New CMS Demo Could Help Incarcerated Individuals Get More SUD Care

The Centers for Medicare & Medicaid Services (CMS) is rolling out a new demonstration that could help expand access to substance use disorder (SUD) services by allowing state Medicaid plans to cover incarcerated individuals before release.

Specifically, the demonstration allows state Medicaid programs to cover a package of pre-release services up to 90 days before a person is released from prison. Typically, individuals lose Medicaid coverage when they are incarcerated, and this can create a gap in care from when an individual is released to when they have Medicaid coverage.

About 85% of the prison population has an SUD, and individuals leaving incarceration are at a higher risk of opioid overdose deaths. In fact, in the two weeks after leaving incarceration, individuals are 40 times more likely to die from an opioid overdose than the general public.


This isn’t the first time CMS has taken steps to address this issue.

In January, the U.S. Department of Health and Human Services (HHS) and CMS approved an 1115 demonstration amendment in California, which allowed Medi-Cal to cover SUD treatment before a Medicaid beneficiary is released from jail, prison or a correctional facility.

“The Biden-Harris Administration has made expanding access to high-quality, affordable health care a top priority,” HHS Secretary Xavier Becerra said in a statement. “We are committed to ensuring all Americans have the peace of mind they deserve knowing they have access to life-saving health care, whether it is medication-assisted treatment for substance use disorders or prescription medication to treat other chronic health conditions.”


Federal lawmakers are also looking to expand access to Medicaid for individuals leaving incarceration with a new bill dubbed The Reentry Act. The bipartisan legislation aims to expand Medicaid access to incarcerated individuals up to 30 days before release.

Advocates in the SUD space have noted the benefits of allowing incarcerated individuals to keep their benefits for some time.

“If [we] allowed incarcerated individuals … to retain their insurance, like their Medicaid or Medicare, or whatever insurance they have,” Meghann Perry, a recovery coach professional educator and person with lived experience of substance addiction and incarceration, previously told BHB, “we’d be able to provide them much better medical care and behavioral health care while incarcerated, which would really support them doing much better when they transition back into the community and not have that gap.”

CMS’ plan comes less than a month before the public health emergency ends – and with it, the special circumstances that allowed more individuals to retain their Medicaid coverage without meeting redetermination criteria.

In addition to expanding access to SUD care, the new CMS proposal looks to improve coordination and communication between correctional systems, Medicaid systems, managed care plans and community-based providers.

“This guidance outlines a pathway to implement historic changes for individuals who are incarcerated and eligible for Medicaid,” CMS Administrator Chiquita Brooks-LaSure said. “By improving care and coordination prior to release from the justice system, we can help build a bridge back to the community and enhance individual and collective public health and public safety outcomes.”

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