Policy & Practice | Spring 2025

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By Julia Kessler, Christine Newhall, Katie Thomas, and Shannon Weaver

Transforming Reentry Services: The Role of CMS 1115 Waivers in Supporting Health and Community Reintegration

T he United States leads the world in its proportion of incarcerated individuals, with a prison population of more than 1.2 million 1 individuals. Many of these individuals face immense barriers when transitioning back into society, particularly in accessing health care. Historically, individuals in carceral settings were excluded from Medicaid benefits. This exclusion, known as the Medicaid Inmate Exclusion Policy, leads to gaps in care and creates additional obstacles for individuals reentering their communities. In 2023, the Centers for Medicare and Medicaid Services (CMS) released groundbreaking guidance 2 to allow states to design and implement 1115 demonstration waivers aimed at improving health care access for individ uals involved in the justice system, often referred to as reentry waivers. These waivers present an opportunity for states to test new approaches for health care coverage, to reduce recidivism, and improve health outcomes for individuals transitioning from incarceration. Why Reentry Waivers Matter Pre-release services are one crucial way for states to address the staggering health disparities faced by individuals involved in the justice system. There are strong correlations between incar ceration and premature death, as well as higher rates of physical, behavioral, and mental health conditions. n 44% of people who are incarcerated in jails have a history of mental illness 3

also mental health and substance use disorders. Reentry waivers are one solution, enabling states to receive Medicaid funding for critical health and social services provided to incarcerated individuals leading up to their release. Services commonly provided include: n Medication-assisted treatment for substance use disorders n Case management and peer support n Housing support and community health worker services n Preventive care and chronic disease management Providing health care through these waivers can play a key role in improving health, as well as

n 33% of sentenced jail inmates meet the criteria for drug dependence 4 n 80% of people who are returning to the community after incarceration have a chronic medical, psychiatric, or substance use disorder 5 The time immediately following release is particularly high-risk. Individuals reentering society are up to 129 times 6 more likely to die from an overdose than the general public. Individuals returning to their com munities also face barriers and stigmas that make reintegration difficult, and that make risk for re-engagement with the justice system high. These statistics underscore the need for services that address not only physical health, but

Illustration by Chris Campbell

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Policy & Practice Spring 2025