This project is a partnership between NASHP and The Health and Reentry Project (HARP).
Two years ago, NASHP, in partnership with the Health and Reentry Project (HARP), launched the first national network that convened both state health and correctional leaders. We built the NASHP/HARP Learning and Action Network (LAN) with the generous support of the Commonwealth Fund to recognize and support the vital role of state leadership in implementing groundbreaking Medicaid changes to strengthen access to care as people return to communities from incarceration. The LAN has served as a national catalyst, bringing states together to share innovative approaches, strategize on ways to tackle shared challenges, and break down longstanding silos that have separated health and corrections agencies.
Since then, states across the country have begun implementing the first-ever policies to support youth and young adults returning to communities from incarceration by strengthening access to screening and case management. They are in the process of making Medicaid enrollment more continuous as people of all ages leave prison and jail by suspending, rather than terminating, Medicaid eligibility. These policies were established in two pieces of federal bipartisan legislation, the Consolidated Appropriations Acts of 2023 and 2024.
In addition, 27 states and Washington, DC, are taking another opportunity Congress created through bipartisan legislation enacted in 2018: using Medicaid 1115 waivers to strengthen continuity of care by providing targeted pre-release services to adult Medicaid beneficiaries as they return from incarceration. Additional states are following their lead.
This month, the LAN comes to a close. But the work of building access to care for people who are returning to communities continues. Over the past two years, states have put in place the first building blocks to provide access to care as people return. And they have also gone well beyond the basics: they have imagined, designed, and executed innovations to build bridges across the correctional and community divide. In the process, state leaders have partnered with a diverse array of state and local government actors, recruited and learned from community partners, and engaged with people who have been incarcerated to develop programs that meet people’s needs. We conclude the LAN by offering a few examples of states’ innovations so far with the hope that these examples inspire and inform all states to build on these groundbreaking efforts.
Implementing New Youth and Young Adult Continuity of Care Requirements: New Hampshire
As of January 1, 2025, all states are required to use Medicaid and the Children’s Health Insurance Program (CHIP) to cover certain services provided to eligible youth and young adults in state prisons, local jails, Tribal jails, juvenile detention, and youth correctional facilities. These policies were authorized in the Consolidated Appropriations Act of 2023.
The services include screening and diagnostic services to identify physical, dental, and behavioral health needs and targeted case management to identify and address physical health, behavioral health, and health related social needs. Eligible youth must be under the age of 21 or be former foster care youth under the age of 26 who are eligible for or enrolled in Medicaid or CHIP and are incarcerated post-adjudication.
For some states, implementing this law marks the first time their Medicaid and corrections systems are collaborating at this level of intensity. In New Hampshire, the state went live with services in state prisons and the state’s only youth facility in January 2025, leveraging their Managed Care Organizations to provide care management and connect to providers in the community for pre-release and post-release services. The state also leveraged a Centers for Medicare and Medicaid Services (CMS) grant to provide dedicated eligibility support for community reentry participants, including an inbox to provide real-time support to check eligibility, support new applications, suspend/reactivate enrollment, and answer questions. Additionally, the state is about to enter into a contract with an insurance navigator agency to support its carceral facilities in assisting individuals with identifying appropriate insurance coverage, prior to release.
The state is now focused on implementation in county jails, which have a smaller population of eligible, post-adjudicated youth, starting with information gathering. The state sent each county a readiness assessment survey requesting information on how they currently provide services, who provides services, their technological capacity for telehealth and information sharing, and other key indicators of readiness to implement. There has been a strong county response, and the first county is expected to go live with services in June 2026 with other counties to follow.
The CMS grant funding will also be used to support a project director and fund infrastructure support for county facilities (for example, one county has requested support with implementing telehealth capabilities). Key to the states’ early success has been bi-weekly operational meetings with key facility staff, managed care organizations, and other key stakeholders.
State Support for Local Coordination: North Carolina
Ensuring that individuals can be seamlessly referred to available, accessible services in the community at reentry is key to achieving continuity of care for people leaving incarceration. Collaboration across corrections and community providers is essential to creating coordinated systems that can connect individuals to critical supports shown to reduce recidivism, improve public safety, and strengthen health and quality of life for individuals returning from incarceration.
To support this collaborative approach, North Carolina established Local Reentry Councils (LRCs) as a statewide strategy to connect returning citizens with community-based health, reentry, and quality of life supports through structured partnerships and coordinated referral networks. Authorized through recommendations from the 2010 Joint Select Committee on Ex-Offender Reintegration into Society, the model positioned the North Carolina Department of Adult Correction Rehabilitation and Reentry division as the lead coordinating agency responsible for statewide implementation, technical assistance, and expansion.
LRCs are collaboratives of stakeholders that serve as a local hub for aligning services. This integrated model improves transitions of care by enhancing coordination and aligning resources, leading to strengthened case management continuity and reduced service gaps during reentry. They operate through intermediary agencies that administer funding, convene stakeholders, and coordinate day-to-day operations. Each LRC includes a broad membership body and an executive committee of probation and parole, prison staff, health and community-based service providers, advisory members, and community leaders who guide operations, ensure accountability, and coordinate system priorities. Key partners include workforce development agencies, behavioral health providers, housing providers, community colleges, faith-based groups, local governments, and nonprofits that support pre-release planning, service coordination, and post-release stabilization. As of 2026, North Carolina maintains 20 state-funded LRCs serving 26 counties, with up to 31 councils operating in 2025.
Guided by Executive Order No. 303 (2024), North Carolina is advancing its participation in the Reentry 2030 initiative through a whole-of-government approach focused on improving coordinated access to health, housing, and employment supports for justice-involved individuals. Within this effort, the LRC model serves as a foundational platform for aligning transition services and strengthening continuity of care across systems. The next phase under Reentry 2030 focuses on scaling LRC services toward statewide coverage across all 100 counties through targeted expansion in unserved areas, regionalization of counties for resource-sharing, increased county engagement, strengthened sustainability planning, expanded technical assistance, and deeper interagency coordination.
The LRCs set up crucial infrastructure and cross-system connections to support pre- and post-release services for individuals leaving incarceration, including to implement North Carolina’s Medicaid 1115 waiver reentry initiative and the new requirements to cover certain services provided to eligible youth and young adults in correctional facilities.
Data and Systems Integration for Eligibility and Enrollment Activities: Utah
In July 2024, Utah received approval from CMS for a Medicaid 1115 waiver reentry initiative that provides limited coverage for up to 90 days for a targeted set of services to incarcerated individuals in state prisons, county jails, or juvenile facilities. Utah, like all states, is also in the midst of implementing requirements to cover certain services provided to eligible youth and young adults in correctional facilities. For effective implementation of Medicaid 1115 waiver reentry initiatives and the new services for youths and young adults, data need to flow between correctional facilities and state Medicaid agencies to facilitate Medicaid eligibility and enrollment activities and billing.
To achieve this, Utah expanded on existing criminal justice system data infrastructure, leveraging a data platform hosted by the Utah Commission on Criminal and Juvenile Justice (CCJJ), to whom jails are legislatively mandated to send custody data from their jail management system. Individual-level data sent to CCJJ includes the facility name, identifying information, date of incarceration, and expected release date.
In a partnership among the CCJJ, Medicaid, Department of Workforce Services’ technology team, the Utah Department of Technology, and the Department of Corrections technology teams, Utah built on this system by adding to the jails’ data sharing agreements with CCJJ to allow CCJJ to send data to Medicaid and by developing the software interface to send data to the state Medicaid program. The interface went live on February 14, 2026, and facilitates the timely sharing of data: jail data is sent to CCJJ in real time and then to the Medicaid eligibility team within minutes. These data help enable Medicaid enrollment activities on the front end of a person’s jail admission, allowing the Medicaid eligibility team to approve applications more efficiently. They also automate suspending Medicaid during incarceration and reactivating it under an “incarcerated benefit” in the 90-day pre-release period during which Utah is approved to provide a targeted set of Medicaid-covered services under their waiver.
The state is in the process of continuous testing of the interface to track and address any issues with data validation before moving forward with plans to add additional counties, and eventually the prison system, to the platform.
Courts, Corrections, and Health Partnerships Support Coordination and Connection to Services: Kentucky
Identifying an individual’s health and behavioral health needs early in their contact with the criminal justice system can foster timely connection to services during reentry. Courts can play a leading role in early identification of these needs and collaborate with jails, health systems, and community supervision partners to coordinate treatment and align supervision strategies. This ensures that individuals do not experience gaps in treatment at release.
Kentucky is advancing a statewide, cross-system approach to reentry that strengthens continuity of care for justice-involved individuals transitioning from incarceration back into the community. This includes a Medicaid 1115 waiver reentry initiative and implementation of the new requirements to cover certain services provided to eligible youth and young adults in correctional facilities, among other efforts. Their efforts recognize that successful reentry requires courts, correctional agencies, jails, behavioral health providers, and community organizations to work collaboratively to identify needs early, coordinate treatment and supervision strategies, and maintain communication throughout the reentry process. By aligning systems and services, Kentucky aims to reduce recidivism, improve health outcomes, and support long-term recovery and stability.
At the center of this effort is the Kentucky Judicial Commission on Mental Health, established by the Kentucky Supreme Court order in 2022 to improve statewide responses for individuals experiencing mental illness, substance use disorders, and intellectual or developmental disabilities across justice systems. Led by Deputy Chief Justice Robert Conley, the Commission serves as a statewide convener, bringing together partners across criminal justice, health care, behavioral health, juvenile justice, and community-based organizations to advance shared goals and strengthen collaboration across systems.
Through workgroups focused on reentry, diversion, competency restoration, and treatment access, the Commission promotes cross-sector coordination, strengthens referral pathways. It also supports local problem-solving efforts through Sequential Intercept Mapping to help communities identify service gaps, improve communication between systems, and improve continuity of care at the local level.
Within this statewide strategy, Kentucky emphasizes the critical role of courts and judges in advancing reentry through evidence-based practices and coordinated service delivery. Courts increasingly serve as hubs for collaboration by working closely with probation and parole, behavioral health providers, local detention centers, and local service agencies to align supervision strategies with treatment and reentry needs. Together, these judicial, correctional, and health partners support continuity of care by supporting earlier reentry planning, improving service connections, stabilizing transitions back into the community, and strengthening long-term reentry outcomes across Kentucky.
Engaging Current and Formerly Incarcerated Individuals in Policy: New Mexico
Having individuals who are currently and formerly incarcerated “at the table” as experts to inform policy and program design, structure, and execution strengthens implementation of interventions focused on people who are incarcerated.
In New Mexico, the Health Care Authority, which oversees the state’s Medicaid program (including its reentry 1115 waiver and the Consolidated Appropriations Act of 2023 implementation work, collectively referred to in the state as JUST Health Plus), and the New Mexico Corrections Department have partnered extensively with the University of New Mexico/Project ECHO Community Peer Education Program (CPEP). CPEP trains incarcerated individuals to become peer educators, addressing critical health issues inside correctional facilities, such as hepatitis C and addiction.
CPEP participants have become key partners to the state as part of reentry policy implementation, helping to increase understanding, awareness, and buy-in for newly changed or expanded services. Peers have been central partners in designing ways to maximize the impact of JUST Health Plus. For example, currently incarcerated CPEP participants helped design and provided art for a comic book series explaining the basics of Medicaid and what changes were taking place under the state’s JUST Health Plus initiative.
CPEP peers assisted state officials in communicating the impact of health and reentry changes to county detention center (local jail) partners, who are implementing JUST Health Plus in a later phase than the state’s prisons. Peers with lived experience have also presented at quarterly state-led stakeholder public forums, sharing their experiences of being incarcerated and how new policies have the potential to change lives.
Communicating the Impact of Reentry Waiver Implementation: California Reentry Initiative
As states begin to implement services under reentry waivers, they are conducting early evaluations to assess effectiveness, identify areas of continuous program improvement, and communicate findings with key partners. Understanding these impacts plays an important role in advancing and informing future policy.
California was the first state to be approved for a reentry waiver in 2023 and the first state to start providing Medicaid-covered pre-release services under its waiver, with some counties going live in October 2024 and other counties and the prison systems following. In March 2026, California released the From Incarceration to Care: California’s Medi-Cal Reentry Initiative Impact Report to highlight progress and lessons learned in the early years of implementation. As of February 2026, 31 state prisons and 33 county jail and youth correctional facilities have started providing pre-release services. Over 159,000 billable pre-release services and prescriptions have been provided to incarcerated individuals across state and county facilities.
Authored by the California Department of Health Care Services, the report and features quotes from people with lived experience of incarceration, state agency partners, county jails and health departments, managed care plans, community providers, and more on the implementation process and early outcomes.
A Captain in the Yuba County Jail reported that the impact on the community is already visible, noting, “The proof is in the pudding. When we don’t see these people back in jail, we see them thriving on the street, we see patrol officers not dealing with them — it literally affects the whole community and our departments now that we have full wraparound services taking care of Reentry populations.”
An individual served by the Reentry Initiative described how important the relationship with their case manager is to their reentry success, sharing, “My life after prison would have been much more difficult to rebuild without ECM and especially without my wonderful care manager…. She had so much compassion for me and connected me with other resources that helped me to acquire my goals.”
While California’s additional evaluation of the impact of the policy is underway, the impact report reflects initial proof of concept of California’s efforts to improve health outcomes by connecting individuals to physical and behavioral health services when they reenter the community.
States have led the way in implementing the first Medicaid policy changes to strengthen continuity of care as people return to communities have taken place. State leaders continue to build on this work by expanding access to health care services pre- and post-release, strengthening partnerships, and building technological solutions to more effectively share information across sectors.
States interested in learning more about this work can take advantage of the NASHP/ HARP Rentry Resource Repository and engage with NASHP directly by contacting Elaine Chhean at echhean@nashp.org. They can also contact HARP, which offers technical assistance to help state and local governments effectively implement health and reentry policies. Email TA@healthandreentryproject.org to learn more about HARP’s technical assistance offerings.
