The Department of Health Care Policy and Finance (HCPF) is working to improve health outcomes for criminal justice-involved individuals. This page offers current information, updates, and the latest guidance so that we may ensure best practices and improve access.
Medicaid Reentry and Community Health (M-REACH)
M-REACH is a new program under Colorado’s 1115 “Expanding the Substance Use Disorder (SUD) Continuum of Care” Waiver (1115 Waiver). On January 13, 2025, the Centers For Medicare and Medicaid Services (CMS) approved a waiver amendment authorizing reentry services. Coverage for reentry services will begin 90 days prior to release for all Medicaid and CHP+ eligible youth and adults and include:
- Re-entry transitional case management services to assess and address physical and BH needs and HRSN;
- MAT, for all Food and Drug Administration (FDA)-approved medications, including coverage for counseling; and
- A 30-day supply of covered medications upon release
Pending additional federal approval, HCPF can begin paying for reentry services at the Division of Youth Services and Department of Corrections on July 1, 2025, and local jails on July 1, 2026. The reentry services that HCPF will offer meet the minimum requirements established by CAA 5121, described below.
Legislative Background
- In 2022, the Colorado General Assembly passed SB22-196, requiring HCPF to evaluate and decide if the state should seek additional federal authority to provide certain reentry services through Health First Colorado (Colorado Medicaid). HCPF engaged Health Management Associates (HMA), a national healthcare consulting firm, to fulfill the requirements of SB 22-196. The final report, Federal Authority to Support Health Related Re-Entry Services, outlines the population that would be covered, the services and benefits, the costs of these services and the potential impact to Coloradans. The report states there are public health and financial benefits to HCPF covering a limited benefit for Medicaid eligible justice-involved population up to 90 days prior to release, and potential to improve outcomes for these individuals transitioning out of jails, prisons, and juvenile facilities. Based on the fiscal analysis, implementing transitional services for Medicaid-eligible members in prisons, jails and juvenile youth facilities is unlikely to increase state dollar expenditure.
- In 2024, the Colorado General Assembly passed HB24-1045, authorizing HCPF to request federal authority for and to implement a limited set of reentry services. On April 1, 2024, HCPF submitted an application to amend the current 1115 Waiver, including a request to provide reentry services.
CAA 5121
CAA 5121 refers to Section 5121 of the Consolidated Appropriations Act of 2023. CAA 5121 creates federal minimum requirements for Medicaid and CHP+ services to be provided to eligible youth who are post-adjudication and 30 days prior to release from a correctional setting.
HCPF has requested federal authority through our 1115 Waiver, described above, to offer a more expansive set of reentry services. Through the phased implementation of Medicaid Reentry and Community Health (M-REACH), HCPF will meet the minimum standards created by CAA 5121. HCPF and our federal partners at the Centers for Medicare & Medicaid Services (CMS) recognize that it will take time after the CAA 5121 effective date of January 1, 2025, to fully implement reentry services in correctional facilities across the state.
For correctional facilities that wish to implement CAA 5121 services prior to M-REACH implementation, CMS guidance states that compliance can be achieved if a correctional facility furnishes the required services to eligible juvenile beneficiaries, regardless of whether those services are billed to Medicaid (SHO24-006).
CMS Guidance for CAA 5121
- SHO# 24-004 RE: Provision of Medicaid and CHIP Services to Incarcerated Youth
- SHO# 24-006 RE: Provision of Medicaid and CHIP Services to Incarcerated Youth - FAQs
Eligibility for Criminal Justice-Involved Populations
All applications for Health First Colorado (Colorado’s Medicaid program) for incarcerated individuals can be completed, submitted, and processed while they are awaiting release. The process should not be postponed until their release. Incarcerated individuals may be approved for Limited Medicaid Benefits for Incarcerated Individuals if all other eligibility criteria are met. After release, an individual may qualify for full Health First Colorado benefits if they continue to meet eligibility criteria.
The county human services office must be informed of the member’s release for full benefits to be reinstated, and the release date may be provided when known. Please reference this Operational Memo (OM23-058) for additional information on the Department’s eligibility policy on Limited Medicaid Benefits for Incarcerated Individuals.
Health First Colorado-covered services are available to Community Corrections (halfway houses) facility residents who would otherwise be Health First Colorado eligible, including individuals who reside at the facility involuntarily. See policy statement from June 1, 2016 - Medicaid Eligibility of Individuals Residing in Community Corrections Facilities (or "Halfway Houses")
Hospital Guidance
Disproportionate Share Hospital (DSH) payments
- August 16, 2002 CMS Letter Concerning DSH Payments for Inmates
In 2002, CMS clarified that states cannot make disproportionate share hospital payments to hospitals to cover the cost of care for inmates of a public institution who become hospitalized.
Inmates Receiving Care at Correctional Care Medical Facility of Denver Health Medical Center
- August 16, 2010 CMS Response Regarding Individuals Receiving Services in a Correctional Care Medical Facility are Eligible for Health Care Services Funded with Federal Financial Participation
In this letter, CMS clarifies that inmates receiving care in the Correctional Care Medical Facility of Denver Health Medical Center are eligible for federal Medicaid funding.
Federal Medicaid Coverage Policy for Inmates of a Public Institution
December 12, 1997 - CMS Letter Concerning the Clarification of Medicaid Coverage Policy for Inmates of a Public Institution. The purpose of this memorandum is to clarify the current Health First Colorado coverage policy for inmates of a public institution.
Resources
Frequently Asked Questions
- Eligibility & Applying for Medicaid
Supporting individuals in gaining or maintaining Medicaid (Health First Colorado, Colorado’s Medicaid program) coverage during incarceration is a key component of ensuring timely access to care upon release. If they meet the eligibility criteria, Medicaid services can provide individuals with benefits allowing for a successful transition into society, reduce mortality rates after release and reduce the likelihood they will return to jail.
This process requires partnership between state agencies, local jails and their County Department of Human/Social Services (DHS/DSS) office. Coordination between jails and DHS/DSS offices will vary across counties and this resource is designed to support all partners in creating an effective system.
Can Medicaid applications be processed during incarceration?
Yes. All applications from incarcerated individuals should be completed, submitted, and processed while the applicant is still incarcerated and should not be postponed until release. These applications are processed the same way as an application from someone who is not incarcerated. Operational Memo 23-058 describes this process.
Where can I find the Medicaid application and where can applications be submitted?
A link to download applications is available on the Medicaid Forms webpage. Applications can be submitted by mail or dropped off at your county of residence's local county office or at a local application assistance site. Jails and County DHS offices can also work together to determine the most effective way for applications to be submitted in their county. Individuals who have been released or have access to internet, applications can also be submitted through the PEAK website.
Can Long-Term Care (LTC) applications be processed during incarceration?
Yes. There is no policy preventing individuals from completing the LTC application during incarceration, and this does not vary across waiver types. The LTC application can be found under the “Disability Applications” section on the Member Forms webpage. The financial application (standard Medicaid application), disability application (if needed to establish disability through Arbor/ARG [Action Review Group) and Level of Care Assessment can all be completed while incarcerated, and then the county can use that to determine eligibility for LTC.
If you are working with someone who is incarcerated and in need of LTC, please move forward with those applications. If you are running into issues, you may escalate cases with the escalation form so that we can address any issues you run into.
Are jails required to help with Medicaid applications?
Yes. CRS 17-26-140 (2) states:
“A county jail shall provide Medicaid enrollment or reenrollment paperwork to a person who is incarcerated in the jail and is eligible for Medicaid benefits when the person enters the county jail. The county jail must file the Medicaid paperwork with the county department of health and human services upon releasing the person from the county jail's custody.”
However, to ensure timely receipt of Medicaid eligibility and coverage, it is in the best interest of the member to process applications prior to their release. Applications should be submitted upon completion and not held until release. Operational Memo 23-058 describes this process.What should I do if an individual does not have an address or ID?
The local county department of human services (DHS) can assist those individuals who may not have a permanent address or ID at the time of application and should not impede the process of enrollment in Medicaid.
- For identification – Applications can be turned in without an ID. If individuals do not include an ID with their initial application, the eligibility sites will attempt to verify identity electronically. If identity may not be verified electronically, additional information will be requested and a reasonable opportunity time period may be provided for members to verify their identity.
- For address – Individuals must put an address on their application. The address must be a place where the individual can receive mail but does not have to be where they are residing. Acceptable addresses include a shelter, friend, or relative within the state in which they are applying for coverage.
- Coverage
What benefits does an individual have access to while incarcerated?
Medicaid benefits provided while the individual is considered incarcerated are limited to covered services when the member is hospitalized for at least 24-hour hours outside the correctional facility. Operational Memo 23-058 has guidance on covered and non-covered services under the Incarcerated Medicaid benefit. These benefits are likely to expand after 2025 through new federally supported program, please stay tuned through the 1115 Demonstration Waiver website and the Criminal Justice Involved Populations website.
What benefits does an individual have access to upon release? Are there resources that I can share with individuals who are releasing?
Members are eligible for full physical and behavioral health benefits beginning the day they are released at no cost to the member, including inpatient substance use treatment. Information on benefits covered by Medicaid is available on the Health First Colorado Benefits & Services webpage. Health First Colorado benefits are also described in the Member Handbook. Individuals can also be referred to their Regional Accountable Entities (RAE). RAEs provide support for individuals who are enrolled in Health First Colorado (Colorado’s Medicaid program) and need connections to medical and non-medical resources.
How are benefits reinstated at release?
A member or an authorized representative can contact your county Department of Human Services (DHS) office or a local application assistance site to update incarceration status in person or by phone. To update status online, an individual can use the PEAK website. The Eligibility Site should then update the individual attributes of the case to reflect that the individual is no longer incarcerated. The date used should be the date of release. Changes such as a scheduled release from prison or jail can be reported prior to the release date. Updated eligibility will then be reflected in interChange as of the day of release. This process is described in Operational Memo 23-058.
Can Medicaid pay for court-ordered services?
It depends. For individuals who are not incarcerated, Medicaid can reimburse medically necessary, covered services regardless of a court order for the services. However, when courts mandate a specific treatment intensity, length, or provider for an individual that are not covered by Medicaid or are not medically necessary, Medicaid is not allowed to reimburse for care. Medicaid cannot make exceptions to coverage for an individual because a service is required by a judge.
Of note, Medicaid does not currently pay for services while someone is in custody, unless the services are provided during a hospital admission lasting 24 hours or longer.
- Utilizing Benefits
How do I find providers that accept Medicaid?
For physical health conditions, providers that accept Medicaid can be found using the Find a Doctor search tool on the Health First Colorado website. For behavioral health providers, please contact the Regional Accountable Entity (RAE) for your region. Member contacts for the RAEs are available at Health First Colorado Regional Organizations webpage and a RAE Referral Tip Sheet for Justice System Partners is available in the “Resources” section of the Health First Colorado and Criminal Justice Involved Populations webpage.
How do I connect a member to their Regional Accountable Entity (RAE)?
A RAE Referral Tip Sheet for Justice System Partners is available in the “Resources” section of the Health First Colorado and Criminal Justice Involved Populations webpage.
For questions related to Health First Colorado and Criminal Justice-Involved Populations or historical documents previously found on this page, please contact:
To ask a question or make a suggestion, please contact us by email: hcpf_cjj@state.co.us