States Plan Medicaid 1115 Demonstration Waivers for Incarcerated People

September 16, 2022 - States across the country are working with the US Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) to obtain Section 1115 demonstration waivers to innovate healthcare for incarcerated patients, researchers from The Commonwealth Fund wrote in a recent blog post.

These waivers come four years after the passage of the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act.

Arizona, California, Kentucky, Massachusetts, Montana, New Jersey New York, Oregon, Utah, Vermont, and Washington recently shared their Section 1115 demonstration requests with CMS. The passing of the SUPPORT Act in 2018 directed HHS to assist states in constructing guidance for providing tools for justice-involved people, however, these eleven states aimed to get a head start in constructing demonstration requests and waivers.

The submitted requests vary in terms of eligibility standards. Oregon, Washington, and Vermont plan to support all who are eligible for Medicaid. Arizona, California, Massachusetts, New Jersey, New York, and Utah all aim to include those with one or more chronic conditions and behavioral health conditions.

Beliefs and desired standards regarding covered services are also inconsistent among states. Massachusetts, Oregon, and Vermont aimed to provide full Medicaid state plan benefits to those who are eligible. Kentucky, however, says it will provide treatment modalities for substance use disorder, such as therapy, peer support, and reentry service planning. Arizona, California, Montana, New Jersey, New York, and Washington centered goals around medication and care management coverage.

Although the commonly requested length of coverage is 30 days before the prison release date, the plans of California, New Jersey, Oregon, and Vermont exceed this duration. Determining the appropriate length of coverage can be difficult, as the length of stay and operational issues are often unforeseeable, The Commonwealth Fund authors explained..

Each of the states said there are inadequate resources and risks for poor health outcomes among patients exiting incarceration. Of those in jail or state prisons, 64 percent and 54 percent have a mental health concern, respectively. Also, the chance of death within the first two weeks of dismissal from state prison was 12.7 times higher than the odds of fatality among other state residents.  

State efforts will be adjusted by CMS, which aims to streamline efficacy. With pending waiver approval, CMS aims to optimize Medicaid services provided to correctional facilities. The steps associated with reaching this objective mainly relate to the application of services, relationship building, and precise planning.

Previous research has found that Medicaid enrollment assistance among justice-involved people can yield good health outcomes.

For example, a study from January found that prerelease Medicaid enrollment assistance among incarcerated people with substance use disorders can produce outpatient utilization benefits. Researchers made this conclusion following the implementation of an enrollment assistance program, which they found had an impact on healthcare utilization.

Another study from April found that Medicaid expansion increased coverage for justice-involved people. Researchers noted that following the passing of the Affordable Care Act, the number of low-income people with criminal legal involvement with insurance coverage was higher within states that had expanded Medicaid.

Also, in May, AIDS Alabama and CHLPI filed a complaint against Alabama Medicaid for denying access to hepatitis C coverage for patients who recently used alcohol or illicit drugs. This involved a request for the removal of a question regarding substance use, along with the recommendation that Alabama Medicaid should educate providers on this topic.