On January 26, 2023, the Centers for Medicare & Medicaid Services (CMS) approved California’s Section 1115 waiver to provide coverage for pre-release services to certain incarcerated individuals 90 days prior to release. The “first-of-its-kind” initiative will help youth and adults access critical behavioral health care before returning home.
The demonstration waiver aims to reduce “adverse health outcomes (including but not limited to decompensation, suicide-related death, overdose, overdose-related death, and all-cause death) in the period preceding their release, immediately afterward, and in the near term.” Key aspects of the waiver include:
- Eligibility: Pre-release services will be available to all Medicaid beneficiaries and individuals who would be eligible for CHIP but for their incarceration status and who are inmates in state prisons, county jails, and youth correctional facilities. Such individuals can receive services up to 90 days immediately prior to release as long as they meet site-specific health-related criteria.
- Health-related criteria: Criteria include confirmed or suspected mental health diagnosis, substance use disorder (SUD), chronic condition or significant non-chronic clinical condition, intellectual or developmental disability, traumatic brain injury, positive test or diagnosis of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), or currently pregnant or within a 12- month postpartum period.
- Pre-release services: Available services include in-reach case management services, physical and behavioral health clinical consultation services, lab and radiology services, medications and medication administration, treatment with medication for SUD with accompanying counseling, and services of community health workers and community navigators with lived experiences.
The waiver follows the 2018 SUPPORT Act, which directed CMS to issue guidance on how waivers can improve transitions for incarcerated individuals who are otherwise eligible for Medicaid. CMS indicated that the guidance is forthcoming and will closely align with California’s approved approach. So far, 14 additional states are seeking waivers to provide pre-release services to eligible individuals.
Learn more here.
Tweet: @CMSGov approved California’s “first-of-its-kind” Section 1115 waiver to provide coverage of pre-release service to certain incarcerated individuals. The initiative will help youth and adults access critical behavioral health care. Learn more here: https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ca-calaim-ca1.pdf
LinkedIn: On January 26, 2023, the @Centers for Medicare & Medicaid Services approved California’s Section 1115 waiver to provide coverage for pre-release services to certain incarcerated individuals 90 days prior to release. The “first-of-its-kind” initiative will help youth and adults access critical behavioral health care before release. Learn more here: