The national picture
The Centers for Medicare & Medicaid Services currently lists 18 states with approved Medicaid Section 1115 reentry demonstrations: Arizona, California, Colorado, Hawaii, Illinois, Kentucky, Maryland, Massachusetts, Montana, North Carolina, New Hampshire, New Mexico, Oregon, Pennsylvania, Utah, Vermont, Washington and West Virginia.
The demonstrations are intended to test whether targeted Medicaid coverage before release can improve continuity of care for people leaving prisons, jails and certain youth correctional settings. They represent a significant departure from the traditional rule that generally prevents federal Medicaid payment for services provided to people while they are incarcerated.
The federal list is a record of approved state authority. It is not a single national launch calendar, and it should not be read as proof that every eligible person in every facility in an approved state can already receive the same services.
What the demonstrations are designed to cover
CMS guidance describes a minimum service framework centered on the period immediately before release. States generally are expected to begin covered services at least 30 days before an expected release date, although CMS may approve longer periods—up to 90 days—when a state justifies the approach and incorporates it into its evaluation design.
The expected minimum package includes case management to assess physical health, behavioral health and health-related social needs; medication-assisted treatment for substance use disorders when clinically appropriate; and a supply of prescription medication at release. States may request authority for additional services, but the approved scope differs by demonstration.
The policy is aimed at preventing an abrupt break in care. A person may leave custody with an active condition, a prescription, a treatment plan or a need for follow-up care, yet still encounter delays in enrollment, provider assignment, records transfer or appointment scheduling. The demonstration model attempts to move those tasks into the pre-release period.
Why approval and implementation are different
A CMS approval document establishes the legal and financial authority for a state to operate its demonstration under specified terms. Before federal Medicaid matching funds can be claimed for pre-release services, CMS expects the state to complete implementation requirements described in the approval and related guidance.
Those requirements can include an approved implementation plan, a reinvestment plan, provider-enrollment processes, billing rules, managed-care contract changes, data-sharing agreements, information-technology upgrades, correctional-facility workflows, staff training and procedures for identifying people whose release dates and Medicaid eligibility fit the demonstration.
CMS expressly allows phased implementation. A state may begin with selected prisons, jails, youth facilities or regions and expand later. As a result, two people in the same state may encounter different availability based on the facility, population category, release timing or stage of rollout.
Who may qualify
The demonstrations apply to people who are incarcerated, are expected to be released, and are otherwise eligible for Medicaid under the state’s rules. States may target the demonstration to defined groups rather than covering every incarcerated Medicaid-eligible person.
State approvals may differ on whether they include adults, youth, people in state prisons, people in county or local jails, individuals in youth correctional facilities, or selected clinical populations. Release-date estimates also matter because the covered pre-release window is time limited.
A person’s presence in an approved state therefore does not establish individual eligibility. The controlling details are found in the state’s special terms and conditions, implementation documents and current operational guidance.
The 18 approved states
CMS’s current tracker identifies the following approved jurisdictions and their broader demonstration programs:
- Arizona, California, Colorado, Hawaii, Illinois and Kentucky
- Maryland, Massachusetts, Montana, North Carolina, New Hampshire and New Mexico
- Oregon, Pennsylvania, Utah, Vermont, Washington and West Virginia
What readers should verify at the state level
Because implementation is state-specific, the most useful questions are operational rather than merely legal:
- Has the state announced an actual service start date?
- Which prisons, jails or youth facilities are participating now?
- Which Medicaid eligibility groups are included?
- How many days before release can services begin?
- What services are covered, and which providers may deliver them?
- How are medications, records, appointments and managed-care enrollment transferred after release?
- Is rollout statewide, regional or limited to pilot facilities?
Data systems are a central implementation challenge
Reentry demonstrations require corrections agencies, Medicaid agencies, managed-care organizations and community providers to exchange information that historically has been stored in separate systems. Release dates can change, eligibility records may be suspended or incomplete, and clinical information may be subject to additional confidentiality requirements.
CMS guidance acknowledges that some relevant information may remain fragmented or non-electronic. States must develop processes that can identify eligible participants, document services delivered before release, connect them to community care and protect sensitive health and justice-system information.
These administrative details are not secondary. A demonstration can be legally approved while still lacking the operational infrastructure needed to deliver and bill for care consistently across participating facilities.
How success will be measured
CMS requires monitoring and evaluation rather than treating approval alone as evidence of success. States are expected to report on implementation progress, service use, care plans at release, referrals, provider participation and data-system development.
The federal evaluation framework also calls for analysis of Medicaid coverage continuity, access to pre-release and post-release services, coordination among agencies and providers, health outcomes, emergency-department use, hospitalizations and beneficiary experience. States must submit evaluation designs and later interim and summative reports.
Those evaluations will be important because the demonstrations differ in populations, facilities, service packages and rollout strategies. Early enrollment totals or service counts may show reach, but they do not by themselves establish whether care continuity or health outcomes improved.
What the policy does not do
The demonstration authority does not convert correctional health care generally into a full Medicaid benefit. It authorizes a targeted, time-limited set of pre-release services for approved populations and settings.
It also does not guarantee immediate access to a community provider after release. Provider capacity, transportation, housing instability, communication barriers, medication availability and managed-care network rules can still disrupt continuity.
Finally, the program does not create one uniform national standard. CMS sets federal expectations, but each state’s approved terms and implementation choices determine how the policy works on the ground.
What happens next
The next phase is less about the number of approvals and more about implementation quality. States must move from waiver language to facility workflows, provider networks, claims systems and measurable care transitions.
For policymakers and service systems, the central questions will be whether eligible people are identified early enough, whether appointments and medications are available at release, whether records follow the patient, and whether coverage remains active in the community.
For individuals and families, the practical starting point is the state Medicaid agency or correctional reentry office—not the federal approval list alone. Current state guidance should identify participating facilities, eligibility rules and enrollment procedures.
Official sources
Centers for Medicare & Medicaid Services — Reentry Section 1115 Demonstrations. View the approved-state tracker ↗
CMS State Medicaid Director Letter 23-003. Read the federal guidance ↗
CMS Evaluation Design Technical Assistance Guide. Review the evaluation framework ↗
Update history
August 7, 2026: Reviewed for publication against the current CMS approved-state tracker and federal implementation and evaluation guidance; reframed as a national policy-status article rather than a new approval announcement.
This article is for general informational purposes. Medicaid eligibility, covered services, participating facilities and implementation dates vary by state and may change. Consult CMS and the relevant state Medicaid agency for current program information.
