Corrections | Mental Health | Reentry | Substance Use

A “Once in a Generation Opportunity” to Improve Reentry for Nearly 2 Million People

By Hallie Fader-Towe, Jessica Saunders, Alex Ruth , Amund Tallaksen

August 20, 2025

“The time is now,” said Sheriff David Rhodes of Yavapai County, AZ.

For years, criminal justice leaders and their behavioral health partners have sought to improve what reentry looks like for the millions of people who cycle in and out of the justice system each year. But too often, lack of money and access to quality services have hindered their efforts.

That has just changed for 19 states who are now partnering with the federal government to reimburse critical reentry services with Medicaid funding. This partnership is creating what many are calling a “once in a generation opportunity,” especially as states and the federal government look for ways to remain cost effective following the passage of H.R. 1.

A Time-Limited Opportunity to Reshape Reentry

Arizona and 18 other states were recently granted permission by the Center for Medicare & Medicaid Services (CMS) to leverage Medicaid funding for up to 5 years in order to provide key services likes prescriptions, case management, and medication-assisted treatment (MAT) for adults preparing to return to the community from incarceration. Additional states are also actively engaged in building similar efforts to support young people returning to the community in compliance with federal legislation that applies to all states.

While these “reentry demonstration waivers” are a small portion of each state’s Medicaid program, the consequence for the justice system has the potential to be groundbreaking. Using the best available data, our analysis shows that approximately 2 million adults exiting jails and prisons annually could receive the reentry services they need to reduce their risk of overdose and recidivism and improve their health and economic opportunities. That kind of impact can change the way reentry services are implemented throughout the country, but only if it’s successful. Similarly, while the national provisions for young people only focus on that group, the partnerships and processes built for that population can serve as a foundation for future efforts covering adults.

Number of People Eligible to Receive Pre-Release Services through Medicaid by State

The Recipe for Success

Although state Medicaid is playing point in working with CMS on the waivers themselves, it will also take the work of state and local corrections leaders, the courts, legislators, reentry professionals, and health providers, both within facilities and in the community, to achieve success. Recognizing how important cross-system collaboration will be to these efforts, the CSG Justice Center convened representatives from 13 states to discuss the opportunity before them. This group, which included Sheriff Rhodes and others representing local government, the state courts, legislature, Medicaid, corrections, and reentry came up with the following key insights:

Robust collaboration among state Medicaid and local justice and health leaders is needed to make the most of this opportunity. While the details of contracts, reimbursement rates, and information technology are necessary for implementation success, reentry planning and delivery of services within facilities will work best with prison/jail leadership and medical and community-based providers working in concert. With the new “community engagement” work requirements for Medicaid eligibility as a result of H.R. 1, employers and workforce development specialists also have a crucial reason to be involved and helping to build pathways to employment.

💡Tip: For youth, child welfare agencies can help corrections identify young people who are eligible for services until age 26.

Use of best practices in reentry will minimize the risk of people returning to their communities without being stabilized on needed treatment for opioid use disorders or without having collaborative comprehensive case plans to coordinate their care. This can also reduce the likelihood that conditions of release will set the stage for a technical violation and return to incarceration.
Don’t just plan around the biggest jurisdiction. While metropolitan areas will see the largest number of returns to the community, state policies and implementation planning need to work for all jurisdictions in each state. The dynamics for state prisons differ significantly from jails, and the staffing needs and available community resources for rural jails differ from those in urban and suburban jurisdictions.
Intentional data collection and sharing is critical for tracking implementation for continuous quality improvement. Having appropriate data will also help relay the impact of these policies beyond what is required by CMS. While waiver proposals include an evaluation component for the “demonstration,” ensuring leaders are collecting and reviewing implementation data can help both justice and health stakeholders understand how the planned processes are working and course correct. This could include, for example, embedding analysts at correctional facilities.

3 Concrete Next Steps

Local and state leaders should not allow the perceived complexity or political climate around Medicaid to get in the way of taking concrete steps toward improving reentry. Below are three things they can do now to move reentry efforts forward:

Understand what’s happening in your state: Even if you are not in a state with an approved 1115 reentry demonstration waiver, your state may have received a planning grant from CMS to build capacity for continuity of care for young people under Medicaid/CHIP. If your state does have an approved waiver, there may be implementation funding available, as well as important planning efforts underway. Each of the 19 states has funding set aside for waiver implementation and is disbursing it through different strategies. State or local planning groups can access this funding—and not just for IT, but also for collaborative planning—and should prioritize its use for true engagement with justice partners.
Add it to the agenda: States that are already undertaking cross-system reentry efforts like Reentry 2030 can use existing workgroups to pursue this work. Similarly, Stepping Up teams in states where Medicaid is or will be available in jails can start talking about what implementing these reentry services would look like and develop an outreach strategy for their state agencies leading reentry waiver implementation. State Stepping Up TA Centers, or other similar entities, can also be a vehicle for supporting implementation across a range of local jails.
Think beyond reentry: States that have expanded eligibility to include people detained pretrial have created the space for their communities to take a holistic look at the intersection of public safety and public health. Cross-system leadership teams, like those guiding Stepping Up efforts, can help map out crisis responses that allow people to receive services from community responders to law enforcement, including how to thoughtfully determine criteria for arrest when public safety is at risk.

How We Can Help

These Medicaid reentry waivers create both an exciting opportunity to provide care and a potential risk of net-widening that has people being detained in order to get enrolled in services.

Ready to make the most of this moment to transform reentry? Looking to accelerate implementation and learn from others to make sure you get it right? The CSG Justice Center is here to assist with our expertise. We aim to work with a handful of states and counties intensively on the justice system aspects of implementation and lift up their efforts nationally. We are also connected to other national technical assistance providers who may be able to support specific implementation questions you have.

Email Hallie Fader-Towe at hfader@csg.org to learn more or request assistance.

Photo by Nathan Dumlao on Unsplash

Authors

Hallie Fader-Towe

Director of Justice and Health Initiatives, Behavioral Health

Hallie Fader-Towe works with local and state policymakers to craft policies, processes, and programs that bring research-informed approaches to their jurisdictions. In her positions with the CSG Justice Center, she has worked with jurisdictions around the country on collaborative, data-driven

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planning and implementation efforts to address criminal justice functions from initial detention through reentry, including a focus on people with mental illnesses. She has also managed the development of training materials on mental health courts and on judicial responses to the prevalence of individuals with mental illnesses involved with the criminal justice system. She has written on court case processing, competency to stand trial, dispute systems design for state trial courts, pretrial responses to people with mental illnesses, information sharing between criminal justice and mental health systems, and mental health court design and implementation. Before joining the CSG Justice Center, she was a management consultant with McKinsey & Company in New York. Hallie received a BA from Brown University and a JD from Harvard Law School.

Jessica Saunders

Director, Research

Dr. Jessica Saunders oversees the Research Division at the CSG Justice Center. She has more than 20 years of experience supporting effective and equitable criminal justice administration through rigorous research, including identifying best practices and addressing systemic racial bias. Her

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research spans the criminal justice system continuum, from school-based delinquency preventive interventions to reentry and system-wide performance metrics. She has been a principal or co-principal investigator on over $25 million in competitive research grants and contracts and has published over 50 scientific articles, books, and technical reports. Prior to joining the CSG Justice Center, she was a policy researcher at RAND Corporation and an assistant professor at Arizona State University. Jessica received her PhD in criminal justice from John Jay College of Criminal Justice.

Alex Ruth

Deputy Program Director, Behavioral Health

Alex Ruth oversees the strategic direction, quality and impact of projects at the intersection of justice, Medicaid, health and housing, including the development and delivery of training and technical assistance for a range of policymakers in states across the nation.

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Prior to joining the CSG Justice Center, Alex served as the justice administrator for Arizona's Medicaid agency, AHCCCS. Alex played a key role in the strategic direction and implementation planning of Arizona’s 1115 Reentry Waiver and the state’s reentry program. Alex modernized outdated justice policies, improved data to support meaningful outcomes for citizens reentering their communities, and presented on statewide justice strategies to local and national leaders. Alex has experience in managed care as a justice system liaison and reentry coordinator. She has served as a psychometrist and mental health evaluator in the Maricopa County Jail system and has worked with youth involved in the justice system. Alex earned a BS in cognitive psychology from Old Dominion University and an MS in forensic psychology from Southern New Hampshire University.

Amund Tallaksen

Data Science Project Manager, Research

Amund Tallaksen provides data analysis and visualization for multiple projects, including Justice Counts, an initiative to help policymakers make better decisions using public safety data. Before coming to the CSG Justice Center, Amund worked as a lecturer at Carnegie Mellon