Poster #113 - Coverage Before Release: How Medicaid Reentry Waiver Design Shapes Access to Life-Saving Medications

• In Event: Saturday Poster Luncheon

Abstract

Introduction/Background
Every year, about 600,000 people are released from U.S. state and federal prisons (Carson, 2020). Many have serious health conditions including addiction, HIV, and heart disease that require daily medication. Research shows that incarcerated individuals experience substantially higher rates of chronic illness, mental health disorders, and infectious diseases compared to the general population (Fazel et al., 2024; Maruschak et al., 2021). However, upon release, most lack health insurance, creating a dangerous gap in care. Interruptions in medications for opioid use disorder or HIV during the first days after release can trigger fatal overdose or life-threatening complications. Individuals released from prison are up to 12.7 times more likely to die within two weeks than other state residents, with overdose as the leading cause (Binswanger et al., 2007). Continuity of medication for opioid use disorder during reentry can reduce this risk by as much as 75% (Degenhardt et al., 2014).

Purpose/Research Question
In 2023, the federal government introduced a new option: a Medicaid reentry waiver allowing coverage to begin up to 90 days prior to release. This policy enables individuals to leave incarceration with medications and care plans already in place.By early 2025, 19 states had received approval, while 31 had not. Among adopting states, program design varies significantly where some provide the full 90-day coverage, others only 30; some include medications for addiction treatment, while others exclude them. This study asks: what drives adoption, how do program designs differ, and who remains excluded?

Methods
This study uses publicly available data to examine three key areas:

1) Adoption drivers: Factors such as Medicaid expansion status, opioid mortality rates, and political context are analyzed to understand why some states pursued waivers while others did not.

2) Program variation: Approved waivers are compared to assess differences in coverage duration, medication inclusion, and service scope.

3) Population impact: The analysis estimates how many individuals are released from non-adopting states and identifies geographic patterns of exclusion, particularly across the South.

Anticipatory Findings
The study expects to find that Medicaid expansion states are significantly more likely to adopt reentry waivers and implement more comprehensive programs. States experiencing higher opioid mortality rates are also anticipated to demonstrate stronger policy uptake, given the direct link between medication access and overdose prevention.Findings will likely show that disparities in access mirror broader healthcare inequities. Individuals released in non-expansion and Southern states are expected to face the highest risk of leaving incarceration without coverage or essential medications, reinforcing existing geographic and structural disparities.

Conclusion
The reentry period is one of the most vulnerable moments in an individual’s life. Overdose risk peaks, and untreated chronic conditions can rapidly worsen. This research provides a comparative analysis of state policy design, offering a framework to identify best practices and gaps and contributes to APPAM’s 2026 theme of 50 States, 50 Systems.

Author

• Diana Saleh, Southern Methodist University
  Presenting Author