Role of Medicaid and Department of Corrections: Pre-Release and Substance Use Disorder Care

Based on the Virginia experience, this session will address the role of Medicaid and a state department of corrections to reduce the negative impact of substance use disorders (SUDs) among those incarcerated and upon release, where individuals are at 129 times the risk of a fatal overdose in the first two weeks. Since January 1, 2019, more adults living in Virginia have access to health insurance due to Medicaid expansion. Covered adults have comprehensive healthcare coverage including access to Medicaid covered SUD treatment. In 2019, about 42,000 (44%) members enrolled through Medicaid expansion were diagnosed with a SUD. This represents a 62% increase in the number of Medicaid members with a SUD diagnosis from 2018. With this expansion in coverage, an important sub-population of focus are members with a SUD and have experience with the legal/carceral system. The legal/carceral population is at higher risk for co-morbid physical and behavioral health needs with around 67% having a SUD.

In Virginia, Medicaid activities focus on expanding SUD treatment capacity and creating a strong partnership between Medicaid and Virginia Department of Corrections (VADOC), which has been crucial in successful re-entry. Expanding treatment capacity includes increasing access to peer recovery support services, linkages to medication for opioid use disorder, and focusing on transitions of care between emergency departments and outpatient SUD treatment. The Medicaid and VADOC partnership includes such actions as facilitating Medicaid enrollment during incarceration and through probation or parole offices, training VADOC and probation/parole staff on Medicaid benefits, and linking members to community-based providers. Future opportunities being exploring include implementing an in-reach care coordination benefit and a statewide re-entry protocol tool, as well as utilizing a Medicaid 1115 demonstration waiver to cover treatment services during incarceration.