CLASP Analysis of States’ Plans to Expand Medicaid Pre-Release Services for Incarcerated Populations

In April 2023, the Centers for Medicare and Medicaid Services (CMS) issued guidance to state Medicaid agencies detailing opportunities to expand Medicaid coverage to people up to 90 days before they are released from incarceration. Through a state flexibility known as a Section 1115 demonstration waiver, states may extend coverage to a population that is currently excluded from receiving Medicaid services.  

As states have applied for and implemented these “pre-release” waivers, CLASP has submitted several public comments in support of states using their waiver demonstrations to connect people in carceral settings with community-based health care and non-punitive social and behavioral health services ahead of their release. Research shows that incarcerated people have higher rates of mental illness, substance use disorder, and chronic disease than the general population. Gaps in health care coverage and racial disparities in incarceration rates are key drivers of health disparities for people of color. 

CLASP’s vision for re-entry requires prioritizing community repair and an active divestment from community supervision, including parole and probation systems. Community supervision continues to criminalize individuals and relegates them to second-class citizenship. Community repair, on the other hand, is an anti-carceral policy approach that requires removing corrections and law enforcement from the re-entry process altogether. In seeking approval for 1115 Medicaid demonstration waivers, states should steer investments away from carceral systems and toward community-based supports for people returning to their communities after incarceration. 


CLASP has submitted comments on the following 1115 demonstration waivers:

Washington (August 2022)

New Mexico (January 2023)

Massachusetts (November 2023)

North Carolina (December 2023)

Kentucky (February 2024)

Pennsylvania (March 2024)

Connecticut (May 2024)