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Reentry Section 1115 Demonstration Opportunity

Demonstration Opportunity

The Centers for Medicare & Medicaid Services (CMS) issued guidance for designing demonstration projects under section 1115 of the Social Security Act (the Act) (42 U.S.C. § 1315) to improve care transitions for certain individuals who are soon-to-be former inmates of a public institution (hereinafter referred to as incarcerated individuals, except when quoting from statute) and who are otherwise eligible for Medicaid.   The opportunity continues to implement section 5032 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) (Pub. L. No. 115-271), Promoting State Innovations to Ease Transitions Integration to the Community for Certain Individuals.

As mandated in section 5032, the Department of Health and Human Services (HHS) convened a stakeholder group to develop best practices for states to ease health care-related transitions for incarcerated individuals to the community and to develop a Report to Congress (RTC). On December 1, 2022, HHS transmitted the RTC to Congress.  Additionally, section 5032 directs the Secretary of HHS, through the Administrator of CMS, to issue this State Medicaid Director Letter (SMDL) regarding opportunities to design demonstration projects under section 1115 of the Act to improve care transitions for incarcerated individuals exiting a public institution and who are otherwise eligible for Medicaid, and to base this guidance on best practices identified in the RTC.

These demonstrations 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.

Approved States
CaliforniaCalifornia Advancing and Innovating Medi-Cal (CalAIM)
MontanaMontana Healing and Ending Addiction through Recovery and Treatment (HEART)
WashingtonWashington Medicaid Transformation Project

Monitoring and Evaluation Materials: Coming Soon!

Learning Collaboration and Other Resources

Background on the Intersection Between Incarceration and Health

Resources for Learning About the 1115 Reentry Opportunity