Report released on 1115 waiver implementation in California

Key Takeaways

In January 2023, California became the first state to receive federal approval for a Medicaid Section 1115 demonstration waiver to partially amend the Medicaid Inmate Exclusion Policy. This waiver focuses on expanding health care services for justice-involved individuals, specifically allowing Medicaid-covered services to be provided to individuals transitioning out of prison or jail. This allows participating counties to target the crucial reentry period when many individuals are at heightened risk for physical and behavioral health complications.  

As of September 2024, 23 states and the District of Columbia have submitted applications or received approval for similar waivers, drawing on California’s experience to inform their own strategies. By October 1, 2024, the first three California counties had begun offering prerelease services, including behavioral health links, to smooth the transition from incarceration to the community.  

Report on 1115 waiver implementation

On March 20, the Justice System Partners (JSP) and the Health and Reentry Project (HARP) with support from the MacArthur Foundation’s Safety and Justice Challenge (SJC), released a report providing critical insights into the implementation of these services across 11 California counties. The report highlights:

• Milestone Achievement and National Implications: California is the first state to gain federal approval for the Medicaid Reentry Waiver, aiming to bridge the gap between correctional and community health care—a significant step forward in criminal justice reform. Insights from their experience are invaluable for other states and counties seeking to implement similar reentry health care initiatives.
• Impact on Opioid Overdose Deaths: Drug overdose is a leading cause of death among individuals reentering communities from jails and prisons, with opioid-related overdoses accounting for more than half of these fatalities. California’s Medicaid Reentry Waiver aims to reduce these overdose risks by offering targeted health services, such as medication for opioid use disorder (MOUD), both during incarceration and immediately upon release.
• Health Care Impact: Approximately 80 percent of jail detainees in SJC participating counties are expected to benefit from these new services, significantly expanding reentry health care coverage, with potential lessons for other sites across the nation.
• Operational Challenges: Counties are navigating complex challenges such as short jail stays and unpredictable release dates, but developing blueprints that aim to incorporate innovative solutions for care continuity.

Read the Full Report

Webinar on implementing the Medicaid Reentry Waiver in California counties

In October, NACo held a webinar to discuss the report’s findings and share lessons learned from California’s participating counties. A recording of the webinar is available below.

View the Webinar Recording

Impacts on counties

The implementation of prerelease Medicaid coverage in California is reshaping how counties approach reentry health care. By offering targeted health services before individuals leave incarceration, counties can help mitigate health risks, including substance use and mental health challenges. This proactive approach not only enhances individuals' health but also has the potential to significantly reduce costs related to emergency care and avoidable hospitalizations, as well as county healthcare expenses for incarcerated individuals up to 90 days prior to their release. Although counties are still navigating the logistical difficulties outlined in the March 20 report, the solutions being developed in California could guide efforts in other states.

For counties across the country, this waiver presents an opportunity to rethink the role of health care in the reentry process, reduce recidivism and improve public health outcomes for justice-involved individuals. The California experience, as detailed in the report, underscores the critical importance of health care access in achieving these goals.