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Webinar

Webinar Replay – Medicaid 1115 Justice Involved Reentry Demonstration Opportunities: Engaging Key Stakeholders

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This webinar was held October 22, 2025.

This webinar explored how states, local agencies, and community organizations can maximize Medicaid’s new 1115 demonstration authority to improve reentry outcomes for justice-involved individuals. Presenters discussed practical strategies for assessing health and social needs, building strong collaborations with community providers, and implementing effective Medicaid enrollment processes. Attendees gained insights into designing and operationalizing reentry programs that promote continuity of care, reduce recidivism, and support successful community reintegration. This session is ideal for State Medicaid agencies, carceral facilities, correctional healthcare companies, health plans, community-based organizations, and federally qualified health centers.

Learning Objectives:

  • Understand the health and resource needs of returning citizens (health, behavioral health and social issues).
  • Identify key partners and formalize collaborations to strengthen the quality of transitions, care and support provided to individuals transitioning to the community.
  • Develop Medicaid enrollment strategies that apply to your state and local framework.
Blog

From Policy to Practice: HMA Offers New Toolkit for Tackling the Challenges of Implementing the 1115 Justice-Involved Reentry Demonstration in Carceral Settings

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The Section 1115 Justice-Involved (JI) Reentry Demonstration marks a transformative step in closing the healthcare gap for incarcerated individuals. By allowing Medicaid coverage to resume up to 90 days prior to release, the demonstration aims to improve care continuity and reduce recidivism. Yet, translating this vision into action within jails, prisons, and juvenile detention facilities presents a host of operational challenges. For implementation to succeed, jurisdictions must navigate fragmented systems, strained resources, and competing priorities. That’s where structured tools—like implementation checklists—become essential.

The Challenges: Implementation in Complex, High-Stakes Environments

Implementing the 1115 JI Reentry Demonstration is more than a policy shift—it’s a systemic overhaul that requires cross-agency collaboration, infrastructure alignment, and cultural change. Among the most significant challenges:

1. Fragmented Systems and Data Silos

Carceral systems, Medicaid agencies, and community-based providers often operate in silos, using different data platforms and standards. This fragmentation hinders real-time information exchange and care coordination during the transition from incarceration to the community.

2. Operational Readiness Gaps

Many facilities lack established procedures for conducting Medicaid eligibility screenings, care plan development, and referrals to community-based services within the release window. Without predefined workflows, implementation can stall.

3. Workforce Capacity and Training Needs

Reentry planning demands coordination among correctional officers, social workers, nurses, behavioral health clinicians, and Medicaid staff. Many jurisdictions face staffing shortages and limited training on trauma-informed care, care management, or reentry protocols.

4. Policy Misalignment and Legal Constraints

Local policies may restrict access to Medicaid-related functions during incarceration, or limit facility staff’s ability to share data. Misinterpretation of federal and state rules can create implementation delays.

5. Trust and Engagement Barriers

Justice-involved individuals often face stigma or mistrust from systems they’ve interacted with. Culturally responsive engagement strategies are crucial but frequently underdeveloped.

The Solution: Using a Checklist-Based Implementation Framework

To navigate these hurdles, stakeholders need more than vision—they need structure. Implementation checklists tailored to jails, prisons, and juvenile facilities serve as a practical roadmap that transforms policy goals into operational plans. Here’s how they help:

  • Clarify Roles and Responsibilities

Checklists break down complex goals into clear, role-specific tasks—who enrolls individuals in Medicaid, who develops care plans, and who ensures warm handoffs to community providers.

  • Promote Cross-Sector Coordination

Structured checklists prompt regular touchpoints across agencies—corrections, health services, Medicaid, and behavioral health—ensuring alignment and accountability.

  • Standardize Procedures and Tools

By specifying recommended workflows, assessment tools, and communication protocols, checklists minimize variation and streamline implementation across facilities.

  • Track Progress and Gaps

Built-in progress indicators make it easier to monitor what’s completed, what’s pending, and where additional support or training is needed.

  • Support Compliance and Evaluation

A checklist-based approach provides the documentation trail needed for program audits, reporting, and continuous quality improvement.

Conclusion: A Strategic Tool for Lasting Impact

Implementing the Section 1115 JI Reentry Demonstration is a bold, necessary move toward health equity and system transformation. But success depends on more than ambition. With structured checklists in hand, agencies can move from aspiration to execution—building a thoughtful, well-orchestrated reentry infrastructure that improves health outcomes, reduces recidivism, and meets federal expectations.

Download the HMA JI Toolkit here.

Other 1115 demonstration resources that may be of interest:

Brief & Report

Section 1115 Justice-Involved Reentry Demonstration Implementation Toolkit for Jail, Prison, and Juvenile Settings

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This toolkit provides a set of implementation checklists for Section 1115 Justice-Involved Reentry Demonstrations tailored to three carceral settings: jails, prisons, and juvenile facilities. Each checklist outlines operational tasks across core domains to support effective planning, coordination, and continuity of care pre- and post-release.

This toolkit is intended to provide information for jails, prisons, and youth detention centers in states contemplating submitting a 1115 Justice-Involved Reentry Demonstration, as well as states that have an approved demonstration. All states with approved demonstrations must provide core services, including care management for physical and behavioral health, medication assisted treatment for individuals when clinically indicated before release, and medication in hand at release. It is important to note that states may vary in their populations of focus, care management models, and processes for submitting claims. It is essential to cross-reference your state’s demonstration when planning to operationalize this initiative.

Solutions

HMA helps support Section 1115 Demonstration initiatives across the country

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Section 1115(a) demonstrations, informally known as 1115 waivers, are experimental, pilot, or demonstration projects that give states flexibility to design, test, and evaluate state-specific approaches to improve their healthcare programs and better serve eligible populations.

Approved by the Centers for Medicare & Medicaid Services (CMS), 1115 demonstrations provide alternative options to provide access, coverage, financing, and delivery of services under the joint federal-state funded programs Medicaid and the Children’s Health Insurance Program (CHIP).  Across multiple administrations, HMA has helped states write, design, implement and evaluate their 1115 demonstrations aimed at improving program and population health outcomes.  Stakeholders need to optimize their role in shaping and implementing 1115 initiatives with practical solutions and effective engagement strategies with states.

Medicaid and CHIP 1115 demonstrations allow states—and their stakeholders—to test new innovations to improve the health of enrollees and advance program efficiencies. These demonstrations require careful planning, political savvy, policy knowledge, and ongoing support through the application, approval, and implementation phases. In today’s environment, 1115 programs must be responsive to the policy priorities at the federal level and grounded in solutions that work in the state. Stakeholders need aligned engagement strategies and communications plans to achieve shared goals, including monitoring that drives continuous improvements after implementation.

HMA consultants bring extensive real-world and leadership expertise from decades of working with states and federal agencies prior to joining HMA. We offer the range of services and support needed to advance 1115 programs, including:

Strengthening healthcare safety net sustainability through financial and operational supports

Developing solutions for complex patient populations such as individuals who are justice-involved or have extensive behavioral needs including substance use disorder

Designing coverage strategies for critical social needs, such as community reintegration of vulnerable populations such as the justice involved, including when these require collaboration with agencies and programs beyond Medicaid

Supporting states in meaningful stakeholder engagement efforts, provider training and guidance, and other activities necessary for successful program implementation

Working with managed care organizations, health plans, providers, and other stakeholders to apply our expertise in implementing 1115 demonstrations

HOW HMA CAN HELP

Providing strategic and operational support to design demonstration programs
With several former state Medicaid directors and former CMS officials on staff, HMA helps states design successful new interventions to address the unique needs of their populations and ensures proposals meet CMS’ approval requirements and expectations, including aligning 1115 interventions with evolving federal priorities and objectives for the program. With HMA, states and stakeholders gain valuable insights on strategic engagement and partnerships.  
 
Developing applications for 1115 demonstration proposals
HMA has supported a variety of 1115 initiatives in several states, including developing proposals for new, continuing, and amended 1115 demonstration programs. HMA consultants bring decades of experience in 1115 program design that covers all of the components critical to developing and operating 1115 programs – policy, actuarial and budgeting, operations, communications, project management, and IT.
 
Supporting federal negotiations for approval of state 1115 demonstration proposals
HMA helps states navigate the federal processes to secure approval for their 1115 initiatives. In many cases, HMA joins in active negotiations with the state agency to support federal negotiations. HMA has unique insight into federal approval parameters with former CMS officials.

Operational Support
We help stakeholders—including state agencies and their partners—manage the challenges of implementing new Medicaid or CHIP initiatives, with a focus on ensuring efficient integration and improvements in outcomes.

Evaluation and Assessment of section 1115 demonstrations
Federal regulations require evaluation of CMS-approved 1115 programs. HMA designs and conducts evaluation reports that meet federal requirements, such as hypotheses, data sources, and comparison strategies. HMA’s work on evaluation designs and evaluation reports has been held out by CMS as best practice models to other states for evaluating new policy interventions as well as for ongoing monitoring activities.
 
Developing materials for and supporting stakeholder engagement from design to implementation.
HMA works closely with states and their partners to engage stakeholders early in the 1115 process to ensure that communities and local organizations are involved in the planning and implementation of 1115 programs. 

Project Spotlights

HMA has supported approved section 1115 demonstration programs testing new strategies for addressing substance use disorder (SUD), serious mental illness (SMI), and/or serious emotional disturbance (SED) through new flexibilities around the federal institution for mental disease (IMD) exclusion in seven states (Alabama, Colorado, Delaware, Indiana, Missouri, Ohio, and Oklahoma).  In addition to initial and extension application support, HMA teams also support the evaluation and financial modeling components of 1115 demonstration development. In the last four years, we have delivered six evaluation designs, two midpoint progress assessments, two interim evaluations, and two summative evaluations approved by CMS. In general, HMA’s approved evaluation design plans use multiple evaluation methods, including a mixed-methods approach, drawing from various data sources, measures, and analytics, including quasi-experimental methods, to produce relevant and actionable study findings to conduct analyses. Additional 1115 demonstration program development activities include completing budget neutrality estimates and rate setting for new interventions proposed under demonstrations.

California is the first state in the nation to receive approval from CMS to provide detained and sentenced individuals with 90-day pre-release healthcare services and behavioral health linkages. HMA helps clients build administrative capacity, information technology, pre-release services, care management models, and Medicaid claiming infrastructure to meet their unique needs and leverage this significant state-federal demonstration opportunity. Our planning and implementation support spans the breadth of the CalAIM Justice-Involved Initiative including: the pre-release Medicaid application process, 90-day pre-release services, behavioral health links, Enhanced Care Management (ECM), and Community Supports services.  In addition to California, HMA supported other states, such as Illinois and Maryland, with the design, approval, and/or implementation of justice-involved demonstrations approved by CMS. Learn more about CalAIM Justice-Involved Reentry Initiative Planning and Implementation Services.

HMA has supported multiple states in developing alternate approaches to Medicaid eligibility and enrollment tailored to their unique policy goals. For example, our consultants have worked with the Indiana Family and Social Services Administration on the program design, approval, and implementation of the Healthy Indiana Plan (HIP), Indiana’s alternative Medicaid expansion demonstration program. We also supported the Iowa Department of Health and Human services in developing the Iowa Health and Wellness Plan (IHAWP) 1115 demonstration which provides an alternative benefit design to traditional Medicaid expansion. HMA also supported the Kentucky Cabinet for Health & Family Services (CHFS) with a variety of services related to its section 1115 demonstration, Kentucky HEALTH, the first community engagement program in the nation approved by CMS.

Webinars and other resources:

Blog

Improving healthcare for justice-involved populations: key insights on Medicaid Section 1115 reentry demonstrations

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This week, our In Focus section considers state and local initiatives centered on the intersection of carceral care and state Medicaid programs.

The Health Management Associates (HMA) team includes clinicians and leaders who bring extensive expertise in justice healthcare, Medicaid, managed care, administration and operations, quality and accreditation, and information technology. Drawing on this wealth of experience, we provide five key insights for states, industry professionals, and other stakeholders aiming to improve healthcare access and related services for justice-involved populations.

Community Reentry: A Pivotal Point to Impact Health Outcomes

The Centers for Medicare & Medicaid Services (CMS) designed the Medicaid Section 1115 Reentry Demonstration Opportunity to improve access to community resources that address the healthcare and health-related social needs of people who are preparing to reenter their communities after incarceration. Medicaid enrollment assistance and prerelease coverage for certain services can help ensure successful care transitions during reentry. This demonstration allows states to provide Medicaid-reimbursable services up to 90 days before release from carceral facilities. These services include care management, behavioral health consultations, and peer support designed aiming to smooth the transition back into the community.

States and their partners are using these Medicaid regulatory flexibilities to develop—and eventually implement—programs that focus on the critical point of transition and reduce emergency department visits and inpatient hospital admissions for both physical and behavioral health issues once individuals are released and return to the community.

Recent State Activity Interest in Medicaid Reentry Initiatives

In July 2024, CMS approved Medicaid Section 1115 reentry demonstration proposals from Illinois, Kentucky, Oregon, Utah, and Vermont. These states join California, Washington, Montana, and Massachusetts in their work to develop the operational details and implementation plans to cover some services prior to release, increasing access to and continuity of care for returning individuals. According to HMA’s monitoring and analysis, another 13 states and the District of Columbia have reentry proposals pending CMS review.

Roles for Medicaid Partners

With 41 states, including the District of Columbia, using managed care for specific Medicaid populations, local and regional managed care organizations (MCOs) are integral to this landscape. The Medicaid Reentry Section 1115 Demonstration highlights the importance of early engagement with state partners and MCOs in preparing to serve the justice-involved population effectively.

By understanding these demonstrations and strategically developing their policy and operational plans, states and MCOs can enhance their services and improve outcomes for individuals transitioning out of carceral facilities. The continued focus on integrating comprehensive care models reflects a commitment to advancing the quality of healthcare for justice-involved individuals and ensuring their successful reentry into the community.

Key Considerations for States and Partners

CMS approval of state reentry demonstration proposals is the first of several critical steps required to improve access to services and health outcomes. Based on their real-world strategy, policy, and operational experience in Medicaid and correctional systems, the HMA team identified the following key considerations for states and their partners pursuing reentry initiatives:

  • Successful reentry programs require breaking down longstanding silos and challenges in policy, funding, contracting, systems/IT, bias, and other aspects integral to reentry.
  • All stakeholders will benefit from operationalizing best practices that use data metrics and reporting to demonstrate compliance with federal and state oversight and monitoring across carceral, public health, and Medicaid programs.
  • State and local carceral facilities may need to change their contracts with healthcare vendors to meet contractual and quality standards and best practices, including, in some cases, transitioning to provision of care to public health systems and university partners.
  • Build a team that will support successful state reentry programs. For example, government and their partners need expertise in the intersection of healthcare and correctional systems, skills in delivery system transformation, and knowledge of the publicly funded healthcare industry. The team will benefit from comprehensive experience with state prison systems, county and municipal jails, drug courts, and probation and parole, including implementing and coordinating medications for addiction treatment along a continuum of care in response to the substance abuse and opioid use disorder crisis facing communities nationwide.
  • Prepare to collaborate with new entities that have a range of experiences and perspectives.

Connect with Us 

The July 2024 edition of HMA’s Podcast, Vital Viewpoints, features a discussion with HMA Managing Director for Justice-Involved Services Linda Follenweider about her insights on this pivotal moment in carceral healthcare. Linda, an advanced practice registered nurse and board-certified family nurse practitioner, discusses the critical gaps in continuity of care for incarcerated individuals. She emphasizes how many people receive necessary medical care while in jail or prison but struggle to maintain these services upon release. The episode showcases the opportunities presented by adopting routine screening questions about incarceration history to ensure better health outcomes and resource utilization.

The upcoming conference, Unlocking Solutions in Medicaid, Medicare, and Marketplace, hosted by HMA, will offer more opportunities to engage with fellow executives, policymakers, and thought leaders across multiple sectors and industries advancing policy and programmatic innovations in carceral care and reentry. Notably, HMA experts Tonya Moore and Stuart Venske offer invaluable insights from their involvement in the development and execution of the CMS Section 1115 demonstration policies, including the reentry opportunity.

For more information about HMA’s work at the intersection of carceral care and Medicaid, contact our featured experts below.

Case Study

Enabling County Governments to Plan for Use of Opioid Settlement Funds

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THE CLIENT

Cabarrus County, NC, located in the south-central part of the state, is the ninth most populous county in North Carolina with a population around 226,000 people as of the 2020 census. It stands to receive approximately $22 million in opioid settlement funds over the next 18 years.

BACKGROUND

Cabarrus County engaged HMA to support the development of a strategic plan that will guide the use of the County’s opioid settlement funds. In partnership with applicable cities and municipalities, the collaborative planning process provided opportunities to engage the community—both professionals working in and around the opioid space as well as those with lived experience—to hear the needs of residents, understand current services offered and existing strengths, and explore barriers to accessing care.

APPROACH

HMA supported all aspects of this project – from process design to research to stakeholder engagement. Below is a brief summary of the key areas of HMA’s support:

Process Design

HMA met with Cabarrus County’s Assistant County Manager, Dr. Aalece Pugh, early in the process to finalize the strategic planning approach, establish protocols for project management and oversight, and identify stakeholders to engage.

Stakeholder Engagement

HMA coordinated and facilitated a series of stakeholder engagement efforts to solicit feedback from key constituencies. HMA facilitated a series of interviews and 14 focus groups – including four focus groups with individuals with lived and living experience. HMA also designed, administered, and analyzed a community survey that received 250+ responses.

Decision-Making

Overseeing the planning process was a team of county leaders – called the Community Response Team – that included representatives from the board of commissioners, county administration, behavioral health, emergency medical services, and the county jail. HMA facilitated four meetings of this group to review data, discuss stakeholder engagement findings, and prioritize strategies to fund.

Deliverable Development and Presentation

Based on the input from the Community Response Team, HMA developed a robust strategic plan deliverable. In addition to developing the document, HMA also supported a presentation to the Board of Commissioners seeking approval of the plan. SUBJECT MATTER EXPERTISE HMA assembled a team that was uniquely qualified to support this work. The team included individuals with the functional strategic planning and stakeholder engagement expertise required to complete this work, as well as subject matter experts in medications for addiction treatment and harm reduction which proved valuable. HMA’s team also included individuals with a depth of county government experience in North Carolina. They were responsive and worked together seamlessly to provide high-quality support throughout the engagement. HMA provided a clear plan and direction to successfully accomplish Cabarrus County’s intended goals, while also demonstrating an ability to adapt as needs and circumstances changed.

TESTIMONIAL

“Nine months ago, and through a rigorous and competitive selection process, HMA was selected to lead our opioid settlement strategic planning efforts. I am very pleased with the final product and the work of HMA’s team of professionals to help Cabarrus develop a strategic roadmap. HMA’s levels of professionalism, expertise, and engagement were above reproach.”

Dr. Aalece Pugh, Assistant County Manager, Cabarrus County Government

RESULTS

The final deliverable was a five-year Opioid Settlement Collaborative Strategic Plan. Cabarrus County wanted to assure that the voice of the community, persons with lived experience, providers, and key stakeholders were elevated to inform the final priorities. T he document provides an overview of the crisis and settlement funds, highlights the strategic planning process and input received, and describes the prioritized strategies and implementation plan. The strategic plan will serve as a guide for the use of opioid settlement funds for years to come, providing a clear roadmap while offering enough flexibility to make adjustments as the crisis continues to evolve. The plan was presented and approved by the Board of Commissioners in June 2024. The plan document can be viewed at cabarrus-county-strategic-plan-opioidsettlements.pdf (cabarruscounty.us)

Podcasts

How Can We Better Transition Healthcare Services for People Leaving Incarceration? 

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Linda Follenweider, an advanced practice registered nurse and board-certified family nurse practitioner with extensive experience in correctional healthcare, discusses the critical gaps in continuity of care for incarcerated individuals. She emphasizes how many receive necessary medical care while in jail or prison but struggle to maintain this care upon release. Highlighting the significant health risks and economic costs associated with this disconnect, she advocates for integrating correctional healthcare into the broader healthcare continuum. The episode showcases the opportunities presented by adopting routine screening questions about incarceration history to ensure better health outcomes and resource utilization. 

Solutions

HMA helps Justice Involved/Behavioral Health services implement the Sequential Intercept Model (SIM)

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The Sequential Intercept Model (SIM) provides a framework to help local governments divert individuals with behavioral health issues from the criminal justice system into community resources.

The model serves communities by helping them identify opportunities for diversion programs, known as “intercepts”, with the highest potential for success based on community strengths and needs. Created by Policy Research Associates in 2004 and promoted by SAMHSA’s GAINS Center, SIM identifies critical diversion points tailored to each community’s strengths and needs.

Key Benefits of Implementing SIM

Guides ongoing stakeholder meetings and county programming by establishing a common language for justice and diversion programs to support sustainability and adaptability over time.

Supports community analysis and integration of new policies by providing a clear visualization of system resources and gaps.

Facilitates collaboration and ensure efficient use of resources by enhancing communication and relationships across systems.

Collects local data for system analysis to identify grant opportunities and funding for critical intercept program development.

Development of a SIM report that highlights current state, gap, and opportunities for improvement.

Educates county leaders on best practices to help assess new programs and identify areas for improvement.

Addressing Community Challenges

SIM supports development of community prevention programs that lower the chance of initial involvement into criminal justice for many, helping provide the needed level of treatment support. The framework further allows jurisdictions to develop meaningful and effective programs to address issues faced by justice-involved individuals, such as unstable housing and income, high overdose risks, and the impact of evolving policies. Many existing programs lack sustainability due to reliance on temporary funding, and traditional planning has been reactive rather than proactive. SIM offers a comprehensive framework for communities to support individuals with behavioral health issues, improving safety and resource efficiency.

HMA’s services include:

  • Facilitating stakeholder meetings and data collection.
  • Mapping current systems and identifying key intercepts.
  • Developing SIM reports to highlight gaps and opportunities.
  • Leading strategic planning for program development.
  • Setting measurable goals and evaluation plans.
PRAinc.com – THE SIM MODEL SAMHSA.GOV – the sim model

If you are ready to talk about implementing a SIM and the next steps for your organization, reach out to our experts today.

Contact our experts:

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Jessica Perillo

Senior Consultant

Jessica Perillo is a driven healthcare professional with extensive experience in the behavioral health, public health and public safety fields. … Read more
HMA News

Health Management Associates Successfully Completes SOC 2 Type 2 Examination

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Health Management Associates (HMA), a leading independent, national healthcare consulting firm today announced that it has successfully completed a Service Organization Control Type 2 (SOC 2 Type 2) audit.

The SOC 2 Type 2 audit was developed by the American Institute of Certified Public Accountants to evaluate an organization’s information security controls over a period of time​. It assessed both the suitability of HMA’s controls and its operating effectiveness, covering the HMA organization as a whole, service offerings, resources used to deliver client work, and technical (cybersecurity) and non-technical controls (administrative strengths such as excellent training and a culture that promotes anti-fraud and ethical behaviors).

“Increasingly, completing a SOC 2 Type 2 audit is an important distinction for many of our clients and partners,” said Doug Elwell, chief executive officer. “Achieving this with no material findings across the firm is yet another way to meet client needs and further demonstrates our commitment to our core values of accountability, client commitment and integrity.”

Founded in 1985, HMA is an independent, national research and consulting firm specializing in publicly funded healthcare and human services policy, programs, financing, and evaluation. Clients include government, public and private providers, health systems, health plans, community-based organizations, institutional investors, foundations, and associations. With offices in more than 30 locations across the country and over 700 multidisciplinary consultants coast to coast, HMA’s expertise, services, and team are always within client reach. Learn more about HMA at healthmanagement.com, or on LinkedIn and X.

Blog

Opportunities for local and regional managed care organizations with justice-involved services

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Previously, HMA developed a comprehensive series of webinars reviewing the potential for using 1115 waivers to expand and improve health care services for the justice-involved population. With California becoming the first state earlier in 2023 to receive approval for the authority to provide a specific set of Medicaid services for up to 90 days in advance of release to youth and adults in state prisons, county jails, and youth correctional facilities, and many other states with pending waivers of a similar type, this blog post considers the implications of this emerging policy trend for local and regional managed care organizations (MCOs) in 2024.

The Opportunity

Delivering Medicaid services through MCOs has become the dominant strategy employed by states with 41 states (including the District of Columbia) using managed care for at least certain Medicaid populations. Local and regional MCOs represent a key component in this landscape across the country and often are deeply rooted in the states and communities they serve because of their specific focus on a single or limited number of markets.

With the precedent now in place for federal authority (and federal financial participation) to provide services such as reentry case management, behavioral health and physical health consultation services (in-person or via telehealth), laboratory and radiology services, medications as well as medication administration, medication assisted therapy inclusive of counseling, and community health worker services, states have a clear pathway toward pursuing the ability to provide services for the justice-involved population prior to release. Among the many important implementation questions states will need to consider as they continue to pursue the authority to provide these services is how the specific services will be delivered and financed. Given the dominance of Medicaid managed care, states will have to grapple with how MCOs can be leveraged to support a successful implementation of the delivery of services to the justice-involved population. The strong community presence of local and regional MCOs within the Medicaid managed care ecosystem makes these MCOs important entities for states to consider. Local and regional MCOs should consider what role they believe they can play as partners to states in these initiatives to serve justice-involved populations as successfully as they have served other Medicaid populations.

While the opportunities for local and regional MCOs will evolve over time, initial opportunities to contemplate are as follows:

  1. Serving as a Thought Partner: There is already significant interest across states in pursuing the ability to deliver services in advance of release but local and regional MCOs can support state officials looking to develop in greater detail the most viable path forward to do so. Local and regional MCOs can be well positioned serve as thought partners to states by educating themselves about California’s 1115 waiver approval and engaging state officials in their markets as partners to think through how the approach taken by California can be adapted to a given state’s goals and environment.
  2. Serving as the Lead Case Manager: Providing reentry case management to coordinate the reentry process for the justice-involved population is likely to be a key service in any service array from this population. To ensure the complex coordination related to this process occurs successfully across multiple organizations, local and regional MCOs can explore working with states to serve as the lead entity for case management as individuals are enrolled (or reenrolled) in managed care.
  3. Facilitating Enrollment Continuity and Continuity of Care: The process for transitioning to Medicaid coverage and care after these have been interrupted as a result of incarceration can be daunting for both the justice-involved population and well as state administrators and providers. Local and regional MCOs can play an intervening role here to provide support to all parties involved to produce a result where the enrollment process is as seamless as possible and critical care delivery is maintained specific to an individual’s health and social needs.
  4. Providing Infrastructure Funding: In partnership with states, local and regional MCOs can infrastructure funding to build capacity to support many of these entities who will be involved with the reentry process. Such entities can include, for example, behavioral health providers, community-based organizations, primary care providers, and social service providers. The type of capacity needed will likely include data sharing, technology changes, and workforce development.
  5. Providing Technical Assistance: In addition to supporting capacity-building, local and regional MCOs can provide technical assistance to entities involved with the reentry process. Complex operational, policy, and technology issues will arise during the reentry process that are specific to a given entity. Local and regional MCOs, because of their focused knowledge and experience in specific markets, are well positioned to provide expertise and guidance on issues ranging from care management to claims submission.

What’s Next?

As more states with pending 1115 waivers for reentry services for the justice-involved population gain approval, local and regional MCOs should anticipate engagement from states on planning and implementation in in 2024. Given this, taking action early to engage state partners and prepare your organization to serve this population is a prudent step to consider now.

For More Information

If you have questions about how HMA can support your efforts related to the Medicaid services for justice-involved populations and local and regional MCOs, please contact our experts below.

Blog

Preventing Type 2 Diabetes in correctional settings

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Today is World Diabetes Day, a day created to keep the importance of diabetes prevention and management in the public and political spotlight. One in every four U.S. healthcare dollars is spent on individuals diagnosed with diabetes, and more than half of that expenditure is directly attributable to diabetes. An estimated 37 million people in the U.S. have type 2 diabetes, and another 96 million (more than one out of every three people) have prediabetes, meaning they are at risk of developing type 2 diabetes.[i]

The urgency of preventing and managing type 2 diabetes is as applicable in correctional facilities as it is in populations in the community. Especially as there is an overrepresentation of populations that have a higher burden of prediabetes and type 2 diabetes in correctional facilities including individuals who:

  • are older,
  • have serious mental illness,
  • have poorer physical and mental health than counterparts in the community,
  • are above recommended body weight,
  • have reduced access to health insurance, and
  • are from racial and ethnic minority groups. 

Administrators of correctional facilities are responsible for the healthcare costs for individuals in their custody who have type 2 diabetes, and the cost of managing this condition in these settings is particularly high.

Fortunately, type 2 diabetes is preventable. One evidence-based and effective strategy for preventing type 2 diabetes is the National Diabetes Prevention Program (National DPP) lifestyle change program. This program is a year-long evidence-based program delivered over 22 sessions using a CDC-approved curriculum. Program participants are expected to lose 5−7 percent of their weight and engage in physical activity for 150 minutes each week.[ii] The National DPP lifestyle change program can be offered in person, online, through distance learning, or a combined approach and is led by a trained lifestyle coach.[iii] The program has been proven to reduce the risk of individuals with prediabetes developing type 2 diabetes by 58 percent (71 percent for people older than age 60).[iv] Projections in other settings that compare the cost of the National DPP lifestyle change program to the costs of treating type 2 diabetes show that the program is cost-effective.[v]

HMA recently published a white paper, “Implementing the National Diabetes Prevention Program Lifestyle Change Program in Correctional Settings,” describing how the National DPP lifestyle change program can be used to achieve cost savings and better health for people at risk of developing type 2 diabetes in correctional settings. There have been two successful implementations of the National DPP lifestyle change program to date. The first is described in the study “Prevention in Prison: The Diabetes Prevention Program in a Correctional Setting,” where 47 people from a federal correctional facility participated in a modified version of the National DPP lifestyle change program. Participants who completed the program demonstrated significant reductions in their body mass index and A1C levels. Weight loss in the study was similar to what participants of the National DPP lifestyle change program in the community typically achieve.[vi]

The second successful implementation is with the Wisconsin Department of Corrections (DOC), which has successfully offered the National DPP lifestyle change program in three correctional facilities. To date, 19 Wisconsin DOC staff have trained as lifestyle coaches and 131 individuals across the three facilities have participated in the program. The Wisconsin National DPP state quality specialist shared the following cohort data in 2018−2019:

  • 16 percent of the participants were Black and 84 percent were White
  • 100 percent of participants were male, with an average age of 45.6 years
  • 58 percent of participants were eligible for the program based on a blood test
  • 100 percent of participants attended 14 or more sessions in months one through six (typically, 16 sessions take place in the first six months)
  • 71 percent of participants attended six or more sessions in months 7−12 (typically, six sessions take place in the second six months)

Overall average weight loss was 8.3 percent during the year-long cohort, well above the National DPP lifestyle change program goal of 5−7 percent weight loss. The response from program participants was positive. Wisconsin DOC plans to scale the National DPP lifestyle change program to all appropriate facilities in the future.

For additional information, consult the white paper “Implementing the National Diabetes Prevention Program Lifestyle Change Program in Correctional Settings.”

If you would like to learn more about how HMA can help your organization implement a DPP program, contact our experts below.

[i] Centers for Disease Control and Prevention. The Facts, Stats, and Impacts of Diabetes. Accessed April 18, 2023.

[ii] Centers for Disease Control and Prevention. Research Behind the National DPP. Accessed on June 15, 2023. 

[iii] National DPP Coverage Toolkit. National DPP Coverage Toolkit: Delivery Options.  Accessed January 18, 2023.

[iv] Centers for Disease Control and Prevention. National Diabetes Prevention Program.  Accessed December 19, 2022.

[v] National DPP Coverage Toolkit. Cost & Value. Accessed June 15, 2023.

[vi] Fine A, Gallaway SM, Dukate A. Prevention in Prison: The Diabetes Prevention Program in a Correctional Setting. Diabetes Spectrum. 2019;32(4):331-337.

Solutions

CalAIM Justice-Involved Reentry Initiative Planning and Implementation Services

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Organizations are facing extensive challenges to improve health outcomes and healthcare quality through broad delivery, payment, and program reforms in CalAIM. With proven expertise in CalAIM policy, operations, and implementation, Health Management Associates (HMA) can help you with identifying needs, developing a strategy, and implementing those plans. We actively support clients across California implementing the CalAIM Section 1115 Waiver Demonstration Justice-Involved Initiative. Our team of Medi-Cal, managed care, and correctional healthcare experts – including physical and behavioral health clinicians, healthcare administrators, and former correctional leaders – are uniquely positioned to help clients navigate this delivery system transformation.

California is the first state in the nation to receive approval from the Centers for Medicare and Medicaid Services (CMS) to provide detained and sentenced individuals with 90-day pre-release healthcare services and behavioral health linkages. Through PATH JI grant funding, HMA is helping clients build administrative capacity, information technology, pre-release services, care management models, and Medi-Cal claiming infrastructure to meet their unique needs and leverage this significant opportunity. Our planning and implementation support spans the breadth of the CalAIM Justice-Involved Initiative including: the pre-release Medi-Cal application process, 90-day pre-release services, behavioral health links, Enhanced Care Management (ECM), and Community Supports services.

That’s why sheriffs’ departments, probation authorities, correctional health services agencies, behavioral health agencies, managed care plans, healthcare providers and community-based organizations see HMA as a trusted partner in helping to develop and implement 1115 waiver healthcare programs.

We provide:

Project management

State policy monitoring and compliance tracking

Current and future state process mapping

Partner and stakeholder collaboration and meeting facilitation

Process and quality improvement recommendations

Protocol development

Implementation plan and readiness assessment drafting

Training

Electronic health record recommendations

Contact our experts:

Headshot of Julie White

Julie White

Managing Director

With more than 25 years of experience in comprehensive healthcare and justice-related service delivery, Julie White has developed policy, strategic … Read more
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