Melissa Denino, Senior Director of Market Access, Innsena
Medicaid 1115 reentry waivers are no longer theoretical. They are active or pending in many states, alongside Section 5121 planning grants that are helping jurisdictions build the infrastructure to support people as they leave incarceration. Together, these tools are intended to change how people are connected to care before and after release.
At their best, Medicaid 1115 reentry waivers create the conditions for real continuity of care: a coordinated transition instead of a discharge list and vague instructions. People can leave custody with appointments scheduled, medications in hand, benefits reactivated, and a connection to providers who understand the full picture. Simply put, no one should leave custody and start over from zero.
Medicaid 1115 reentry waivers and Section 5121 planning grants are, in theory, among the clearest opportunities we have to address systemic failures. They create space for states to provide coverage in the weeks before release, so “coming home” is not just a ride and a bag of belongings, but a much-needed warm handoff into care.
Section 5121 planning grants provide an opportunity to improve the system itself: who is accountable, how the pieces fit together, and where things break down. They give states much-needed time and resources to plan how reentry courts, probation, jail medical units, and community providers will address key questions, such as: How will stakeholders work together before release, with clear roles, information, and funding? How do these entities share enough data safely and avoid gaps in medications, appointments, sponsor programs, and other supports? Where does trauma-informed care actually show up?
It should show up in real life, in decisions about housing, work, and treatment. This is about real people and families whose lives are shaped by what systems do—and fail to do—for them.
For example, a family watches as someone they love enters the justice system. What begins as a single court date quickly turns into a pattern of repeated offenses, brief moments of hope, and then another relapse that no one in a position of authority seems surprised by. Behind the legal language and the consequences is a long-overlooked, now-diagnosed mental health disorder. Add unaddressed trauma and substance use disorder, and it is astounding that the circumstances behind many incarcerations are still treated as moral failures rather than clinical ones.
Consider another example. A reentry court decides that owning and operating a bar is a legitimate employment plan for someone with a known substance use disorder because it checks the box: “employment secured.” The family, without real experience in addiction or a full understanding of mental health, has naïve faith in the system. They believe the court would not sign off on something likely to undermine someone’s recovery.
This decision shows exactly what happens when care coordination, clinical input, trauma-informed thinking, and multidisciplinary reentry planning are missing from the process. Approving alcohol-related employment for someone with a substance use disorder perpetuates the very problem the system is supposed to help solve.
The court system can move files. The probation officer can check boxes. The reentry court can sign off. But there is still damage. It lands on a family that never had a say in those decisions or a full understanding of the ramifications.
Stories like this should be considered when we think about the magnitude of what 1115 waivers, 5121 planning grants, and care coordination can help shape. Policy changes and federal authority are important, but a holistic strategy requires more. We should also be asking whether families will ever get a chance at stability; whether mental health screenings are occurring early enough to change the trajectory; whether substance use is met with evidence-based treatment instead of a signature in a Narcotics Anonymous book; and whether “employment support” means a safe, trauma-informed plan instead of a setup for relapse, recidivism, and failure.
In more states, correctional health teams are meeting with Medicaid agencies and managed care plans to plan reentry and care coordination. Community mental health and substance use providers are being invited to the table, and there is more focus on care coordination, peer recovery, and reentry planning as a shared responsibility across all divisions involved.
These are important steps in the right direction, but we still have a long way to go. Too many families are still chasing prescriptions and reapplying for benefits that should never have been cut off. Fewer than half of people leaving incarceration can though about four in ten have a diagnosed mental illness. That gap is exactly where these waivers, planning grants, and more robust care coordination have the potential to make a real impact.
My hope is that these tools, now being implemented, will mean that families like the one in this story are no longer treated as sad mishaps, but as the reason we do better.
Melissa Denino is senior director of market access for Innsena, a go-to-market consultancy for organizations operating in the health care technology sector.
