By Gabrielle de la Guéronnière
Medicaid and access to health care has long been an important part of successful reentry. But new federal eligibility rules put this health coverage at risk for millions of people, including those preparing to reenter the community from incarceration.
As such, it will be essential for corrections professionals to understand these rules, which are set to take effect at the beginning of the new year, and to help reentering individuals access coverage and needed care.
H.R. 1, the federal budget reconciliation bill passed in July of 2025, mandates states to implement new community engagement requirements for adults covered under Medicaid expansion, which applies to the vast majority of formerly incarcerated individuals, no later than January 1, 2027. Generally, the law requires affected adults to demonstrate at least 80 hours per month of employment or other qualifying activities such as community service, certain educational activities, and/or participation in an approved work program to keep their health coverage — or they must qualify for an exemption.
While one such exemption exists for formerly incarcerated individuals, it only lasts for three months. Due to widespread stigma and discrimination, not to mention the many competing priorities of reentry, it takes an average of 6 months — and often, far longer — for previously incarcerated people to secure employment. Thus, connecting individuals to other means of satisfying the requirement as well as longer-lasting exemptions will be paramount. Furthermore, ensuring individuals can seamlessly access the post-release exemption will require effective coordination between corrections agencies and state Medicaid and local social service offices.
The stakes are high. People leaving incarceration face a significantly elevated mortality risk, particularly during the first two weeks post-release. Ensuring Medicaid is active and usable immediately upon release is thus fundamental, not just to people’s successful reintegration, but to saving people’s lives.
Here are six steps corrections facilities should take now to help.
1. Ensure Medicaid is a standard part of release planning from the start
As of January 1, 2026, federal law prohibits states from terminating Medicaid upon a person’s incarceration – to preserve eligibility, they can only suspend coverage. Although most states now suspend, this does not necessarily mean that coverage will be active and usable when someone walks out the door. It will be important to understand how your state implements suspension and reinstatement, including whether additional steps are needed to reactivate benefits.
Medicaid screening and enrollment assistance should therefore be integrated into existing intake, classification, case management, discharge planning, and reentry processes. Systems should be developed or strengthened to identify existing coverage, help eligible individuals apply when necessary, and establish a process for confirming people’s coverage will be active immediately upon their release.
The operational goal should be straightforward: every person leaving custody who is eligible for Medicaid should have active coverage in place upon reentry.
2. Support staff recognition and understanding of work requirements and exemptions
Across the country, state Medicaid agencies are working to implement H.R. 1’s work requirements, and many are providing informational trainings and technical assistance and developing educational materials to support stakeholders who are trying to navigate these complex changes. It will be important for corrections professionals to participate in these efforts to increase staff understanding of the work requirements and how to identify protections that reentering individuals may be eligible for.
As mentioned above, one especially important protection applies directly to the reentering population. Under H.R. 1, anyone who was incarcerated at any point in the 3 months prior to a given month is deemed compliant with the community engagement requirement for that month. Again, this temporarily provides a critical safeguard during an especially vulnerable period, but it is not a permanent exemption from future requirements — and without streamlined coordination between corrections and local social service/state Medicaid agencies, could still be inaccessible for the formerly incarcerated individuals it is intended to support.
There are also other protections that may apply, depending on an individual’s circumstances. Exemptions for certain parents and caregivers, pregnant or postpartum individuals, people who are “medically frail” or have qualifying medical needs, certain veterans, former foster youth, American Indians and Alaska Natives, and people participating in qualifying substance use disorder treatment programs are some examples.
Engaging with your state Medicaid agency is key to increasing corrections staff understanding of the work requirements and how to identify such additional protections. Working with state and local Medicaid and corrections leaders, facilities should develop concise, accessible guidance explaining the exemptions, the information necessary to establish eligibility for them, and the process for connecting individuals to state Medicaid officials who can make determinations.
3. Send people home with the documents they need
All individuals should be released with valid identification and dated proof of release. Depending on a person’s circumstances and state procedures, other useful documents may include: proof of Medicaid enrollment or application status, a Medicaid identification number, relevant eligibility notices, and instructions for accessing the state’s benefits portal or contacting their local Medicaid office. Individuals should also receive information about upcoming renewal deadlines and any steps required to maintain coverage.
Providing people with their health records pre-release can be equally important. Adhering to appropriate consent and authorization procedures, facilities should help individuals obtain relevant medical records, discharge summaries, current medication lists, treatment plans, and documentation of conditions that could support a medical exemption. Records relating to substance use disorder treatment may be especially important when arranging continuity of care.
Facilities should provide documents in formats that people can realistically retain and use and thoroughly explain what each document is for.
While documentation alone does not establish an exemption or guarantee continued eligibility, it is integral to helping individuals and authorized agencies verify relevant facts without unnecessary delays.
4. Assign responsibility for every step
A policy that deems Medicaid a part of reentry planning is not enough if staff members are unclear about who actually completes the work.
Leadership should establish, disseminate, and explain a written protocol facility-wide that assigns responsibility for each stage of the process. Depending on local staffing models, responsibilities may be distributed among case managers, discharge planners, health services personnel, benefits specialists, managed care plans, and designated administrative staff.
The protocol should specify who screens for existing coverage, who assists with applications, who identifies potential exemptions, who gathers supporting documentation, who communicates with the Medicaid agency, and who verifies active coverage before release.
The protocol should also address short-notice releases from jails, where staff may have little advance warning, to ensure no individuals fall through the cracks.
Ultimately, Medicaid enrollment should be a defined institutional responsibility, not an informal task dependent on an individual employee’s initiative.
5. Build partnerships to facilitate automatic data-sharing while protecting privacy
Corrections facilities must continue to strengthen existing and establish new working relationships with state Medicaid agencies as well as managed care organizations, community health centers, behavioral health providers, substance use disorder treatment programs, and community-based reentry organizations to enhance system-wide collaboration.
These partnerships can help clarify Medicaid enrollment and reinstatement procedures, establish referral pathways, coordinate post-release appointments, and resolve more complex cases. Where available, facilities should also explore whether their state participates in a Medicaid reentry demonstration that supports eligible in-reach services before a person is released.
Data-sharing must be handled carefully though. Facilities must ensure secure methods for transferring information and follow applicable privacy laws, including HIPAA for medical records and 42 CFR Part 2 for records related specifically to substance use disorder.
6. Audit reentry process before implementation begins
While January 1, 2027, is the federal implementation deadline for the new community engagement requirements for Medicaid, there is no reason for facilities to wait until the end of 2026 to prepare. Facilities should review their release processes now, making sure to compare any written policies with what actually transpires.
Facilities should simultaneously obtain state-specific guidance and adjust their process accordingly as federal regulations establish the core requirements, but implementation may vary by state and will ultimately determine what people encounter in practice.
A practical investment for safer reentry
Medicaid provides a critical link between correctional health services and community care at a time when many reentering individuals face significant health, social, and other challenges.
By integrating enrollment into routine planning processes, supporting staff understanding of Medicaid work requirements and exemptions, providing supportive documentation, clearly delineating staff responsibilities, coordinating with state Medicaid offices and community partners, and auditing procedures now, corrections facilities can prevent dangerous gaps in coverage.
Not only is this critical to helping the formerly incarcerated population navigate the new requirements, but doing so helps ensure that people can access the services and supports they need to rebuild their lives and avoid re-incarceration.
About the author
Gabrielle de la Guéronnière is the Vice President of Health and Justice Policy at the Legal Action Center.