California Secures Federal Approval of Its Justice-Involved Section 1115 Medicaid Waiver
January 26, 2023
Today, the federal Centers for Medicaid and Medicare Services (CMS) notified California that it is the first state in the nation to receive approval to offer a targeted set of Medicaid services to youth and adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release. Through a federal Medicaid 1115 demonstration waiver, the Department of Health Care Services (DHCS) will work with local partners and stakeholders to establish a coordinated community re-entry process to assist individuals leaving incarceration to connect to the physical and behavioral health services they need upon release.
Until now, due to a provision of federal Medicaid law known as the “inmate exclusion,” inpatient hospital care was the only service that could be covered by Medicaid for incarcerated individuals. According to DHCS, more than one million adults and youth enter or are released from California prisons and jails annually, and at least 80 percent of these justice-involved individuals are eligible for Medi-Cal.
The intent of the demonstration is to build a bridge to community-based care for justice-involved Medi-Cal members, offering them services to stabilize their condition(s) and establishing a re-entry plan for their community-based care prior to release to improve health outcomes and prevent unnecessary admissions to inpatient hospitals, psychiatric hospitals, nursing homes, and emergency departments, and reduce overdose, suicide, homelessness, and recidivism.
The waiver additionally authorizes $410 million for Providing Access and Transforming Health, Justice-Involved Capacity Building grants to support collaborative planning, and IT investments intended to support implementation of pre-release and reentry planning.