The Medicaid Reentry Section 1115 Demonstration Opportunity, launched in 2023 by the Centers for Medicare & Medicaid Services (CMS), marks a significant shift in how we approach healthcare for individuals transitioning from incarceration back into the community. As a health IT vendor specializing in correctional healthcare services technology, Fusion sees this initiative (sometimes referred to as the Medicaid 1115b Re-entry Initiative or Section 1115 Re-entry Demonstrations) as a critical step towards improving health outcomes and reducing recidivism rates.
What is the Medicaid Reentry Section 1115 Demonstration Opportunity?
This program, authorized by Section 1115 of the Social Security Act, allows states to obtain Medicaid re-entry waivers to provide Medicaid benefits to eligible individuals up to 90 days before their release from incarceration. Though varying from state to state, eligible individuals generally include adults and/or juveniles currently in a prison, jail, penitentiary, or detention center.
As of December 2024, 11 states are approved to participate in the Medicaid Reentry Section 1115 Demonstration Opportunity, while 13 states are under review. For states that want to apply to participate in this program, the CMS has issued guidance for designing demonstration projects that need to be submitted as part of the application process.
This pre-release Medicaid coverage opens doors to essential correctional healthcare services, including:
- Medication-assisted treatment (MAT). For individuals with substance use disorders, states must provide access to all types of MAT, along with counseling support, to aid in recovery and reduce the risk of relapse.
- Medication continuity. Patients must receive a 30-day supply of all necessary prescription medications upon release. This helps ensure uninterrupted treatment.
- Transitional care planning: Connecting individuals with community-based providers and resources to support their successful reintegration.
By bridging the gap between correctional facilities and community health services, the Medicaid 1115b Re-entry Initiative aims to improve health outcomes, reduce the likelihood of individuals returning to incarceration, and ultimately foster healthier communities.
The Vital Role of EHRs, PMS, and Other Health IT
Fusion’s view is that health IT is essential for the successful implementation of the Section 1115 Re-entry Demonstrations. Here’s how correctional healthcare technology can support this initiative:
- Electronic Health Records (EHRs): Comprehensive EHRs facilitate the secure documentation of patient information, tracking of health conditions, and seamless care coordination between correctional facilities and community providers. Furthermore, EHRs with integrated billing functionalities can streamline the claims process for Medicaid reimbursement under the 1115b program, ensuring timely and accurate payments for correctional healthcare services rendered.
- Pharmacy Management Systems: These systems streamline medication refills, track potential drug interactions, and ensure medication adherence post-release, minimizing the risk of relapse or complications.
- Specialized Behavioral Health IT Solutions: Specialized software can help identify and address mental health and substance use disorders, providing crucial support during the vulnerable re-entry period.
By leveraging these health IT solutions, we can optimize care delivery, improve data sharing between stakeholders, and enhance communication among providers, ultimately leading to better patient outcomes and a smoother transition back into society.
Benefits for Jails, Prisons, and Other Corrections Departments
The Medicaid Reentry Section 1115 Demonstration Opportunity offers numerous advantages for corrections facilities who choose to participate. These include:
- Improved health outcomes: Addressing health concerns pre-release reduces the risk of complications and hospital readmissions post-release, leading to better overall health for individuals re-entering the community.
- Reduced recidivism rates: Access to healthcare can help address underlying issues that contribute to criminal behavior, such as substance use disorders or mental health conditions, leading to lower recidivism rates.
- Enhanced care coordination: Health IT solutions facilitate seamless transitions between correctional facilities and community providers, ensuring continuity of care and reducing the burden on both systems.
How HealthIT Vendors Can Support Re-Entry
As a leading health service IT vendor for correctional facilities, we are committed to supporting the Medicaid 1115b Re-entry Initiative by:
- Providing comprehensive EHR solutions: Our electronic health record solution, FusionEHR, was designed from the ground up to meet the unique needs of corrections facilities, with robust security features and specialized modules for managing health conditions prevalent in this population.
- Offering integrated pharmacy management systems: Our systems streamline medication management, reducing errors and improving adherence, which is critical for individuals transitioning back into the community.
- Developing innovative behavioral health IT solutions: We provide tools for screening, assessment, and treatment of mental health and substance use disorders, helping to address these critical needs during re-entry.
We believe that the Medicaid Reentry Section 1115 Demonstration Opportunity represents a significant advancement in our efforts to improve the health and well-being of individuals leaving incarceration. By collaborating with corrections and and community providers, we can leverage health IT to create a more seamless and effective re-entry process, ultimately benefiting both individuals and society as a whole.