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StateStatusInitial or Amended RequestExpected Implementation Date Implementation Plan Reinvestment Plan Eligible Population (Bolded = Key Population for HCV or HIV) Services in Addition to MAT and Behavioral Health Support, Case Management, and 30 Days Rx Post-ReleaseLength of Pre-Release WindowCarceral Setting: Youth Detention, County Jail, Tribal Jails, and/or State PrisonAre HCV or HIV Prescription Included Pre-ReleasePrEP AccessDoes Evaluation Strategy Include Metrics Related to HIV and HCV Rx/Prev. and Continuity of Care Notes
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ArizonaApproved by CMSRequestTBDDue: 6/18/2025Due: 6/27/2025All otherwise eligible Medicaid and CHIP beneficiariesPractitioner office visit (e.g. physical exam; wellness exam; evaluation and management visit; mental health or SUD treatment, therapy, or counseling); practitioner services include recommendations or orders for needed labs, radiology, and/or medications upon release; Peer support services90 DaysPrisons, Jails, Youth Correctional Facilities, Tribal Correctional FacilitiesNoEligible beneficiaries may have access to PrEP in the 30 day post-release period under the required minimum benefits. However, prescription coverage is not proposed for the pre-release period, which may undermine widespread access.No
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CaliforniaApproved by CMS Section 3.74/1/2024PublishedPublishedMust meet certain "health-related criteria," including, but not limited to: confirmed or suspected mental health diagnosis, SUD, chronic condition or significant non-chronic clinical condition*, intellectual or developmental disability, traumatic brain injury, positive test or diagnosis of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), or currently pregnant or within a 12-month postpartum period. Note: Individuals incarcerated in a youth correctional facility who are eligible for Medicaid or who would be eligible for CHIP except for their incarceration status...qualify to receive coverage of pre-release services without any requirement to meet specific clinical criteria. *Chronic condition is defined in Implementation Plan, and specifically lists all forms of active hepatitis and HIV/AIDS. In-reach case management services, physical and behavioral health clinical consultation services provided in-person or via telehealth, laboratory and radiology services, medications and medication administration, services of community health workers and community navigators with lived experiences, and durable medical equipment.90 DaysYouth Correctional Facilities, County Jails, and State PrisonsYes, both HIV and HCV are qualifying conditions for services, and services include medications and medication-administration during pre-release as well as 30-days post-releaseYes, PrEP is a covered service, but some high-risk populations may not be included because eligibility is limited to chronic conditions (e.g. MSM or cis Black women with no chronic conditions--GAC is covered as a chronic condition so most trans people should receive access to PrEP).Reentry metrics are expected to track, at minimum: beneficiary participation in demonstration components, number of primary and specialist provider participation, utilization of services, quality of care, health outcomes, key equity gaps (including HIV)*, data-sharing between state or patner entities and contracted providers, Medicaid renewal, SNAP/WIC enrollment, and reentry demonstration implementation (e.g. administration of screenings to identify individuals who qualify for pre-release services, utilization of applicable pre-release and post-release services (e.g. case management, MAT, clinical/behavioral health assessment pre-release and primary and behavioral health services post-release), provision of health or social service referral pre-release, participants who received case management pre-release and were enrolled in ECM case management post-release, and take-up of data system enhancements among participating carceral settings). *See reference to CMS Health Equity Framework 2022-2023
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ColoradoApproved by CMSRequestTBDDue: 5/13/2025Due: 7/13/2025All otherwise eligible Medicaid and CHIP beneficiariesNo additional services90 DaysState Prison, Local Jails, Tribal Jails, and Youth Correctional FacilitiesNoEligible beneficiaries may have access to PrEP in the 30 day post-release period under the required minimum prescription benefit. However, prescription coverage is not proposed for the pre-release period, nor is physical clinical consultation, which may undermine widespread access.Reentry metrics should include post-release outcomes for utilization of acute care services for chronic and other serious conditions, overdose and overdose and suicide related and all cause deaths in the period soon after release. The metrics should also include whether the 90 day timeline enabled pre-release management and stabilization of clinical, physical, and behavioral health conditions.
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HawaiiApproved by CMSRequestTBDDue: 5/08/2025Due: 7/08/2025All otherwise eligible Medicaid and CHIP beneficiariesPractitioner office visit (e.g. physical exam; wellness exam evaluation and management visit; mental health or SUD treatment or counseling; or other), Diagnostic services including laboratory and radiology services; medical equipment supplies; and peer support services. 90 daysJails, Prisons and Youth Correctional FacilitiesNoEligible beneficiaries may have access to PrEP in the 30 day post-release period under the required minimum benefits. However, prescription coverage is not proposed for the pre-release period, which may undermine widespread access.The evaluation strategy will track utilization of health services, medication refills among individuals receiving pre-release services. The program will also evaluate short term physical health outcomes. Thus it is possible that they will track usage of medication for HIV and HCV.
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IllinoisApproved by CMS Section 6, Pilot Initiative No. 2TBDDue: 10/30/2024Due: 1/2/2025All otherwise eligible Medicaid and CHIP beneficiariesCommunity Health Worker services, diagnostic and treatment (including laboratory and radiology services), medications pre-release, and durable medical equipment.90 DaysYouth Correctional Facilities, State or Local Jails, and State PrisonsYesYesNeither the initial request to CMS, nor the approval indicate that HCV or HIV will be included in evaluation metrics for the 1115 waiver.
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KentuckyApproved by CMS Request7/1/2025Due: 10/30/2024Due: 1/2/2025All otherwise eligible Medicaid and CHIP beneficiariesNo Additional Services60 DaysYouth Correctional Facilities or State PrisonsNoEligible beneficiaries may have access to PrEP in the 30 day post-release period under the required minimum prescription benefit. However, prescription coverage is not proposed for the pre-release period, nor is physical clinical consultation, which may undermine widespread access.Neither the initial request to CMS, nor the approval indicate that HCV or HIV will be included in evaluation metrics for the 1115 waiver.
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MarylandApproved by CMSRequestTBDDue: 5/13/2025Due: 7/13/2025Eligible Medicaid beneficiaries who have been diagnosed with SUD and/or SMINo Additional Services90 DaysState-Managed Prisons and JailsNoEligible beneficiaries may have access to PrEP in the 30 day post-release period under the required minimum prescription benefit. However, prescription coverage is not proposed for the pre-release period, nor is physical clinical consultation, which may undermine widespread access. Moreover, some high-risk populations may not be included because eligibility is limited by certain conditions.Neither the initial request to CMS, nor the approval indicate that HCV or HIV will be included in evaluation metrics for the 1115 waiver.
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Massachusetts Approved by CMS Section 87/1/2025DraftDue: 10/16/2024All otherwise eligible Medicaid and CHIP beneficiariesPhysical and behavioral health clinical consultation services provided through telehealth or in-person, as needed, to diagnose health conditions, provide treatment, as appropriate, and support pre-release case managers’ development of a post-release treatment plan and discharge planning, medications and medication administration, laboratory and radiology services; durable medical equipment and supplies, provided to the beneficiary immediately upon release from the correctional facility, consistent with approved Medicaid or CHIP state plan coverage authority and policy.90 DaysYouth Detention, County Jails or House of Corrections, and State PrisonsYesYesReentry metrics are expected to track, at minimum: beneficiary participation in demonstration components, number of primary and specialist provider participation, utilization of services, quality of care, health outcomes, key equity gaps (including HIV)*, data-sharing between state or patner entities and contracted providers, Medicaid renewal, SNAP/WIC enrollment, and reentry demonstration implementation (e.g. administration of screenings to identify individuals who qualify for pre-release services, utilization of applicable pre-release and post-release services (e.g. case management, MAT, clinical/behavioral health assessment pre-release and primary and behavioral health services post-release), provision of health or social service referral pre-release, participants who received case management pre-release and were enrolled in ECM case management post-release, and take-up of data system enhancements among participating carceral settings). *See reference to CMS Health Equity Framework 2022-2024Massachusetts will have varying levels of service for facilities to implement. Level one will be the minimum set of services. "The Commonwealth may define such levels of services, describe how a participating facility may move between levels of services, and the timeline for initial implementation and shifting, if any, between levels of service in its Implementation Plan. The Commonwealth may define such levels of services, describe how a participating facility may move between levels of services, and the timeline for initial implementation and shifting, if any, between levels of service in its Implementation Plan, including the implications for evaluation."
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MichiganApproved by CMSRequestTBDDue: 4/26/2025Due: 6/27/2025All otherwise eligible Medicaid and CHIP beneficiariesPhysical, behavioral health and dental screening services as necessary; Evaluation and management visits and wellness exams, including face to face for DME. Screening services including appropriate immunizations according to age and health history. Physical and behavioral diagnostic services, as medically necessary. Medications and medication administration during the pre-release period, as clinically appropriate. 90 DaysState Prisons, Local County Jails, Juvenile Facilities (Including Juvenile Justice Facilities and County-Operated Juvenile Detention Centers), and Tribal Correctional FacilitiesYesYesReentry metrics will track continuity of care following reentry into the community. Neither HIV nor HCV are explicitly mentioned in the evaluation metrics.
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MontanaApproved by CMS RequestTBDDue: 11/26/2024Due: 11/26/2024Must be 19 years of age or older and meet the following criteria: meet the definition of an inmate of a public institution and be incarcerated in a state prison; and have a confirmed mental health diagnosis or a confirmed or suspected SUD diagnosis.Limited clinical consultation as clinically appropriate provided through telehealth or in-person, as needed30 daysState PrisonsNoEligible beneficiaries may have access to PrEP in the 30 day post-release period under the required minimum prescription benefit. However, prescription coverage is not proposed for the pre-release period, which may undermine widespread access. Moreover, some high-risk populations may not be included because eligibility is limited by certain conditions.Neither the initial request to CMS, nor the approval indicate that HCV or HIV will be included in evaluation metrics for the 1115 waiver.The initial request in October 2021 specifically included PrEP and PEP and curative medications for HCV as part of the 30 day supply given, in hand, on release. Though this language was not included in the approval from CMS, Montana submitted an amendment request on 2/15/2024 that is currently pending before CMS.
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New HampshireApproved by CMS RequestTBDDue: 11/22/2024Due: 1/25/2025Must be a qualifying individual age 18 and
older with certain behavioral health conditions diagnosis of SUD, SMI, or SED.		Access to clinical consulation for physical and behavioral health needs; Peer support services45 daysState or Local Jails, or State PrisonsNoEligible beneficiaries may have access to PrEP in the 30 day post-release period under the required minimum prescription benefit. However, prescription coverage is not proposed for the pre-release period, which may undermine widespread access. Moreover, some high-risk populations may not be included because eligibility is limited by certain conditions.Neither the initial request to CMS, nor the approval indicate that HCV or HIV will be included in evaluation metrics for the 1115 waiver.
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New MexicoApproved by CMS RequestTBDDue: 11/22/2024Due: 1/25/2024All otherwise eligible Medicaid and CHIP beneficiariesDiagnostic services, including laboratory and radiology services, and treatment services in addition to coverage for MAT described above; Prescribed drugs and medication administration; Medical equipment and supplies and/or medical equipment provided upon release; Family planning services and supplies; Services provided by community health workers; Peer support services; Treatment for Hepatitis C; and Physical and behavioral health clinical consultation services, as clinically appropriate, to diagnose health conditions, provide treatment, and support pre-release case managers’ development of a post-release treatment plan and discharge planning. 90 DaysTribal, State, or Local Jail, Tribal or State Prisons, and Youth Correctional FacilitiesYesYesNeither the initial request to CMS, nor the approval indicate that HCV or HIV will be included in evaluation metrics for the 1115 waiver.New Mexico will require participating facilities to select a service level for implementation. Level One in the minimum set of services and must be the first service category that is implemented. Additional service levels will be defined by the State in their Implementation Plan. Additional service levels can be phased in in any order (example a facility can jump to Level Three without going through Level Two) but each facility must achieve and maintain provision of Level One services.
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North CarolinaApproved by CMS Request TBDDue: 4/17/2025Due: 6/18/2025All otherwise eligible Medicaid and CHIP beneficiariesPractitioner office visit (eg physical exam; wellness exam; evaluation and management visit; mental health or substance use disorder treatment; therapy or counseling; or other); Diagnostic services, including laboratory and radiology services; Prescribed drugs (in addition to MAT and the 30-day supply of prescription medications) and medication administration; and tobacco cessation treatment services.90 DaysState/Local Jails, State Prisons, Youth Correctional Facilities, and Tribal Jails.YesYesNeither the initial request to CMS, nor the approval indicate that HCV or HIV will be included in evaluation metrics for the 1115 waiver.
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OregonApproved by CMS Section 3.2TBDDue: 10/30/2024Due: 1/2/2025All otherwise eligible Medicaid and CHIP beneficiaries Limited clinical consultation services, as clinically appropriate, provided through telehealth or in-person, as needed; Diagnostic services, including laboratory and radiology services, and treatment services in addition to coverage for MAT described above; Prescribed drugs, in addition to MAT and the 30-day supply of prescription medication described above, and medication administration; Family planning services and supplies; Services provided by community health workers; and Peer support services. 90 DaysYouth Correctional Facilities, County or Regional Jails, and State PrisonsYesYesNeither the initial request to CMS, nor the approval indicate that HCV or HIV will be included in evaluation metrics for the 1115 waiver.Oregon will require participating facilities to select a Service Level for implementation. Service Level One consists of the required pre-release services…
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PennsylvaniaApproved by CMS RequestTBDDue: 4/25/2025Due: 6/26/2025Must be 19 years of age or older and have a SUD; SMI; be eligible for Medicaid funded 1915(c) home and community based services; have one or more chronic health conditions; be pregnant or in the 12-month postpartum period; have autism spectrum disorder.No additional services90 daysPrisons and JailsNoEligible beneficiaries may have access to PrEP in the 30 day post-release period under the required minimum prescription benefit. However, prescription coverage is not proposed for the pre-release period, which may undermine widespread access. Moreover, some high-risk populations may not be included because eligibility is limited by certain conditions.Neither the initial request to CMS, nor the approval indicate that HCV or HIV will be included in evaluation metrics for the 1115 waiver.
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UtahApproved by CMS RequestTBDDue: 10/30/2024Due: 1/2/2025All otherwise eligible Medicaid and CHIP beneficiariesPhysical and behavioral health clinical consultation services, as clinically appropriate, to diagnose health conditions, provide treatment, and support pre-release case managers’ development of a post-release treatment plan and discharge planning; Diagnostic services, including laboratory and radiology services, and treatment services in addition to coverage for MAT described above; Prescribed drugs, in addition to MAT and the 30-day supply of prescription medication described above, and medication administration; Family planning services and supplies; Services provided by community health workers; Peer support services; Treatment for Hepatitis C; and Medical equipment and supplies and/or medical equipment provided upon release. 90 DaysYouth Correctional Facilities, County Jail, or State PrisonsYesYesThe approval indicates that Utah will track a variety of evaluation metrics, including health outcomes, and because hepatitis C treatment is specifically covered as a service, it is possible that Utah will include hepatitis C in it's evaluation metrics.
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VermontApproved by CMS Section 3TBDDue: 10/30/2024Due: 1/2/2025All otherwise eligible Medicaid beneficiaries who are post-adjudicationPrescribed drugs, in addition to MAT and the 30-day supply of prescription medication described above and medication administration; Peer support services; Treatment for Hepatitis C; and Screening for common health conditions. 90 DaysState Correctional FacilitiesYesYesNeither the initial request to CMS, nor the approval indicate that HCV or HIV will be included in evaluation metrics for the 1115 waiver.Vermont will not provide pre-release coverage to people awaiting trial.
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WashingtonApproved by CMS Section 1.27/1/2025PublishedDue: 10/28/2023All otherwise eligible Medicaid and CHIP beneficiariesMedications during incarceration; CHW with lived experience services (to support HRSN screening and planning for access to social services and other community supports based on identified HRSNs); laboratory and radiology services; physical and behavioral health consultations; lab and radiology services; and medical equipment and supplies in-hand upon release. 90 DaysState Prisons, County and City Jails; and Youth Correctional Facilities YesYesNeither the initial request to CMS, nor the approval indicate that HCV or HIV will be included in evaluation metrics for the 1115 waiver."HCA continues to engage several advisory groups including the Re-entry Advisory Workgroup (RAW). Initially mandated by legislation, RAW offers guidance on reentry program design and implementation. Comprised of representatives from state agencies, carceral facilities, associations, community-based organizations, and other justice-involved policy leaders, RAW collaborates to improve re-entry services. Furthermore, HCA ensures alignment with reentry initiative requirements through coordination with the Department of Corrections (DOC)." (See Quarterly Monitoring Report (3/1/24))
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West VirginiaApproved by CMSSection 4.2.1TBDDue: 4/10/2025Due: 6/11/202518 years of age, elgibile for Medicaid or CHIP and, diagnosed or suspected SUD.No additional services90 DaysState and Local Jails, State Prisons, and Youth Correctional FacilitiesNoEligible beneficiaries may have access to PrEP in the 30 day post-release period under the required minimum prescription benefit. However, prescription coverage is not proposed for the pre-release period, which may undermine widespread access. Moreover, some high-risk populations may not be included because eligibility is limited by certain conditions.No
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