Breaking Ground: How California is Using Medicaid to Improve the Health of People Leaving Incarceration

Margot Cronin-Furman
Vikki Wachino
John Sawyer
Silicia Lomax
May 2023
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California leveraged Medicaid waiver authority to cover targeted pre-release services with the goal of improving the health of people reentering the community after incarceration.


People who are incarcerated often have complex health needs that persist upon reentry into the community, where they experience high risk for adverse health events including deaths from heart disease, suicide, and overdose. Medicaid’s inmate exclusion policy has historically prevented Medicaid from covering services for this population during incarceration and it can take time to enroll or re-activate Medicaid upon reentry.


This brief provides an overview of California’s 1115 waiver amendments which now authorize Medicaid and the Children’s Health Insurance Program (CHIP) to cover a targeted set of services to incarcerated individuals starting up to 90 days prior to their release, as a part of California’s Advancing and Innovating Medi-Cal (CalAIM) initiative. Pre-release services include case management, physical and behavioral health clinical consultation, laboratory and radiology testing, prescription and over the counter drug administration, medication assisted treatment for opioid use disorder and alcohol use disorder as well as community health worker services. California noted that this initiative would advance goals related to facilitating greater access to pre-release health care services, provide more timely intervention and advance health equity more broadly.


Over the next several months, California will develop an implementation plan that outlines how this program will be operationalized and proactively address barriers to implementation including consistency across facilities, workforce capacity and accountability mechanisms. Approval of California’s Section 1115 waiver amendments also has national implications as other states who are interested in strengthening Medicaid services for this population can use California’s example to inform their own efforts.

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