral to community settings? This stakeholder-informed brief synthesizes the perspectives of over 70 people from diverse backgrounds, experiences, and perspectives to identify key principles for changing Medicaid’s role at reentry, propose a new care model to support successful reentry, and share essential elements for successful policy implementation.

Issue Brief: Medicaid and Reentry: Policy Changes and Considerations for Improving Public Health and Public Safety (March 2022)

Recent Medicaid policy advances propose to change the relationship between Medicaid and prisons and jails. This background brief provides a 101 on Medicaid and Reentry, including an overview of how Medicaid operates, the role it plays within the healthcare system, and its current role for the carceral population. It also summarizes recent policy changes and proposals and identifies key policy implementation issues.

Webinar Recordings

A New Way Home: Medicaid & Reentry Symposium 

Hosted by the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) on April 1, 2024, the symposium “highlighted opportunities and limitations related to Medicaid Section 1115 Waivers for pre-release coverage of people leaving incarceration, encouraged networking amongst stakeholders involved in the policymaking process, and explored barriers and solutions to collaboration.” Click the link above for recordings from the symposium, including a keynote from HARP Executive Director Vikki Wachino.

Engaging Community Organizations in Redesigning Reentry

Presented as part of the Rx Foundation’s Power is a Social Determinant of Health series, this webinar provides overview of groundbreaking policies that are creating a new opportunity to build systems of care for people leaving incarceration and their potential to improve health and wellbeing. The session included a discussion of how community based organizations can help translate these policies into improvements in peoples’ lives.

What Adult Jails Need to Know about Mandated Implementation of Medicaid for Detained Youths

Webinar Slides  and Webinar Recording, password: 9xXmT6ed

Co-hosted by HARP in collaboration with the National Sheriffs’ Association, American Jail Association, and the National Association of Counties, this 12.5.23 webinar provides an overview of new federal legislation that will require jails and prisons to provide certain health care-related services to youths upon re-entry under Medicaid. The law also gives states the option of using Medicaid to cover some youth who are pre-trial. This law goes into effect on 1/1/2025 will directly affect adult jails because, depending on certain factors, the definition of “youth” can include some individuals through age 25. The webinar briefed adult jail administrators on: 

  • the provisions of this new law, including who will receive services, timeframes for providing them, and types of services included
  • some of the implementation choices jail administrators will need to make in conjunction with state Medicaid agencies
  • what we don’t yet know (because specific federal guidance is still forthcoming), and 
  • what jails can begin doing now to prepare.  

Medicaid and Reentry: New Policy Advances

Hosted by HARP and Council on Criminal Justice (CCJ), this 4.27.23 webinar discusses CMS’ groundbreaking new reentry guidance, which offers states a roadmap for using Medicaid to strengthen health care at reentry and improve people’s health and wellbeing as they leave prison and jail. The webinar features HARP founder and executive director Vikki Wachino in conversation with Daniel Tsai, CMS Deputy Administrator and Director of the Center for Medicaid and CHIP Services; Amy Solomon, Principal Deputy Assistant Attorney General at the U.S. Department of Justice; Juliana Stratton, Lieutenant Governor of Illinois; and Khalil Cumberbatch, Director of Strategic Partnerships at the Council on Criminal Justice.

CMS Opens Door for Pre-Release Services for Justice-Involved Populations: Health Care and Justice System Implications

This 3.27.23 webinar, hosted by the Center for Health Care Strategies (CHCS) and the Council of State Governments Justice Center (CSG Justice Center), provides a brief background on how California’s waiver to expand pre-release services and the CalAIM Justice-Involved Initiative will address health equity in the criminal justice system. The virtual panel features HARP founder and executive director Vikki Wachino; Allison Hamblin, CHCS President and Chief Executive Officer; Autumn Boylan, Deputy Director at California Department of Health Care Services; Liz Buck, CHCS Senior Program Officer; Brenda Graelish, Executive Officer, Council on Criminal Justice and Behavioral Health, California Department of Corrections and Rehabilitation; and Ayesha Delany-Brumsey, former Behavioral Health Division Director, CSG Justice Center.

Other Media

       

      “Medicaid has the potential to connect eligible people leaving jails and prisons to services that can maintain or improve their health and mental health, financial security, and ability to participate fully in their families, their communities, and the workforce”

      Redesigning Reentry: How Medicaid Can Improve Health and Safety by Smoothing Transitions from Incarceration to Community

      What is Medicaid’s role in addressing the health needs of people returning to communities?

      Medicaid is the nation’s publicly-financed insurance program for people with low incomes. People who have low incomes – as well as people of color – are more likely to be incarcerated than are other people. Consequently, many people who are incarcerated are eligible for Medicaid. However, Medicaid has historically been prevented from covering services for people who are incarcerated due to a federal law known as the “inmate exclusion.”

      inmate exclusion

      States and jurisdictions have increasingly identified the inability to reach into prisons and jails as a barrier to getting people the health, mental health, and substance use services as they transition from incarceration to the community. Recently, policies have been gaining traction at the state and federal level to address that historical barrier.  Medicaid has the potential to connect eligible people leaving jails and prisons to services that can maintain or improve their health and mental health, financial security, and ability to participate fully in their families, their communities, and the workforce. Medicaid coverage has also been associated with positive public safety outcomes and reduced recidivism.