California becomes first state to expand Medicaid to incarcerated individuals


Hannah Saunders


On Thursday, California became the first state in the country 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. Prior to this announcement, services were generally available after release from incarceration. 

California’s Department of Health Care Services (DHCS) will establish a coordinated community reentry process through the federal Medicaid 1115 demonstration waiver, which will connect individuals leaving carceral settings to physical and behavioral health services they need upon release. 


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“Californians who reenter the community following incarceration have significant physical and behavioral health needs and are at high-risk of injury and death, especially in the days and weeks immediately following their release,” State Medicaid Director Jacey Cooper said. 

People of color are disproportionately incarcerated. In California, about 29% of the male prison population is Black, despite making up 6% of California’s male population, according to DHCS. Formerly incarcerated individuals are more likely to experience negative health outcomes and face greater rates of physical and behavioral health diagnoses. 

DHCS states that the number of incarcerated individuals in California jails and prisons who are under active care for mental health challenges rose by 63% over the last decade, and about 66% of people in California carceral settings have a moderate or high need for substance use disorder treatment. In the two weeks after release from incarceration, overdose death rates are more than 100 times higher when compared to the general population, according to DHCS. 

“Our justice-involved initiative is a key part of the state’s plan to create a new standard for what person-centered and equity-focused care looks like for all Californians, including the currently and formerly incarcerated,” Cooper said. 

The waiver will provide appropriate healthcare interventions earlier on to reduce acute service use and adverse health outcomes, including decompensation, suicide-related death, overdose, overdose-related death, and all-cause death. The waiver will also improve coordination and communication efforts among correctional systems, Medicaid systems, and community-based providers. According to DHCS, over one million adults and youth enter and are released from carceral facilities in the state each year, and at least 80% of these individuals are eligible for Medi-Cal. 

“Historically, Californians residing in prisons, jails, and juvenile detention facilities have gaps in their healthcare services and transition back into their communities with limited services and without a solid plan,” Secretary of California’s Health & Human Services Agency, Dr. Mark Ghaly, said.

Ghaly explained how individuals living with HIV, hypertension, diabetes, epilepsy, cancer, schizophrenia, or addictions can now expect to have additional support by obtaining medications, appointments, and services they need upon leaving prisons and jails. 

“Through this initiative, those leaving incarcerated settings will have access to services that make it less likely they go straight from an incarcerated setting to an emergency room or hospital,” Ghaly said. “This initiative will have a lasting impact on individuals as they return to the community by providing stable and reliable access to the care they need. We extend our gratitude and thanks to our federal partners for their innovative spirit and collaborative partnership.”

CMS approved California’s first section 1115 demonstration amendment that makes this coverage possible. Pre-release services for incarcerated individuals will be centered around comprehensive care management, including physical and behavioral clinical consultations, labs and radiology, Medication Assisted Treatment (MAT), community health worker services, medications, and durable medical equipment. 

“Of the pre-release services approved in California’s 1115 waiver, a subset, but not all, of those services are currently available and provided to incarcerated individuals,” said spokesman for DHCS, Anthony Cava. ”

Those who are eligible will be assigned a care manager in the carceral setting or through telehealth to establish a relationship, understand health needs, coordinate vital services, and make a plan for community transition, such as connecting people to community-based care managers to work with upon release. 

“In partnership with HHS, the state of California is leading the way in providing coverage to justice-involved individuals,” HHS Secretary Xavier Becerra said. “This is the first time in history Medicaid will be providing coverage to justice-involved individuals before they’re released. It is a step forward in closing gaps in services this underserved community experiences, and I encourage other states to follow California’s lead.”