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13 Health & Just. 1 (2025)

handle is hein.journals/hlthjs13 and id is 1 raw text is: Bandara etal. Health&Justice (2025) 13:1 Health & Justice https://doi.org/10.1186/s40352-024-00311-7 Implementation of carceral medicaid suspension and enrollment programs: perspectives of carceral and medicaid leaders Sachini Bandara1 2 , Brendan Salonerl , Hannah Maniates3, Minna Song2 and Noa Krawczyk4 Abstract Background Medicaid expansion via the Affordable Care Act, more recent legislation and Medicaid 1115 waivers offer opportunity to increase health care access among individuals involved in the carceral system. Effective enrollment of new beneficiaries and temporary suspension and reactivation of existing Medicaid benefits upon release is key to the success of these efforts. This study aims to characterize howjails, prisons and Medicaid agencies are implementing Medicaid suspension and enrollment programs and identifies barriers and facilitators to implementation. Methods We conducted 19 semi-structured interviews with 36 multi-state leaders in carceral facilities, Medicaid agencies, local health departments and national policy experts from 2020 to 2021. Interviews covered 4 domains: (1) the role of policy in influencing carceral and reentry Medicaid practices, (2) implementation strategies to suspend and enroll incarcerated individuals into Medicaid, (3) barriers and facilitators to successful implementation, and (4) variation in implementation between jails and prisons. Results Participants identified logistical challenges with suspension and enrollment, including limited infrastructure for data sharing between carceral facilities and Medicaid agencies, burdensome bureaucratic requirements, and challenges with Medicaid renewal, particularly in the jail environment. They offered opportunities to overcome barriers, such as the creation of specialized incarcerated Medicaid benefit categories and provision of in-reach services via managed care organizations. Participants also called for improvements to Medicaid reactivation processes, as even when facilities successfully suspended benefits, individuals faced significant challenges and delays reactivating benefits upon release. Participants also called for further loosening of the Medicaid Inmate Exclusion Policy. Discussion Findings highlight the need to update data sharing infrastructure, which will be critical to the implementation of the 1115 waivers, as carceral facilities will be subject to Medicaid billing and reporting requirements. In addition to investing in the ability to newly enroll and suspend Medicaid benefits, attention towards improving timely reactivation practices is needed, particularly given the highly elevated risk of mortality immediately after release. Participants calls for further reforms to the Medicaid Inmate Exclusion Policy are consistent with proposed legislation. *Correspondence: Sachini Bandara sbandara@jhu.edu Full list of author information is available at the end of the article C ©The Author(s) 2024. Open Access This articie is licensed under a Creative Commons Attribution 4.0 International Ucense, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and he source, provide a link to the Creative Commons licence, and indicate if changes were made.The images or other third party material in this artide are incuded in the articdes Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not incuded in the articies Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy ofthis licence, visit http//creativecommons.org/licenses/by/4.0/.

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