Louisiana Reentry Demonstration

1115 Medicaid Waiver

The Louisiana Department of Health (LDH) is pursuing a Medicaid 1115 waiver to expand access to healthcare services and facilitate enrollment in Medicaid managed care before individuals are released from prison or jail.  The Louisiana Reentry Demonstration aims to support transitions back into the community, particularly for those with mental health and substance use needs, to make sure reentering individuals have health coverage, medications, and connections with community-based providers prior to release. 

On September 27, 2024, LDH submitted an application for the Louisiana Reentry Demonstration 1115 Medicaid Waiver to CMS.  The application is currently pending with CMS.  On April 15, 2026, LDH announced the anticipation of waiver approval from CMS after aligning with new federal requirements. 

Need for Reentry Demonstration

Federal law prohibits most Medicaid coverage for incarcerated individuals.  This policy is commonly referred to as the Medicaid “inmate exclusion” policy and limits Medicaid reimbursement to inpatient care provided at certain facilities.  In April 2023, the Centers for Medicare and Medicaid Services (CMS) released guidance encouraging states to apply for a new Section 1115 demonstration opportunity, a policy change that would effectively “waive” the restriction on using federal funds to cover Medicaid services for eligible individuals who are incarcerated.

Currently, Medicaid benefits are suspended while individuals are incarcerated, and healthcare services for inmates (who otherwise may be eligible for Medicaid) are paid for by state and/or local funds.

Waiver Impact on Healthcare Coverage

Nearly one-third of incarcerated individuals have a mental illness and over 70% struggle with substance use disorder.  Most are eligible for Medicaid prior to and post-incarceration.  By nature of entering and exiting institutional facilities, these individuals often experience disruptions in healthcare coverage and access to physical and behavioral health services including substance use treatment, making it challenging to foster recovery pre- and post-release.  Evidence has demonstrated that engaging incarcerated individuals with intensive in-reach services and establishing a plan for post-release services is one of the most impactful ways to ensure that individuals remain linked with services post-release.  The Louisiana Reentry Demonstration aims to bridge the gap for individual transition from incarceration back into the community.

waiver impact on healthcare coverage

Waiver Goals

Through this demonstration, LDH seeks to achieve the following outcomes for the reentering population:

  • Increasing coverage, continuity of coverage, and appropriate service uptake through assessment of eligibility and availability of coverage for benefits in carceral settings just prior to release;
  • Improving access to services prior to release and improving transitions and continuity of care into the community upon release and during reentry;
  • Improving coordination and communication between correctional systems, Medicaid systems, managed care plans, and community-based providers;
  • Increasing additional investments in healthcare and related services, aimed at improving the quality of care for beneficiaries in carceral settings and in the community to maximize successful reentry post-release;
  • Improving connections between carceral settings and community services upon release to address physical health, behavioral health, and health-related social needs (HRS);
  • Reducing all cause deaths in the near-term post-release;
  • Reducing overdose deaths occurring within 12 months of release; and
  • Reducing the number of ED visits and inpatient hospitalizations among recently incarcerated Medicaid beneficiaries through increased receipt of preventive and routine physical and behavioral healthcare.
Key Reentry Demonstration Components

Correctional Facilities
The demonstration will be implemented in state prisons and up to 13 parish jails.

Eligible Individuals
The demonstration will cover all Medicaid-eligible individuals incarcerated in participating adult facilities.

Pre-Release Timeframe
Enrollment and service coverage will begin at a set timeframe before the individual's expected release date.

Demonstration Providers
Both community-based and correctional facility-based providers will be able to deliver covered services either in-person or via telehealth.

Proposed Pre-Release Services

LDH plans to cover the following services for individuals expecting to release within at least 60 days from state prison or a participating local jail. 

  • Case management;
  • Medication Assisted Treatment (MAT), including SUD counseling;
  • A 30-day supply of prescription medications upon release;
  • Prescribed drugs, in addition to MAT and the 30-day supply, and medication administration;
  • Mental health evaluation and counseling;
  • Behavioral health peer support services;
  • Laboratory services, including but not limited to testing for infectious diseases; and
  • Durable medical equipment (DME).
Contact
Resources 
Infographic explaining the process to obtain a 1115 Demonstration Waiver from the Centers for Medicare and Medicaid Services

Surgeon General Evelyn Griffin, MD

Secretary Bruce D. Greenstein

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