Overview
Historically, an estimated 58% of individuals in state prisons and 63% of individuals in jails have met the criteria for drug dependence or abuse.1 Nationwide, 40% of correctional facilities currently provide some type of substance abuse treatment service onsite to inmates with a substance use disorder (SUD), including opioid use disorders (OUDs).2 Expanding the availability of OUD services in correctional facilities and community settings is crucial to support individuals with OUD during and after incarceration. Recent Medicaid Section 1115 demonstration waivers — which allow Medicaid to cover targeted services for up to 90 days before a Medicaid beneficiary is released from prison or jail — create a significant new opportunity to expand access to SUD and OUD services.
As of August 2025, 19 states have received federal approval to implement Medicaid reentry waivers, and 8 additional states and the District of Columbia have waiver proposals under review by the federal Centers for Medicare & Medicaid Services (CMS). Providing OUD services through the waivers will increase the number of individuals receiving OUD treatment for up to 90 days before reentry, at reentry, and as people return to communities. This access to services can promote public safety, reduce mortality, and avoid some spending in emergency rooms, prisons, and jails. Overall, these new waiver policies will increase access to and continuity of pre-release and post-release care, supporting individuals’ successful return while enhancing communities’ public safety.
The Health and Reentry Project (HARP) developed this toolkit to help state Medicaid agencies (SMAs) and their state and local correctional partners as they implement Medicaid reentry waivers to effectively expand access to OUD treatment for Medicaid beneficiaries returning to the community from incarceration. Implementing Medicaid coverage of pre-release OUD services requires building continuity of care to bridge the health and criminal justice system, navigate variation across correctional facilities, and address differences in health care access and quality between community health and correctional health.
This toolkit is designed to advance implementation of Medicaid reentry waivers, specifically by assisting SMAs, which oversee implementation, in designing and implementing the OUD services component of their 1115 reentry waivers, as well as other pre-release services that are important to people with OUD. Officials in correctional facilities, who play a key role in reentry waiver implementation, can also turn to this toolkit as they build out operational plans to support implementation.
This toolkit builds upon recent HARP products written to support effective implementation of Medicaid and reentry policies, including:
- Design considerations for getting started
- Models for delivering pre-release services
- Medicaid enrollment
- Pre- and post-release service delivery
- Transitions in care
- Technical assistance and training
- Developing and measuring demonstration effectiveness
- Reimbursement and infrastructure
Acknowledgements
This toolkit was authored by John O’Brien, Colette Croze, Margot Cronin-Furman, and Vikki Wachino. It was developed with support from CommunicateHealth, Inc. The authors would like to thank David Ryan, James Pagano, John Sawyer, and Silicia Lomax from the HARP team, Third Horizon Strategies, and Dr. Daniel Teixeira da Silva for their expert contributions to the toolkit. The authors would also like to thank the following individuals who provided feedback to ensure that the toolkit reflects the state and local health and corrections perspective: Sheriff Michelle LaJoye-Young, Leah Julian, Angie Smith-Butterwick, and Meghan Sifuentes Vanderstelt of Michigan; Assistant Sheriff Nate Wilson, Tim Critz, Hadi Elali, Brian Hanson, Janene DelMundo, and Mardet Homans of California; Bruce Herdman of Pennsylvania; Deputy Director Rebecca Brown, Commander Robert Ballard, Nolan Bell, Dave Wilde, Leah Kitzmiller, and Varonica Little of Utah; Nancy Clayman and Diane York of New Hampshire; and Commissioner Cookie Crews, Dr. Leslie Hoffmann, and Ranesha Stone of Kentucky. This work was funded by the Health and Reentry Project (HARP) with support from the Foundation for Opioid Response Efforts (FORE). The views and conclusions contained in this document are those of the authors and should not be interpreted as representing the official policies or stance, either expressed or implied, of FORE. FORE is authorized to reproduce and distribute reprints for Foundation purposes notwithstanding any copyright notation hereon. This toolkit was informed by 3 reports that HARP published in 2023 and 2024. These reports recommended services and standards, performance measures, and payment strategies for Medicaid coverage of OUD services in prisons and jails. The recommendations were based on input and insights from a wide range of health and criminal justice policymakers and stakeholders, including those who would receive services. The reports are as follows:- Recommendations for Medicaid Coverage of Opioid Use Disorder Services in Jails and Prisons, which defines the services and standards Medicaid could support for incarcerated individuals with OUD, separated into 5 key service areas that promote continuity of care — screening, assessment, medication for opioid use disorder (MOUD) initiation and continuation, counseling and intensive outpatient care, and reentry services.
- Recommendations for Medicaid Performance Measures for Opioid Use Disorder in Jails and Prisons, which outlines 15 clear goals, measurable objectives, and metrics to monitor and evaluate how well states, their managed care partners, and providers (including jails and prisons) meet the intended objectives — and ultimately improve care and results — for Medicaid beneficiaries with OUD, both in jails and prisons and during community reentry.
- Recommendations for Medicaid Payment Models for Opioid Use Disorder Services in Jails and Prisons, which proposes 4 different payment systems for states to consider as models for Medicaid-funded OUD services for individuals who are incarcerated.