Expanding the availability of opioid use disorder (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 substance use disorder (SUD) and OUD services.
With support from the Foundation for Opioid Response Efforts (FORE), The Health and Reentry Project (HARP) developed this toolkit for state Medicaid agencies (SMAs) and their state and local correctional partners to help maximize this important opportunity and yield better outcomes for individuals and communities. HARP’s toolkit aims to support 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.
The toolkit translates key policy recommendations into actionable steps for state and local-level implementation. You can use the toolkit to find more information about:
- 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
A companion publication on how to initiate medication-assisted treatment (MAT) during short stays in incarceration is also available to stakeholders, as well as a two-page snapshot on how to implement effective policies.
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.
To implement Medicaid coverage of pre-release OUD services, stakeholders should aim 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. HARP’s toolkit aims to support these goals and serve as a resource to come back to during the policy development and implementation process.
HARP has also created resources to support effective implementation of Medicaid and reentry policies, which the toolkit builds upon. Those earlier publications include:
- Eight Key Considerations for Successful Implementation of New Medicaid Reentry Policies
- From Policy to Practice: Seizing the Moment to Transform Health and Reentry
- Getting Ready: Key Elements for the Implementation of Section 5121 Youth Requirements in Adult Correctional Facilities
There is a need for action. Historically, approximately 60% of individuals in state prisons and jails have met criteria for drug dependence or abuse, but only 40% of correctional facilities provide onsite treatment. This gap leaves many without the care they need — during both incarceration and community reentry.
Reach out to HARP if your state needs technical assistance or has questions about implementation: TA@healthandreentryproject.org.