Medicaid is a vital source of coverage for the almost four million justice-involved people who live in the community — and who are disproportionately poor and people of color. Upon release from prison or jail, many face significant obstacles accessing medical and behavioral health care services. Therefore, many state Medicaid programs, and the federal government, are looking at ways to improve continuity of coverage.

A major obstacle states face in trying to improve access to care for justice-involved people is the Medicaid inmate exclusion policy, which prohibits use of federal Medicaid funds for most health care services during incarceration. One way a growing number of states are trying to support reentry for justice-involved people is by providing Medicaid services before release from prison or jail through a Section 1115 demonstration waiver.

In April 2023, the Centers for Medicare & Medicaid Services (CMS) issued new guidance outlining opportunities for states to design 1115 demonstration projects to improve care transitions for incarcerated people. Earlier this year, California became the first state to receive approval to waive the inmate exclusion and provide some Medicaid services in the 90 days before release. An additional 14 states have pending reentry demonstration proposals before CMS.

SHADAC produced this issue brief, Opportunities to Learn More About Serving Justice-Involved Individuals Through 1115 Demonstration Evaluations, with support from CHCF. It provides an overview of the 15 current justice-involved 1115 demonstration initiatives and summarizes what is known from existing evaluations of these activities. It also identifies opportunities to design robust and equity-focused 1115 demonstration evaluation plans specific to justice-involved populations.