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.
| State | Demonstration |
|---|---|
| California | California Advancing and Innovating Medi-Cal (CalAIM) |
| Montana | Montana Healing and Ending Addiction through Recovery and Treatment (HEART) |
| Washington | Washington Medicaid Transformation Project |
Monitoring and Evaluation Materials: Coming Soon!
Learning Collaboration and Other Resources
- MAC Learning Collaboratives (Expanding Coverage Under Medicaid and CHIP)
- Justice-Involved Populations
- Information and tools to assist states in implementing strategies that implement Medicaid enrollment and care coordination strategies for eligible justice-involved populations.
- Transcript - Operational Planning for a Section 1115 Reentry Demonstration September 2023
- Operational Planning for a Section 1115 Reentry Demonstration September 2023
- Medicaid and Justice-Involved Populations: Strategies to Increase Coverage and Care Coordination August 2017
- Medicaid Eligibility and Enrollment for Justice-Involved Populations February 2015
- Justice-Involved Populations
- CMCS Medicaid & CHIP All State Calls
Background on the Intersection Between Incarceration and Health
- Health During and After Incarceration (National Institute of Health Care Management): https://nihcm.org/publications/health-during-after-incarceration
- Issue Brief 1: Medicaid and Reentry, Policy Changes and Considerations for Improving Public Health and Public Safety (HARP), https://counciloncj.org/issue-brief-1/
- Issue Brief 2: Redesigning Reentry, How Medicaid Can Improve Health and Safety by Smoothing Transitions from Incarceration to Community (HARP), https://counciloncj.org/harp-issue-brief-2/
Resources for Learning About the 1115 Reentry Opportunity
- Report to Congress: Health Care Transitions for Individuals Returning to the Community from a Public Institution: Promising Practices Identified by the Medicaid Reentry Stakeholder Group. (https://aspe.hhs.gov/sites/default/files/documents/d48e8a9fdd499029542f0a30aa78bfd1/health-care-reentry-transitions.pdf)
- Recordings of the Medicaid Reentry Stakeholder Group Convening in August 2021: Part 1, Part 2, Part 3, Part 4
- SHADAC: An issue brief on the 1115 demonstration opportunity, California’s approved demonstration, and recommendations for evaluation measures that states should consider (https://www.shadac.org/sites/default/files/publications/CHCF%20Justice%20involved%20brief.pdf)
- Council on Criminal Justice: Medicaid and Reentry: New Policy Advances to Improve Public Health and Public Safety (https://www.youtube.com/watch?v=3gcRuJlrQyw)