HHS Authorizes Pre-Release SUD Treatment for Incarcerated People in 5 States

Five U.S. states are now allowed to provide incarcerated people with coverage for substance use disorder (SUD) care and other services before their release.

Medicaid traditionally does not provide SUD treatment to otherwise eligible people who are incarcerated in jails, prisons or youth correctional facilities. Now, the U.S. Department of Health and Human Services (HHS) has authorized Illinois, Kentucky, Oregon, Utah and Vermont to expand coverage to these populations up to 90 days prior to their release.

“For the first time ever, thousands of incarcerated people in Illinois, Kentucky, Oregon, Utah and Vermont will have critical supports during their transition out of a carceral setting, thanks to this important health care coverage,” Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure said in a statement. “At the heart of that work are Medicaid and CHIP — programs that continue to bring states and the federal government together to meet the needs of our communities. Under the Biden-Harris Administration, that’s meant more innovation than ever before to enhance public health and public safety.”


SUDs disproportionately impact incarcerated people. Approximately 65% of incarcerated people in the U.S. have an SUD, according to the National Institute on Drug Abuse.

Lack of coverage of SUD services prior to release can result in delayed treatment and worsened health outcomes.

To address this disparity and create a stable pipeline to treatment and recovery, states can submit Medicaid Reentry Section 1115 waivers to petition HSS to allow for coverage before an incarcerated person’s release.


California paved the road to achieving this flexibility, and Massachusetts, Montana and Washington have followed suit.

Industry insiders told Addiction Treatment Business in February that they expect waivers allowing SUD services for incarcerated people will become increasingly common.

Indeed, CMS has now streamlined the waiver process to set the stage for other states to continue the trend. The agency developed a standardized application process to expedite the approval of these requests.

For incarcerated people with SUDs, the increased coverage will provide enhanced continuity of care, enhanced SUD care access before their release and improved transitions back to the community, according to HHS.

HHS’ authorization also includes access to other health care services besides SUD care, including physical care.

“For people involved in the justice system, ensuring a successful transition back into the community includes having the health care supports and services they need,” HHS Secretary Xavier Becerra said in a statement. “I’m pleased to see more and more states putting resources behind efforts that will ensure these individuals have what they need to thrive.”

The decision will also increase the utilization of stabilizing medications, like long-acting injectables for SUDs, increase investments in health care services aimed at incarcerated people and reduce unnecessary emergency department visits, according to HHS.

Outcomes like reduced ED visits are what makes giving benefits to incarcerated individuals a “win-win,” Cooper Zelnick, chief revenue officer at opioid use disorder (OUD) treatment provider Groups Recover Together, previously told ATB.

“If you can give people access to benefits, they are much more likely to pursue care,” Zelnick said. “That care is likely to have a positive impact on recidivism, which massively reduces the cost center that is our criminal justice system, and on top [of that, you get positive] health outcomes, so it’s win-win.”

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