How States Are Implementing Medicaid Section 1115 Justice-Involved Reentry Demonstrations

July 20, 2026

Medicaid Section 1115 Justice-Involved Reentry Demonstrations allow states to provide selected Medicaid-covered services before an individual is released from incarceration. This report highlights the operational, governance, technology, and care coordination strategies needed for successful implementation across multiple jurisdictions.

HMA’s new report, Lessons Learned from Implementing 1115 Justice-Involved Reentry Initiatives: Strategic Planning and Operational Considerations, shares practical implementation strategies, lessons learned, and operational best practices drawn from supporting justice-involved healthcare initiatives in multiple states. For organizations strengthening an existing program or preparing for a new demonstration, the report offers actionable guidance to improve implementation readiness, reduce operational risk, and build sustainable systems that support better outcomes for justice-involved populations.

Key Takeaways

Readers will learn how successful organizations are:

• Building governance structures that align corrections, Medicaid, healthcare providers, and community partners
• Designing operational workflows that support seamless transitions from incarceration to community care
• Preparing correctional facilities, managed care organizations, and providers for new responsibilities
• Addressing technology, interoperability, eligibility, and data-sharing challenges
• Creating person-centered care coordination models that improve continuity of care
• Identifying implementation risks before they become operational barriers
• Using performance measurement and continuous quality improvement to strengthen long-term program success

Why Medicaid Section 1115 Justice-Involved Reentry Demonstrations Matter

For decades, individuals leaving incarceration have faced significant barriers to accessing healthcare. Interruptions in Medicaid coverage, gaps in medication, delayed connections to primary care and behavioral health services, fragmented care coordination, and limited communication between correctional and community providers have contributed to poorer health outcomes and increased reliance on emergency and crisis services.

Medicaid Section 1115 Justice-Involved Reentry Demonstrations are designed to address these long-standing challenges by allowing eligible individuals to receive selected Medicaid-covered services before being released from incarceration. Early engagement with healthcare providers establishes care prior to reentry, improves coordination with community-based organizations, and strengthens transitions into ongoing medical, behavioral health, and social support services.

As more states implement Medicaid reentry demonstrations, organizations are discovering that operational success depends on thoughtful planning, strong governance, effective partnerships, and sustainable implementation strategies.

Why Organizations Struggle with Implementation

Across states implementing Medicaid Justice-Involved Reentry Demonstrations, several consistent challenges have emerged.

Cross-Agency Governance

Correctional agencies, Medicaid programs, managed care organizations, healthcare providers, behavioral health organizations, and community-based organizations often have different operational processes, funding structures, and priorities. Building shared governance and clear decision-making processes is essential for successful implementation.

Operational Workflow Design

Organizations must create new workflows for eligibility determination, care management, medication continuity, discharge planning, provider referrals, and community handoffs—many of which have never existed before.

Technology and Interoperability

Connecting correctional electronic health records with community healthcare systems remains one of the largest implementation challenges. Secure data exchange, interoperability, privacy requirements, and real-time communication require significant planning and investment.

Workforce Readiness

Successful implementation requires training correctional healthcare staff, case managers, community providers, managed care organizations, and Medicaid partners on new roles, responsibilities, and operational processes.

Care Coordination

Person-centered care coordination begins before release and continues after individuals return to the community. Organizations must establish sustainable partnerships that support continuity of care across healthcare, behavioral health, housing, and social service systems.

The most successful organizations recognize that Medicaid Section 1115 Justice-Involved Reentry implementation is not simply a compliance exercise—it is a comprehensive system transformation effort.

HMA’s Five Pillars of Successful Medicaid Reentry Implementation

Drawing on implementation experience across multiple states, HMA has identified five foundational elements that consistently support successful implementation:

1. Governance and Cross-Sector Collaboration

Building shared leadership, accountability, and decision-making across agencies.

2. Operational Planning

Developing standardized workflows that support eligibility, care coordination, referrals, and continuity of care.

3. Technology and Data Exchange

Improving interoperability between correctional and community healthcare systems while supporting secure information sharing.

4. Person-Centered Care Coordination

Designing services around the needs of individuals transitioning from incarceration into their communities.

5. Continuous Quality Improvement

Using performance measures, implementation feedback, and operational data to improve program effectiveness over time.

Readers will gain insights into:

• Building effective cross-sector governance and decision-making structures
• Designing operational workflows that support continuity of care
• Preparing correctional facilities and community providers for new responsibilities
• Strengthening partnerships with managed care organizations and Medicaid agencies
• Addressing technology, interoperability, and data-sharing challenges
• Developing person-centered care coordination models
• Measuring performance and using continuous quality improvement to refine implementation
• Identifying common risks before they become operational barriers

Rather than focusing solely on policy requirements, the paper emphasizes the organizational strategies that position programs for long-term success.

Who Should Read This Report?

This report is designed for leaders responsible for planning, implementing, financing, managing, or overseeing Medicaid Section 1115 Justice-Involved Reentry Demonstrations, including:

• State Medicaid agencies
• Departments of Corrections
• County jail administrators
• Probation and parole agencies
• Managed care organizations
• Correctional healthcare providers
• Behavioral health providers
• Federally Qualified Health Centers (FQHCs)
• Community-based organizations
• County and state policymakers
• Healthcare executives
• Medicaid program managers
• Reentry program leaders
• Population health and care management leaders

Whether your organization is launching a new demonstration or refining an existing implementation strategy, this report provides actionable guidance that can accelerate implementation while improving long-term outcomes.

Why HMA?

HMA has supported Medicaid agencies, correctional systems, managed care organizations, behavioral health providers, healthcare organizations, and community-based partners across numerous justice-involved healthcare initiatives. Our experience spans policy development, implementation planning, operational design, governance, technology strategy, care coordination, and program evaluation.

The recommendations in this report reflect real-world implementation experience and practical lessons learned from helping organizations navigate the complex operational challenges of Medicaid Section 1115 Justice-Involved Reentry Demonstrations.

Frequently Asked Questions

• What is a Medicaid Section 1115 Justice-Involved Reentry Demonstration?

A Medicaid Section 1115 Justice-Involved Reentry Demonstration allows eligible individuals to receive selected Medicaid-covered healthcare services before they are released from incarceration. The goal is to improve continuity of care, strengthen transitions to community providers, and improve long-term health outcomes.

• What are the biggest implementation challenges?

Organizations commonly face challenges related to governance, cross-agency coordination, operational workflow design, technology integration, data sharing, workforce readiness, eligibility processes, and care coordination.

• Who is responsible for implementing Medicaid reentry demonstrations?

Implementation requires collaboration among state Medicaid agencies, correctional systems, managed care organizations, healthcare providers, behavioral health organizations, community-based organizations, and technology partners.

• Why is operational planning important?

Successful implementation depends on designing sustainable workflows, governance structures, technology infrastructure, and partnerships that support individuals before release and throughout their transition back into the community.

• How can organizations improve implementation readiness?

Organizations can improve readiness by establishing cross-sector governance, investing in technology and interoperability, standardizing operational processes, strengthening care coordination, measuring performance, and continuously refining implementation based on lessons learned.

Download the Report

As additional states pursue Medicaid Section 1115 Justice-Involved Reentry Demonstrations, organizations have an unprecedented opportunity to transform how healthcare is delivered to justice-involved populations.

Lessons Learned from Implementing 1115 Justice-Involved Reentry Initiatives: Strategic Planning and Operational Considerations provides practical implementation strategies, operational recommendations, governance models, technology considerations, and lessons learned to help organizations avoid common pitfalls, accelerate implementation, and build sustainable Medicaid reentry programs that improve outcomes for individuals and communities.

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