Alternatives to Medicaid Section 1115 Waivers to Ease Reentry
As described in more detail in the NCSL report Connecting Recently Released Prisoners to Health Care, states have a variety of non-waiver options to improve connections to Medicaid coverage and care post-release. For example, states may suspend, instead of terminate, an incarcerated individual's Medicaid eligibility to streamline reinstatement of benefits upon release. According to available data, 47 states suspend benefits upon entry to prison and 46 states suspend benefits upon entry to jail instead of terminating benefits. In January 2026, all states will be required to suspend, rather than terminate, benefits for incarcerated people under the Consolidated Appropriations Act of 2024.
To facilitate suspension and reactivation of benefits states have implemented policies to improve data-sharing and care coordination between Medicaid and correctional facilities. Arizona's Enrollment Suspense initiative uses electronic data sharing agreements with Arizona prisons, jails, and detention facilities to temporarily suspend the member's health plan during incarceration. Arizona also facilitates care coordination through the Justice System Reach-In Care Coordination program. To implement Washington state legislation mandating the suspension of benefits, the Washington Medicaid agency formed a partnership with the Department of Corrections (DOC) and the Washington Association of Sheriffs and Police Chiefs. This collaboration aimed to merge data from DOC, jails, and Medicaid to streamline changes in eligibility status.
Beyond the Medicaid program, states can take action to improve access to care in correctional facilities and following release. For example, Alabama HB 465 (2023) appropriated $1.5 million in opioid settlement funds to the department of corrections for opioid and co-occurring substance abuse treatment, including for FDA-approved medications and pre- and post-release services to justice involved individuals. Connecticut SB 448 (2022) requires correctional facilities to screen each person for drug and alcohol use history, ensure supervision of withdrawal by certain health care providers, offer substance use disorder counseling services and to refer an individual for treatment following release. Maine HB 490 (2021) created a comprehensive substance use disorder treatment pilot program for the incarcerated population that included screening, assessment, medically managed withdrawal, medication-assisted treatment, and individual and group counseling. Additionally, Maryland and New York require that state and county jails and prisons offer all three medications associated with MOUD.