Incarcerated individuals often leave prison with complex health needs and little support waiting for them outside. Medicaid’s Section 1115 reentry waivers offer a chance to change that, but translating policy into impact takes more than paperwork. It requires strategic design, on-the-ground knowledge, and systems that don’t fall apart after the pilot phase.
To help states navigate this terrain, Acentra Health convened a panel of Medicaid and corrections leaders from Washington, Arizona, and Michigan, states at the forefront of reentry innovation. Together, they shared lessons learned, pitfalls to avoid, and strategies that can scale nationwide to serve this at-risk population.
The result? Five grounded insights that can help states turn reentry waivers into real-world results.
- Build a Data Foundation Early: Design with Evaluation in Mind
All successful programs are built on clear goals and the ability to measure progress, as well as performance, over time. From the start, it’s important to think about how you’ll collect and use data. Not just to coordinate care, but also to assess what’s working (or not) at every point in the member’s journey.
States like Arizona and Michigan are already investing in systems that track care before and after release. This helps them evaluate outcomes like ER use, medication continuity, and recidivism. As Vikki Wachino, Executive Director of the Health and Reentry Project (HARP), put it, “states are really eager to know if these efforts are working, and that means building evaluation plans early, not after launch.”
Pro Tip: Before launching, map how data will flow across Medicaid systems, correctional health records, and MCOs both before and after release to set the stage for smoother coordination, stronger impact, and better outcomes.
- Account for Wide Variation in Facility and Community Readiness
Facility readiness varies widely, from clinical staffing to EHR infrastructure, and it matters. Washington, for example, is rolling out its waiver program in phases across 11 prisons, based on each facility’s ability to deliver key services like targeted case management, MOUD (medications for opioid use disorder), and 30-day medication supplies at release.
This readiness didn’t happen overnight. In this case, Washington conducted detailed facility assessments and worked hand-in-hand with correctional leaders to identify gaps and direct funding where it was needed most. “We’ve had to look not just at clinical services, but also at IT systems, pharmacy logistics, and telecom infrastructure,” said Lisa Flynn from Washington’s Department of Corrections.
Pro Tip: A readiness assessment that goes beyond clinical services to include staffing, data systems, and operations, and can help avoid surprises later.
- Ensure Systems Integration to Bridge the Carceral-to-Community Gap
Transitions fall apart when systems don’t talk to each other—often with serious consequences.
For people leaving incarceration, the transition back into society is already one of the most socially complex experiences any patient population faces. Add fragmented health systems to the mix, and things unravel fast. Panelists emphasized the need for strong bridges between correctional and Medicaid systems where eligibility data, care plans, and release timelines move seamlessly to prevent individuals from falling through the cracks the moment they walk out the gate. Washington developed a third-party platform to manage provider enrollment and claims processing, while Michigan focused on intensive training for providers new to Medicaid. “This is a totally new provider group,” said Meghan Vanderstelt from the Michigan Department of Health & Human Services. “We can’t assume they understand how Medicaid billing or credentialing works.”
Pro Tip: Create shared workflows and offer hands-on technical support to both correctional and community-based teams.
- Integrate Community Supports for Holistic Reentry Success
Health care is just one piece of the reentry puzzle. Housing, transportation, behavioral health, and job assistance all matter and need to be coordinated. States talked about the importance of working with CBOs, standing up advisory groups, and using closed-loop referral tools to make sure people don’t fall through the cracks.
Ted Ryles from Washington’s Department of Children, Youth, and Families shared, “We've long had wraparound plans for youth, but without funding and dedicated staff, those plans often sit on paper. This waiver helps us operationalize real support.”
Looking ahead, weaving HRSN (health-related social needs) and other SDOH (social determinants of health) into waiver design, especially for youth populations, will be key, especially with new federal guidance on the horizon.
Pro Tip: Use waiver authority to support services that connect people to real-world resources, including peer supports, housing navigators, and culturally informed care partners.
- Balance Resources and Plan for Sustainability
One of the toughest challenges states face is figuring out how to allocate limited dollars and resources. Should a program plan for more services or more time? Arizona chose to lean into the 90-day pre-release window, even if that meant narrowing the menu of services. The idea was to build trust and engagement before release, when it can make the most significant difference.
Ideally, it isn’t one or the other, but a balance. Planning for sustainability needs should start early. Washington is already exploring how Medicaid MCOs can support ongoing services after the waiver ends and where legislative backing might be needed.
Pro Tip: Don’t wait until the waiver is halfway through to think about what comes next. Work closely with your budget office and legislative partners from the beginning.
Moving Forward: Partnering for Impact
This moment marks more than a policy update. It’s a critical inflection point. As states advance efforts to integrate Medicaid and reentry services, the path forward demands not only vision but also execution grounded in evidence and partnership. Acentra Health is committed to being more than an observer. We are an active partner in this transformation. Whether you are developing, piloting, or scaling a Section 1115 waiver, we offer proven strategies, actionable data, and scalable tools to support long-term success.
Together, we can close the gap between carceral and community care – for good.