President Donald Trump's administration is expanding a Medicaid initiative developed during the Biden administration that allows states to provide certain health care services to incarcerated people shortly before they are released.
The Centers for Medicare & Medicaid Services approved new Section 1115 reentry demonstrations for Louisiana, Minnesota, Maine and Nevada, while renewing Washington, D.C.'s, broader Medicaid demonstration and giving the district authority to cover certain prerelease services.
The approvals took effect October 1 and run through September 30, 2031.
Alex Beene, a financial literacy instructor for the University of Tennessee at Martin, said the decision to approve the reentry programs “reflects a growing understanding that individuals leaving incarceration often face serious barriers to healthcare.”
“For participating states, these programs could provide greater federal financial support for connecting eligible individuals with healthcare services before their release, potentially reducing long-term costs to taxpayers and improving public safety,” Beene told Newsweek.
Why It Matters
The move is a continuation of a policy developed under former President Joe Biden. In April 2023, CMS issued guidance encouraging states to seek Section 1115 demonstration authority to provide targeted Medicaid services before eligible incarcerated people return to their communities.
However, the policy also has roots that predate Biden. The 2018 SUPPORT Act, signed during Trump's first term, directed CMS to issue guidance on how Medicaid waivers could improve health care transitions for people leaving incarceration.
Medicaid historically has generally been unable to pay for health services provided to people while they are incarcerated, apart from limited qualifying inpatient care. For people with mental health or substance-use disorders, this could be especially important.
What To Know
Under Biden, CMS released guidance in April 2023 establishing the Medicaid Reentry Section 1115 demonstration opportunity. States could seek federal approval to use Medicaid for certain services for eligible incarcerated people in the period shortly before their expected release.
Health policy research firm KFF said the minimum benefits contemplated by the Biden-era guidance included case management, medication-assisted treatment for substance-use disorders alongside counseling, and a 30-day supply of prescription medication at release.
States could seek coverage for additional services, and prerelease coverage could generally extend from 30 to 90 days before an individual's expected release.
Now, Trump's CMS has approved additional states to participate.
“This is less of a political reversal than it first appears. The idea has roots in a 2018 law signed by Trump, expanded through Biden admin guidance in 2023, and is now receiving additional approvals under Trump,” Michael Ryan, a finance expert and the founder of MichaelRyanMoney.com, told Newsweek.
“There's a practical reason it crosses administrations. Someone leaving prison with diabetes, a serious mental illness or an opioid addiction may need treatment immediately. Waiting until they're back in the community to arrange care creates a dangerous gap.”
On September 23, CMS announced approvals for several of the states and also renewed Washington, D.C.'s Whole-Person Care Transformation demonstration, authorizing the district to receive federal Medicaid funding for certain prerelease services.
The nonprofit Health and Reentry Project said the approvals brought the total to 22 states plus Washington, D.C., with approved Medicaid reentry waivers, with another four states' requests pending.
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What A Medicaid Reentry Plan Does
The Louisiana Department of Health has already said eligible individuals will be able to receive medically necessary Medicaid-covered services during the 60 days before release.
Those services include medication-assisted treatment and substance-use disorder counseling, behavioral health assessment and treatment, laboratory and diagnostic services, durable medical equipment and a 30-day supply of prescription drugs upon release.
The state plans to begin the demonstration at Elayn Hunt Correctional Center in early 2027 before expanding it to the remaining state prisons and participating parish jails.
“Our goal from the beginning has been to build a system that helps keep Louisianians safe while using taxpayer dollars more efficiently and effectively,” said LDH Secretary Bruce D. Greenstein in a statement. “By beginning care before release and connecting people with providers in their communities, we can improve health outcomes and build a more effective, sustainable system of care.
Louisiana Governor Jeff Landry, a Republican, also welcomed the approval.
"Louisiana is leading the way with an approach that can improve health, strengthen communities, and help people successfully return to their families and build productive lives,” Landry said.
A Policy Spanning Trump and Biden
While the specific Section 1115 demonstration framework was laid out by CMS under Biden in 2023, federal efforts to connect incarcerated Medicaid beneficiaries with health care upon release have stretched across both Republican and Democratic administrations.
The SUPPORT Act, signed by Trump in 2018, directed CMS to provide guidance on using waivers to improve health care transitions for people leaving incarceration. That eventually helped lay the groundwork for the demonstration opportunity subsequently developed by CMS.
“While it may seem unusual for a Republican administration to advance an initiative started under President Biden, the policy addresses concerns that extend beyond common political divisions,” Beene said. “If these programs show that earlier healthcare intervention reduces overdoses, hospitalizations, and repeat offenses, they could encourage other states to adopt similar approaches and fundamentally change how America connects its criminal justice system with healthcare.”
Congress has also taken additional steps. The Consolidated Appropriations Act of 2023 established requirements involving prerelease Medicaid and CHIP services for eligible young people, and legislation enacted in 2024 required states beginning in 2026 to suspend rather than terminate Medicaid coverage when people become incarcerated.
What Happens Next
The demonstrations for Louisiana, Minnesota, Maine and Nevada became effective October 1, 2026, and run through September 30, 2031. Washington, D.C.'s renewed demonstration operates over the same period.
Implementation will vary by each state’s jurisdiction. Louisiana plans its initial launch for early 2027 before expanding the program to additional correctional facilities.
Another four states had Medicaid reentry waiver requests pending, but even for the states that have been approved, there’s still more work to be done, Ryan said.
“States may reduce costly emergency treatment and improve continuity of care, but they have to build working connections between corrections departments, health providers and Medicaid systems,” Ryan said.
“The longer term obstacle is funding. New federal budget neutrality requirements beginning in 2027 will put greater pressure on states to demonstrate the financial case.”
Newsweek’s reporters and editors used Martyn, our AI assistant, to produce this story. Learn more about Martyn here. Contact Newsweek editors on this story: Jason Lemon and Gray R. Thomas