U.S. flag

An official website of the United States government

Reentry Section 1115 Demonstration Opportunity

Demonstration Opportunity

The Centers for Medicare & Medicaid Services (CMS) issued guidance for designing demonstration projects under section 1115 of the Social Security Act (the Act) (42 U.S.C. § 1315) to improve care transitions for certain individuals who are soon-to-be former inmates of a public institution (hereinafter referred to as incarcerated individuals, except when quoting from statute) and who are otherwise eligible for Medicaid.   The opportunity continues to implement section 5032 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) (Pub. L. No. 115-271), Promoting State Innovations to Ease Transitions Integration to the Community for Certain Individuals.

As mandated in section 5032, the Department of Health and Human Services (HHS) convened a stakeholder group to develop best practices for states to ease health care-related transitions for incarcerated individuals to the community and to develop a Report to Congress (RTC). On December 1, 2022, HHS transmitted the RTC to Congress.  Additionally, section 5032 directs the Secretary of HHS, through the Administrator of CMS, to issue this State Medicaid Director Letter (SMDL) regarding opportunities to design demonstration projects under section 1115 of the Act to improve care transitions for incarcerated individuals exiting a public institution and who are otherwise eligible for Medicaid, and to base this guidance on best practices identified in the RTC.

These demonstrations will test innovative approaches to coverage and quality to improve care transitions, starting pre-release, for individuals who are incarcerated, thereby facilitating improved continuity of care once the individual is released.  Further, improving care transitions will likely help these individuals access high-quality, evidence-based, coordinated, and integrated care during reentry.

Approved States
StateDemonstration
ArizonaArizona Health Care Cost Containment System
CaliforniaCalifornia Advancing and Innovating Medi-Cal (CalAIM)
ColoradoColorado Expanding the Substance Use Disorder Continuum of Care
HawaiiHawaii QUEST Integration
IllinoisIllinois Behavioral Health Transformation
KentuckyTEAMKY
MarylandMaryland Health Choice
MassachusettsMassHealth Medicaid and Children’s Health Insurance Plan (CHIP) Section 1115 Demonstration
MontanaMontana Healing and Ending Addiction through Recovery and Treatment (HEART)
North CarolinaNorth Carolina Medicaid Reform Demonstration
New HampshireSubstance Use Disorder, Serious Mental Illness, and Serious Emotional Disturbance, Treatment Recovery and Access
New MexicoNew Mexico Turquoise Care
OregonOregon Health Plan
PennsylvaniaPennsylvania Keystones of Health
UtahMedicaid Reform 1115 Demonstration
VermontVermont Global Commitment to Health
WashingtonWashington Medicaid Transformation Project
West VirginiaEvolving West Virginia Medicaid's Behavioral Health Continuum of Care

Monitoring and Evaluation Materials: Coming Soon!

Learning Collaboration and Other Resources

Templates for a Section 1115 Reentry Demonstration Initiative

These three templates are intended to accelerate CMS's review of reentry demonstration initiative applications and to support state implementation planning and related transparency by standardizing the presentation of key information necessary for approvals, thereby reducing rounds of clarifying questions with state applicants. The three templates include the: (1) reentry demonstration initiative preprint, (2) reentry implementation plan template, and (3) reentry budget neutrality formulation workbook. The below linked templates are strongly encouraged but optional.

  • Reentry Demonstration Initiative Preprint: This tool is a fillable PDF, whose use is strongly encouraged by CMS, that may help a state further clarify its proposed reentry demonstration design parameters reflected in the state's application for CMS consideration. This form is intended to capture the key features of the state's proposed reentry demonstration initiative and is not a substitute for a Section 1115 demonstration application and transparency requirements. Instructions for this tool can be found here.
  • Reentry Implementation Plan Template:  This template may help a state document the approach to implementing a section 1115 Reentry demonstration initiative and help establish what information the state will report in its monitoring reports by describing whether and how the state will phase in implementation. This does not supersede or replace standard CMS approval processes.
  • Reentry Budget Neutrality Formulation Workbook: This workbook is specific to reentry demonstrations. CMS strongly recommends that states complete this workbook to support more timely and effective development of the expenditure ceilings for the reentry demonstration initiative approval and under which that demonstration will operate. This workbook has been designed to reduce user burden by tailoring the required input for reentry demonstration initiatives and automating calculations where possible.

MAC Learning Collaboratives (Expanding Coverage Under Medicaid and CHIP)

CMCS Medicaid & CHIP All State Calls

Background on the Intersection Between Incarceration and Health

Resources for Learning About the 1115 Reentry Opportunity