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Medicaid 1115 Waiver Resources
Medicaid Section 1115 waivers are transforming how states support individuals transitioning from incarceration back into their communities. These waivers expand access to critical health services before release, bridging gaps between correctional and community care to improve outcomes, reduce recidivism, and strengthen public safety. This page brings together key resources, policy briefs, and toolkits to help stakeholders understand the evolving landscape of Medicaid reentry initiatives and implement effective strategies that promote continuity of care and recovery.
The Health and Reentry Project (HARP) hosts a wide-ranging media and resource library where visitors can search by keyword and filter by topic or resource type. While the collection covers many areas of health and reentry, visitors may choose the topic titled “1115 Waivers” to view only resources in this category. This page offers a curated collection of articles, reports, and analyses that provide deeper insight into how these waivers shape access to care and innovation across states.
HARP’s Media & Resource Library
The Basics: Medicaid Section 1115 & Reentry
The new Medicaid reentry policies enable Medicaid to cover some reentry services for individuals nearing release from incarceration, aiming to bridge the health and criminal justice systems for improved public safety, reduced mortality, and cost savings. This document describes eight strategic steps for states to consider while implementing new policies.
Build active, ongoing collaboration across sectors and stakeholders.
Invest in data and systems.
Navigate operational issues to strengthen health services in criminal justice settings.
Assess and resolve differences in healthcare quality and access standards.
Tackle the challenge of unpredictable release dates and short stays.
Prioritize building community capacity to provide services after release.
Prepare the correctional and community workforce.
Build accountability for service provision across sectors.
This policy brief reviews recent developments in Medicaid’s role in supporting individuals reentering communities following incarceration as of mid-2025. Congress and the Centers for Medicare & Medicaid Services (CMS) have introduced significant policy changes to ease reentry transitions, improve health outcomes, and reduce recidivism, such as expanding coverage for targeted health services during the pre-release period. Notable federal action includes the 2023 mandate for all states to provide Medicaid and CHIP case management, screenings, and referrals for eligible youth and young adults in the 30 days pre- and post-release, with former foster youth covered until age 26.
Additionally, CMS now allows states, through Medicaid Section 1115 demonstration waivers, to provide a minimum set of services, including case management and medication-assisted treatment, up to 90 days pre-release for incarcerated individuals. As of summer 2025, 19 states have implemented waivers, with eight others pending. Further, beginning January 2026, all states must suspend rather than terminate Medicaid eligibility during incarceration to promote continuity of care. Over $100 million in state planning grants is available to assist states with these transitions and new policy requirements
This chart answers frequently asked questions about the Medicaid 1115 waiver policy and operational expectations laid out in federal guidance and in California, Washington, Montana, and Massachusetts’ approved waivers. As of publication, fifteen additional states and the District of Columbia have proposed reentry waivers to CMS
A Medicaid Reentry Toolkit for States
The Health and Reentry Project's (HARP) toolkit provides practical guidance for state Medicaid agencies and correctional partners as they implement the new Medicaid Section 1115 reentry waivers. They allow Medicaid to cover substance use disorder (SUD) services, including opioid use disorder (OUD) treatment, for up to 90 days before an individual's release from incarceration. As of August 2025, 19 states have received approval for these waivers, which are designed to bridge gaps in treatment by ensuring access and continuity of care during and after incarceration, supporting successful reentry, and reducing negative outcomes such as emergency room use and recidivism.
The toolkit outlines key considerations for building OUD service delivery under the waivers, offering strategies for pre-release and post-release care coordination, Medicaid enrollment, technical assistance, service delivery models, and payment systems. It incorporates best practices, implementation models, and performance measures to help states and correctional facilities efficiently expand access to high-quality, evidence-based OUD treatment for Medicaid beneficiaries returning to their communities.
MAT Initiation Model for Short Stays
This model, developed by HARP with support from the Foundation for Opioid Response Efforts (FORE), provides a structured approach for initiating medication-assisted treatment (MAT) for opioid use disorder (OUD) among individuals experiencing short jail stays, typically lasting seven days or less. Recognizing the limited window for intervention, the Health and Reentry Project (HARP) model outlines a coordinated, time-sensitive process that begins at intake and continues through immediate post-release follow-up. This framework aims to improve access to life-saving treatment and reduce overdose risk following release.
Pre-release case managers facilitate electronic referrals within the first two days and link individuals to community MAT providers. Facility staff then coordinate handoffs, discharge documentation, and post-release continuity of care. The model emphasizes proactive communication, flexibility around variable release dates, and integration with community-based case management to support safe and effective reentry.
key steps include:
Screen for OUD and withdrawal
Obtain necessary consents
Initiate medications for opioid use disorder (MOUD) protocol
Arrange post-release treatment with community providers
Provide naloxone and usage training
Facilitating Collaborative Systems Transformation through the Medicaid Reentry Waiver
This report examines how a peer learning network supported 11 California counties in implementing the Medicaid Reentry Section 1115 Demonstration Waiver under the state’s CalAIM Justice-Involved (JI) Initiative. The initiative, approved in 2023, marks a national first by allowing Medi-Cal to provide pre-release health services to incarcerated individuals 90 days before release, bridging the gap between correctional and community health systems. Funded by the MacArthur Foundation’s Safety and Justice Challenge and led by Justice System Partners (JSP) with the Health and Reentry Project (HARP), the effort fostered cross-sector collaboration among correctional health, behavioral health, managed care, and justice partners. The learning collaborative included virtual sessions, surveys, and a two-day statewide convening designed to share strategies, identify challenges, and strengthen county-level implementation.
A product of the aforementioned collaborative process, “Implementing the Medicaid Reentry Waiver in California” presents the county-level policy and operational insights that emerged. Drawing from interviews, group discussions, and convenings, it highlights how counties are adapting their jail health care, reentry planning, and community linkages, translating the collaborative learning into concrete implementation strategies.
State Planning Grants to Promote Continuity of Care
The Centers for Medicare & Medicaid Services (CMS) announced the State Planning Grants to Promote Continuity of Care for Medicaid and CHIP Beneficiaries Following Incarceration, authorized under Section 206(a) of Division G of the Consolidated Appropriations Act (CAA), 2024. These four-year planning grants, awarded in 2025 to 29 states and territories, support efforts to strengthen operational systems that ensure Medicaid and CHIP coverage continuity for individuals transitioning from incarceration back into the community.
The grants fund activities that help states comply with new federal requirements: beginning January 1, 2025, states must provide specific Medicaid and CHIP services to eligible juveniles leaving public institutions, and as of January 1, 2026, they may not terminate eligibility for incarcerated individuals. Funds are designated for addressing logistical barriers and modernizing systems across state, tribal, and local correctional facilities to improve healthcare continuity during reentry. CMS also issued a Q&A resource to guide implementation and encourages stakeholders to visit its Reentry Services webpage for related initiatives.
A New Way Home:
Medicaid & Reentry Symposium
In April 2024, the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) and the Massachusetts Law Reform Institute (MLRI) hosted a symposium highlighting opportunities and limitations related to Medicaid Section 1115 Waivers for pre-release coverage of people leaving incarceration, encouraged networking amongst stakeholders involved in the policymaking process, and explored barriers and solutions to collaboration. Among the Symposium’s themes were the need to meaningfully involve people with lived experience and community-based organizations in planning for these programs, and the potential of these programs to improve the health of individuals and communities disproportionately impacted by incarceration.
“The importance of ensuring health care access for justice-involved youth cannot be overstated. If our goal is to position youth to do well and to keep communities safe, we must ensure that the youth’s health needs are met.
The recent changes to the Medicaid policy present a remarkable opportunity to do just that.”
Michael Umpierre, Center for Youth Justice
State Implementation of New Policies to Strengthen Continuity of Care for Youth at Reentry
This issue brief examines the implementation of new Medicaid reentry provisions for youth and young adults leaving incarceration. The 2023 Consolidated Appropriations Act created the first federal exception to Medicaid’s inmate exclusion since 1965, permitting states to cover certain screening, diagnostic, and case management services in the 30 days before and after release. These changes aim to maintain health coverage and continuity of care, reduce recidivism, and support successful reentry into communities. Drawing on early implementation examples from Massachusetts, North Carolina, and New Mexico, the brief highlights effective state strategies, such as cross-agency coordination, prompt Medicaid enrollment, and early transition planning, that link justice-involved youth to essential community-based care.
Engaging Community Organizations in Redesigning Reentry
Role: community organizations
This webinar introduces how new Medicaid policies, such as state 1115 waivers and upcoming youth-focused initiatives, are creating opportunities for community organizations to support people transitioning from incarceration. These organizations are now included in Medicaid coverage under the "inmate exclusion policy." Their contributions include addressing health, behavioral health, and social needs, and reducing barriers to reentry through trusted, community-based support.
Essential Connections: Facilitating Healthy Transitions
role: community health centers
This issue brief highlights the role of Community Health Centers (CHCs) in supporting people transitioning from incarceration. CHCs offer integrated medical, behavioral, and social care. They can prepare for transitions by coordinating care and referrals before release. CHCs play a key role in building trust and reducing barriers to care. The issue brief also helps CHCs support healthy transitions and promote high-quality reentry outcomes through person-centered care.
Engaging People with Lived Experience
role: peers
This article explores the importance of involving people with lived experience of incarceration, either personally or through family, in reentry efforts. These individuals provide peer support, help identify barriers and needs, and support successful transitions. Organizations are encouraged to hire and support them in outreach and service roles, offering compensation and meaningful involvement. Their recommendations and insights improve service delivery, inform policy development, and help build trust with those reentering the community.
