CMS Issues Guidance on Medicaid Innovations for Reentry of Incarcerated People
The Centers for Medicare & Medicaid Services (CMS) has issued guidance to state Medicaid directors to help states design Section 1115 demonstration projects to improve care transitions for incarcerated individuals who are eligible for Medicaid.
In January, CMS announced that California would become the first state to provide a set of pre-release healthcare services and improve access to care for people returning home from jails and prisons. In February 14 other states announced they would seek similar approvals from CMS.
CMS approved a first-of-its-kind Section 1115 demonstration amendment that will allow Medi-Cal to be able to cover substance-use treatment before a Medicaid beneficiary is released from jail, prison, or youth correctional facility. Additionally, the state will be able to help connect the person to community-based Medicaid providers 90 days prior to their release to ensure they can continue their treatment after they return to the community.
In its letter to Medicaid directors, CMS said these demonstration projects will test innovative approaches to coverage and quality to improve care transitions, starting pre-release, for individuals who are incarcerated, thereby facilitating improved continuity of care once the individual is released. Further, improving care transitions will likely help these individuals access high-quality, evidence-based, coordinated, and integrated care during reentry.
In detailing the scope of the problem, CMS notes that formerly incarcerated individuals with physical and mental health conditions and substance use disorders (SUDs) typically have difficulty succeeding upon reentry because of obstacles present immediately at release, such as high rates of poverty and/or high risk of poor health outcomes. They face stigma and legal barriers when seeking to obtain housing, education, employment, government benefits, and healthcare access, and can be confronted with negative community perceptions and corresponding lack of support that hinder successful reentry. Additionally, without access to affordable healthcare services post-release, individuals who were formerly incarcerated often do not seek outpatient medical care, including needed SUD or mental health treatment and are at significantly increased risk for emergency department (ED) use and hospitalization.
For states that adopted the Affordable Care Act’s Medicaid expansion for the adult group, most incarcerated individuals are eligible for Medicaid. Many states are seeking to put in place policies and processes to ensure that Medicaid-eligible individuals are enrolled prior to release and able to receive Medicaid-covered benefits and services as quickly as possible after release. In general, to meet the statutory purpose of improving care transitions for soon-to-be released incarcerated individuals who are otherwise eligible for coverage, the services covered under this demonstration opportunity should aim to improve access to community resources that address the healthcare and health-related social needs of this population, with the aims of improving health outcomes and reducing ED visits and inpatient hospital admissions for both physical and behavioral health (mental health and SUD) issues once they are released and return to the community.
A policy watch item from the nonpartisan KFF (also known as The Henry J. Kaiser Family Foundation) details how the 14 other states are approaching providing services to justice-involved individuals.
The KFF researchers Sweta Haldar and Madeline Guth found that most of these states intend to provide coverage to eligible inmates 30 days prior to release. Three states (New Hampshire, New Jersey, and Vermont) seek to provide coverage between 45 and 90 days prior to release. Kentucky proposes to provide fee-for-service benefits for the duration of an inmate’s commitment and through a managed care organization beginning 30 days prior to release. The other two states (Oregon and Massachusetts) would cover some inmates throughout the duration of their commitment, while covering other groups for a more limited pre-release period.
The report said four states (Oregon, Rhode Island, Vermont, and Washington) are seeking to provide benefits to all inmates of state and county facilities. The remaining states would limit these services to inmates who meet health or risk criteria (frequently related to behavioral health needs).
Finally, four states (Massachusetts, Rhode Island, Utah and Vermont) seek to provide full Medicaid State Plan benefits to eligible inmates during the pre-release period. Oregon proposes to provide full benefits to individuals in jail, while state prison inmates would receive a limited package of care coordination services. The remaining states would provide a limited benefit package for all eligible inmates (typically to include services such as reentry support, enhanced case management, and behavioral healthcare).
