Essentials: California’s Justice-Involved Reentry Initiative

What it is, how it works, and why it matters for behavioral health care access

California’s behavioral health and criminal legal systems have long intersected. People with mental health conditions and substance use disorders are disproportionately represented in jails and prisons — so much so that Los Angeles County is often described as the nation’s largest provider of mental health care.

But significant gaps persist in inmates’ ability to receive care, especially when transitioning back to the community. These gaps in care before and after incarceration contribute to repeated emergency department visits, hospitalizations, and returns to custody — outcomes that are costly, avoidable, and misaligned with California’s broader behavioral health reform goals.

The CalAIM Justice-Involved Reentry Initiative helps address these gaps. By allowing Medi-Cal services to begin before release from incarceration, the initiative aims to improve continuity of care, reduce reliance on emergency services, and support more stable reentry outcomes. While the initiative applies broadly to physical and behavioral health care, it is especially consequential for people with serious mental illness and substance use disorders, who are overrepresented in California’s jails and prisons.

Source: Public Policy Institute of California, 2023

Why California created the Justice-Involved Reentry Initiative

Because Medi-Cal coverage is typically suspended during incarceration due to longstanding federal rules, individuals often face delays in Medi-Cal reactivation, lack medications, and have no established connection to community providers.

This pattern has significant system-level impacts – increased emergency department use, higher inpatient utilization, and Medi-Cal costs driven by crisis care rather than planned outpatient treatment. Individuals released from jail or prison are also at substantially higher risk of poor health outcomes in the weeks following release. In California, overdose death rates are more than 100 times higher in the two weeks after release compared to the general population, and nationally, formerly incarcerated individuals face a significantly elevated risk of suicide.

Across the country, people of color are more likely to be incarcerated due to untreated mental health conditions, the criminalization of substance use disorders, and systemic inequities in the criminal justice system. Although Black and Latino individuals are not more likely than White individuals to misuse alcohol or drugs, they are more likely to be incarcerated for related behaviors, making gaps in care during incarceration and reentry disproportionately harmful for these communities.

By offering care to individuals before release, the Justice-Involved Reentry Initiative aims to stabilize care transitions, improve health outcomes, and reduce disparities driven by delayed or disconnected access to care.

What is the Justice-Involved Reentry Initiative?

The Justice-Involved Reentry Initiative is a CalAIM program that allows eligible individuals in state prisons, county jails, and youth correctional facilities to receive a targeted set of Medi-Cal services for up to 90 days prior to release.

Approved in January 2023 through California’s Section 1115 Medicaid demonstration waiver, the initiative partially waives long-standing federal restrictions that limited Medicaid coverage during incarceration. California was the first state in the nation to receive this approval.

The goal: ensure people leave incarceration already connected to care, rather than attempting to navigate enrollment, treatment, and follow-up on their own after release.

Measuring success

DHCS will assess the initiative’s effectiveness using measures tied to its core objectives, including:

• Continuity of Medi-Cal coverage at release, including reduced gaps in enrollment and benefits activation
• Connection to community-based care, particularly mental health and substance use disorder services following release
• Utilization of emergency and inpatient services, with the goal of reducing avoidable emergency department visits and hospitalizations
• Engagement in ongoing behavioral health treatment, including medication continuity and follow-up care
• Equity in access and outcomes, given the disproportionate impact of incarceration on communities of color

Because the Justice-Involved Reentry Initiative is still in the early stages of implementation, statewide outcome data are not yet available. At this phase, the state’s focus is on ensuring systems are operational, coordinated, and positioned to deliver services consistently across correctional facilities and counties.

How the initiative works

The Justice-Involved Reentry Initiative is designed to stabilize health needs before release and support a seamless transition to community-based care.

Pre-release Medi-Cal services

Eligible individuals can receive Medi-Cal services during the 90 days prior to release, including:

• Comprehensive care management and reentry planning
• Physical and behavioral health clinical consultations, in person or via telehealth
• Medications and medication administration, including long-acting injectable medications
• Medications for substance use disorder, including FDA-approved treatments
• Peer support and community health worker services
• Medications and durable medical equipment provided upon release

These services are intended to initiate or continue treatment, address unmet needs, and reduce the likelihood of service gaps immediately following release.

Care coordination and continuity

Each participant is assigned a care manager who works with them before release to assess physical, behavioral health, and social needs, develop a reentry care plan, and coordinate referrals and follow-up appointments.

The initiative also requires “warm handoffs” between pre-release providers and community-based providers to minimize disruptions as individuals move from custody to community.

Who is eligible?

Individuals already enrolled in Medi-Cal who meet the following criteria are eligible to receive initiative services:

• Adults with a confirmed or suspected mental health diagnosis or substance use disorder
• All justice-involved youth, regardless of diagnosis

Although this initiative’s eligibility requires individuals to already be enrolled in Medi-Cal, California is required to establish pre-release Medi-Cal application processes for adults and youth in county correctional facilities and county youth correctional facilities. These processes are intended to better position individuals leaving incarceration to have Medi-Cal coverage in place immediately upon release, rather than experiencing gaps in enrollment or benefits activation.

How is the initiative funded?

The Justice-Involved Reentry Initiative is supported through:

• California’s 1115 demonstration waiver authorizes federal Medicaid matching funds for approved pre-release services
• Providing Access and Transforming Health (PATH) funding supports the implementation of the initiative, including planning, staffing, information technology, and operational readiness

Implementing the initiative

Successful implementation requires coordination across correctional facilities, county behavioral health agencies, managed care plans, and community-based providers — a central aim of CalAIM’s broader system-integration strategy. California took a phased approach to implementing the Justice-Involved Reentry Initiative, with full implementation completed in October 2025.

• October 1, 2024: Core services and program components went live with pilot counties, including Inyo, Santa Clara, and Yuba.
• February 3, 2025: Early launch within the state prison system
• October 1, 2024 – April 2026: Statewide launch in correctional facilities
• October 1, 2025: Launch across every California county