Did you know that approximately one in 28 children grows up with a parent behind bars? That’s not just a number – it’s a glimpse into the lives of young people who face this challenge and need support to break the cycle.

According to the US Department of Health and Human Services, at any one time, nearly 6.9 million people are on probation, in jail, in prison or on parole. More than 600,000 individuals are released each year from state and federal prisons. Another 9 million cycle through local jails. More than two-thirds of prisoners are rearrested within three years of release, and half are reincarcerated.

In many states, prisons and jails are some of the largest mental health and substance abuse providers. This way of serving people has created a fragmented system of care that causes roadblocks for people re-entering the community and too often creates a revolving door leading directly back to incarceration.

Read more stories about how analytics is modernizing Medicaid and Medicare

These facts and others demand our collective attention, empathy and action. The cycle of incarceration is a human story that resonates with many in society. It’s also a story of resilience, redemption and the possibility of a fresh start.

Fortunately, new policies are emerging through Medicaid that will provide people with critical support systems to help bridge the transition back into the community. In January 2023, the Centers for Medicare and Medicaid Services (CMS) approved California’s Medicaid inmate payment exclusion waiver, allowing a limited number of benefits to be paid for by Medicaid before release.

By the time CMS guidance was issued to states in April 2023, 14 more states had submitted a waiver, and several more are considering it.

As these Medicaid waiver demonstrations begin, here are five points to consider:

1. Know who will be released and when

It sounds simple, but it’s one of the biggest barriers to helping people re-enter society today. The people, processes and technology exist to solve this challenge. Still, we've operated in disparate programs and organizational silos for so long that building this pillar of the bridge to re-entry has been tough. Best practices are occurring nationwide, but we are far from scaling this solution.

2. Collaborate across agencies and organizations

A lot of important work is going on in Medicaid and corrections agencies across the country. Running large programs with daily fires to manage and carving out time to strategize is exhausting. Equally critical, cross-agency staff must serve together as teammates toward a common cause.

3. Study what works with true advanced analytics

Medicaid waivers offer a historic opportunity to pilot different solutions across states. It's a chance to apply truly advanced analytics and move beyond basic reporting with simple but informative visuals.

States can build smarter, stronger bridges to re-entry by using proven analytic techniques with social determinants of health, medical and pharmaceutical utilization; and provider, member, and justice system data. That way, we'll all know which programs are working and how to make better, more informed resource allocation decisions.

4. Enhance care management capacity

Through AI and machine learning technology, we can create smarter workflows, adding capacity to care management staff and filling gaps in services more quickly. A common data platform with a data management strategy between government agencies and their managed care and community organization partners is another important pillar of strengthening the bridge as these waivers are implemented.

5. Prove a return on investment

States need the right data analytics infrastructure to prove the return on investment for Medicaid and partner agencies. Investing in these critical services and support systems for people re-entering the community is a critical step. Still, it may not be sustainable if states can’t prove that it reduces societal costs. With the right data and analytics, states can be ready to prove their efforts were successful not only with improved member outcomes but also for taxpayer savings and community safety.

As leaders work to solve these critical issues, partners stand ready to help build the stronger and smarter bridges it will take to improve outcomes for people re-entering our communities. The more engaged and supportive we can be to get people back on their feet, the better off we’ll all be.

Want to learn more? See how SAS is using analytics to modernize Medicaid.


About Author

Brett Davis

Principal Industry Consultant

Brett has over 20 years of combined experience working in state and federal government, and the private sector, with over 10 years focused specifically on health care. He serves as a Health Care Solutions Manager on SAS’ U.S. government health care consulting team and is responsible for providing subject matter expertise related to State Medicaid agencies and managed care plans.

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