CMS approves first-ever MIEP waiver for the state of California

Key Takeaways

On January 26, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), approved a first-of-its-kind Medicaid and Children’s Health Insurance Program (CHIP) section 1115 demonstration amendment in California, which will connect justice-involved people in jails and prisons with community-based Medicaid providers 90 days before their release to ensure continuity of care upon return to the community. For those that meet certain criteria, the demonstration will permit the use of federal Medicaid dollars for certain physical and behavioral health care treatment and community services to address health-related social needs.

The waiver applies to all juveniles or adults with substance use disorder, mental health diagnosis, chronic conditions, intellectual/developmental disability, traumatic brain injury, HIV/AIDS or pregnant/postpartum. The package of reentry services includes case management, physical and behavioral health clinical consultation services, obstetrics, laboratory and radiology services and medications such as Medication Assisted Treatment for substance use disorders. Additionally, qualifying enrollees will receive covered outpatient prescription and over-the-counter drugs and durable medical equipment upon release.

The approval of California’s 1115 waiver was accompanied by a new report from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) entitled, Health Care Transitions for Individuals Returning to the Community from a Public Institution: Promising Practices Identified by the Medicaid Reentry Stakeholder Group. The report summarized recommendations from a 2021 stakeholder meeting that was required under Section 5032 of the SUPPORT Act. NACo was one of several key stakeholder groups that took part in the meeting, which informed the design of an 1115 waiver approval for Medicaid reentry services.

The National Association of Counties (NACo) applauds HHS for approving this waiver and urges approval of other pending state waivers aimed at improving access to care for justice-involved individuals, a population faced with disproportionately high rates of SUD, serious mental illness and infectious and other chronic physical health conditions.

Amending the Medicaid Inmate Exclusion Policy (MIEP), which makes no distinction between individuals housed in jails versus prisons, is a top priority for counties. The policy, outlined under Section 1905(a)(A) of the Social Security Act, unfairly denies or revokes federal health benefits for adults and juveniles that are being housed in local jails prior to conviction, meaning these individuals, who are pending disposition, are still presumed innocent under the United States Constitution.

Counties appreciated the bipartisan support and passage of policy included in the Consolidated Appropriations Act of 2023 (P.L. 117-103), which authorized continued access to federal benefits such as Medicaid, Medicare and CHIP for eligible juveniles that are detained pre-trial in local jails. This policy change would tackle the issue particularly for juveniles in the justice system pending disposition, a population disproportionately impacted by higher rates of mental health challenges.

NACo aggressively advocated for the inclusion of these reforms to the MIEP in an end of year spending package and will continue to collaborate with members of the 118th Congress on the introduction and advancement of such bills that will break the cycle of recidivism exacerbated by untreated physical and mental illnesses and substance use disorders.

Additional Resources

• Medicaid Inmate Exclusion Policy Advocacy (MIEP) Toolkit
• NACo Blog: Nearly 150 County Officials Sign onto NACo’s Behavioral Health Advocacy Letter to Congress
• NACo Webinar: MIEP Call to Action- Advancing Legislation that Address the Medicaid Inmate Exclusion Policy
• NACo Press Release: NACo Joins over 135 Local and National, Health, Mental Health and Justice Organizations in Calling on Senate Finance Committee to Consider Bipartisan Medicaid Reentry Act