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1. Expanding support services to populations who face barriers to health care due to their social circumstances; 2. Improving coordination and integration of physical, behavioral, and social services for beneficiaries who have complex health and social needs; 3. Enhancing quality and efficiency of care delivery by addressing the root causes of poor health outcomes; and 4. Promoting health equity and reduce health disparities by targeting services and supports to beneficiaries who experience higher rates of morbidity and mortality due to their social risk factors.

1) Pre-Release Services under the Reentry Demonstration Initiative

Expenditure authority is being provided to Pennsylvania to provide limited coverage for a targeted set of services furnished to certain incarcerated individuals for 90 days immediately prior to the individual’s expected date of release. The state’s proposed approach closely aligns with CMS’ “Reentry Demonstration Opportunity” as described in the State Medicaid Director Letter (SMDL) released on April 17, 2023.

Eligible Individuals

Pennsylvania will cover a set of pre-release benefits for certain individuals who are inmates residing in prisons and jails (herein after referred to as “correctional facilities”). To qualify for services covered under this demonstration approval, individuals residing in a correctional facility have been determined eligible for Medicaid pursuant to an application filed before or during incarceration, be age 19 or older, have an expected release date within 90 days, and meet one or more of the following health-related criteria:

1. Have one or more substance use disorders (SUD); 2. Have serious mental illness (SMI); 3. Be eligible for Medicaid funded 1915(c) home and community-based services (HCBS) administered by the Office of Long Term Living or Office of Developmental Programs upon release; 4. Have one or more chronic health conditions; 5. Be pregnant or in the 12-month postpartum period; 6. Have Autism Spectrum Disorder (ASD).

Medicaid Eligibility and Enrollment

CMS is requiring, as a condition of approval of this demonstration, that Pennsylvania make pre- release outreach, along with eligibility and enrollment support, available to all individuals incarcerated in the correctional facilities listed above and outlined in the STCs.

For a Medicaid covered individual entering a correctional facility, Pennsylvania will not terminate Medicaid coverage, but will suspend the individual’s coverage. For individuals not enrolled in Medicaid upon entering a correctional facility, Pennsylvania will ensure the