FOR IMMEDIATE RELEASE
Cambridge, MA – 3/12/2025 – The Center for Health Law and Policy Innovation (CHLPI) of Harvard Law School recently released an updated Reentry Waiver Tracker to highlight uptake and implementation of state Medicaid waivers allowing states to provide Medicaid coverage to individuals that are preparing for reentry to the community from incarceration. CHLPI’s Tracker underscores how these innovative waivers, if used strategically, can be used to expand access to hepatitis C and HIV treatment and prevention. This comprehensive tracker serves as a valuable resource for policymakers, advocates, and community members seeking to understand and promote the effective implementation of these critical waivers.
Both hepatitis and HIV are widespread among people who have been involved in the criminal legal system, yet access to treatment and prevention are often sparse in carceral settings. Hepatitis C rates are approximately ten times higher among incarcerated populations than in the general population, and recent reports indicate that HIV rates are three times higher among prison populations. One contributor to disproportionate rates of chronic illness among people who are currently or formerly incarcerated is the lack of Medicaid coverage in the days leading up to and preceding release, which can cause gaps in health care coverage as someone returns to the community. Reentry waivers can help mitigate these issues.
The update to the tracker adds analysis on recent approvals from December 2024 and January 2025, highlighting which states are utilizing reentry waivers and whether they include coverage for key services like direct-acting antivirals (DAAs) for hepatitis C, antiretroviral therapy for HIV, and PrEP (pre-exposure prophylaxis) for HIV prevention. States have flexibility in designing their programs, and even the most limited waivers can increase opportunities for better care.
“We applaud the states that have taken this strategic step toward better supporting the unique and sometimes complex health needs of people who have been incarcerated,” said John Card, Staff Attorney, CHLPI. “Successfully navigating health care in the days before and after release can be critical to preventing and treating life-changing and incredibly costly chronic conditions. Reentry waivers can help address obstacles to success and provide significant opportunity for stakeholders invested in reentry to imagine a new, more successful reentry system that reduces excess reincarceration and disjointed health care access.”
The tracker reveals several key insights. First, just over half of approved states include pre-release medication and medication administration, and, while not required under federal guidance, these services are key to increasing access to lifesaving treatments. Moreover, of the 19 approved waivers, most provide coverage for 90 days before release, with a few exceptions. For the few states with more limited waiver approaches, policymakers will likely gain additional insight to the challenges of assessing eligibility, enrolling beneficiaries, and supporting meaningful access to healthcare in such a short window. These lessons may be informative as policymakers pursue other legislative efforts to improve Medicaid access in carceral facilities. Lastly, most states expanded coverage to multiple facility types, including youth detention, prisons, jails, and tribal facilities. The broad array of settings will allow Medicaid and other stakeholders to better understand the unique obstacles to healthcare that arise when integrating Medicaid into various carceral settings for the first time.
“Both hepatitis C and HIV can be managed with timely, consistent access to doctors and prescription medications,” said Carmel Shachar, faculty director of the Health Law and Policy Clinic, CHLPI. “The vast majority of hepatitis C cases can be cured in 8-12 weeks, and if designed strategically, reentry waivers have the potential to provide—and maybe even finish—a full regimen before release. Similarly, reentry waivers can also enhance continuity of care for people living with HIV and provide more widespread access to HIV prevention. We are excited to see ongoing bipartisan support for these cost-saving initiatives that support efficient and strategic resource coordination for people returning to their communities.”
With limited services currently underway in California, and as Massachusetts is expected to begin implementation in the fall of 2025, the impact of reentry waivers is just beginning to be understood. On March 11, 2025, the Centers for Medicare and Medicaid extended an opportunity for states and territories to receive funds for reentry planning grants, signaling the possibility of plans to continue bipartisan efforts to improve health care for people leaving incarceration. CHLPI will continue to track waiver implementation, analyze waivers’ effectiveness in expanding access to care, and complementary efforts to reduce the health impacts of incarceration. The updated tracker and further information about CHLPI’s Health and Reentry project can be found on CHLPI’s website.
Media Contact: Ada Ezeokoli: aezeokoli@law.harvard.edu
About the Center for Health Law and Policy Innovation (CHLPI)
The Center for Health Law and Policy Innovation (CHLPI) advocates for legal, regulatory, and policy reforms in health and food systems, with a focus on the health, public health, and food needs of systemically marginalized individuals. CHLPI’s broad range of initiatives aim to expand access to high-quality health care and nutritious, affordable food; to reduce health- and food-related disparities; to develop community advocacy capacity; and, to promote more equitable, sustainable and effective health care and food systems. Learn more at www.chlpi.org
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