In a groundbreaking shift toward equitable healthcare access, five states—Illinois, Kentucky, Oregon, Utah, and Vermont—have been granted federal approval to provide Medicaid-covered healthcare in prisons and jails for individuals up to 90 days before their release. This historic move addresses long-standing gaps in care for incarcerated people, particularly those living with substance use disorders (SUDs).
Traditionally, Medicaid has excluded coverage for incarcerated individuals, leaving thousands without vital treatment as they reenter society. The new initiative, supported by the U.S. Department of Health and Human Services (HHS), marks a pivotal moment in aligning justice reform with public health priorities.
Addressing the Gap: Why This Matters
According to the National Institute on Drug Abuse, about 65% of incarcerated people in the U.S. have a substance use disorder. Yet, the majority are released without a care plan, medication, or support—leading to high relapse and overdose rates shortly after reentry. The policy of denying healthcare in prisons and jails has long undermined efforts to treat addiction as the chronic condition it is.
Chiquita Brooks-LaSure, Administrator of the Centers for Medicare & Medicaid Services (CMS), emphasized the significance of the change:
“For the first time ever, thousands of incarcerated people… will have critical supports during their transition out of a carceral setting, thanks to this important health care coverage.”
The Role of Section 1115 Waivers
This policy evolution is made possible through Medicaid Reentry Section 1115 waivers, which allow states to test new approaches in Medicaid service delivery. These waivers give states the ability to provide healthcare in prisons and jails before an individual’s release, helping to close the treatment gap and reduce preventable deaths.
California was the first to pilot this initiative, with other states like Massachusetts, Montana, and Washington following suit. Now, with CMS streamlining the waiver process, the path has been paved for more states to adopt similar programs.
What’s Covered Under the New Policy?
The waiver doesn’t just apply to SUD care—it expands access to a broad range of healthcare in prisons and jails, including:
- Medication-assisted treatment (MAT) for opioid use disorder
- Mental health services, including psychiatric care
- Chronic disease management, such as for diabetes and heart disease
- Case management and care coordination
- Discharge planning and referrals to community-based services
By starting treatment in custody and continuing care after release, these services ensure a smoother, more stable transition.
Transforming Reentry: The Broader Impact
The consequences of neglecting healthcare in prisons and jails are well-documented: increased overdose risk, higher recidivism, and strained emergency systems. This new model focuses on continuity of care, which supports public health and improves public safety.
HHS Secretary Xavier Becerra highlighted the far-reaching effects:
“Ensuring a successful transition back into the community includes having the health care supports and services they need… I’m pleased to see more and more states putting resources behind efforts that will ensure these individuals have what they need to thrive.”
Providing healthcare in prisons and jails doesn’t just benefit the individuals—it benefits society at large. It reduces costly emergency visits, encourages long-term recovery, and offers people a real chance to rebuild their lives.
A Win-Win for Health and Justice
Industry experts are applauding the move as a smart investment in health, safety, and economic efficiency. Cooper Zelnick, Chief Revenue Officer at Groups Recover Together, explained:
“If you can give people access to benefits, they are much more likely to pursue care. That care is likely to have a positive impact on recidivism… so it’s win-win.”
By rethinking how we deliver healthcare in prisons and jails, states are not only improving outcomes but also saving money and lives.
The Road Ahead
As more states apply for waivers and CMS accelerates the approval process, we’re witnessing a national shift. Offering healthcare in prisons and jails is becoming a model for how to effectively bridge the gap between incarceration and reentry.
This policy change is about more than expanding Medicaid. It’s about restoring dignity, saving lives, and transforming a justice system that has too often failed to address the root causes of addiction and poor health.
Final Thoughts
The authorization granted to Illinois, Kentucky, Oregon, Utah, and Vermont is a testament to what’s possible when health and justice systems work together. With access to healthcare in prisons and jails, people can start their recovery before they leave incarceration—giving them the tools they need to thrive outside of it.
This is a new chapter in health policy and criminal justice reform. And it’s one worth celebrating.
