Area of Expertise: Medicaid

People who return to the community after experiencing incarceration face many challenges in reorienting to life in their communities. Addressing basic needs like food, clothing, and shelter is likely their priority, as many of them do not have a home where they can return upon discharge. Even for those who receive family support, it is challenging to navigate the process of obtaining and maintaining the services, including healthcare, that they need to thrive in the community.

States looking to improve health, improve public safety, and decrease costs are providing Medicaid insurance coverage to this population in new and innovative ways. Various states have been approved by the federal Centers for Medicare & Medicaid Services (CMS) to use 1115 research and demonstration waivers to facilitate the enrollment of Medicaid for justice-involved persons, primarily 90 days before release.

This resource highlights the requests and approvals of Reentry Demonstrations by states. The below table summarizes state programs that are focused on the justice-involved population based on research conducted by CSH.

A number of states are looking to both increase supportive housing capacity and quality. One component of improving quality could be developing more intensive supportive services. Many barriers exist to increasing supportive housing capacity for most communities, including a lack of a Medicaid Authority. Nearly 30 states already have in place some supportive housing services benefit, and CSH’s map can help you find where your state is in the process. This brief provides a detailed summary of state actions and lessons that could be replicated in your state.

Updated November 2025

H.R.1 is estimated to reduce federal spending on Medicaid by more than $1 trillion over ten years, and cause as many as ten million people to lose their health insurance.

The new law enacts policy and funding changes to key housing development financing tools: the Private Activity Bonds (PABs) and 4% Low Income Housing Tax Credit (LIHTC) Program and the 9% LIHTC Program.

H.R.1 includes requirements and budgetary changes that will make continuous health care coverage a challenge for individuals who are experiencing homelessness or have experienced homelessness and housing instability, including most supportive housing residents. This brief summarizes solutions to help states ensure that Medicaid eligible individuals remain enrolled and compliant with the new law.

The purpose of the CSH Supportive Housing Services Staffing and Budget Tool is to support agencies, communities, and project planners to estimate comprehensive costs for supportive housing services. The tool uses a template that includes built-in assumptions around best practice for four staffing models: Assertive Community Treatment (ACT), Intensive Case Management (ICM), Tenancy Support Services (TSS), and Critical Time Intervention (CTI). Each of these models is well-researched and has a strong evidence base for efficacy with supportive housing tenants across a variety of constituencies. The tool allows the user to model out scattered site and project-based programs and input their average staffing costs, budget assumptions, and productivity expectations to determine rates needed by agencies for a fiscally sustainable program.

Last updated: August 2025

An increasing number of states are including coverage of Housing Related Services (HRS) in their Medicaid programs. These new services aim to provide more units of supportive housing and higher quality services. CSH has found that states who include these six strategies in their efforts are more likely to be successful. Learn more about these efforts, examples and concrete next steps your state can take to ensure these programs lead to greater supportive housing capacity and higher quality supportive housing statewide.

This brief titled Supportive Housing and Olmstead: State of the Conversation, February 2024, delves into critical considerations for policymakers and advocates amidst implementing state HCBS settings rule transition plans and endeavors to ensure compliance with the landmark Olmstead v. L.C. decision. The essence of Olmstead lies in its vision to empower individuals with disabilities by fostering their seamless integration into communities and affording them the autonomy to choose supportive housing as a pathway to realizing this vision. This document recognizes the pivotal role of quality supportive housing in advancing these objectives and bolstering Money Follows the Person (MFP) initiatives across states.

A Resource for Housing and Homeless Programs Considering Options for Billing for Medicaid Eligible Services

This review of Medicaid models is designed to assist supportive housing providers and homeless service organizations consider strategies to enhance their services (and services funding) through partnerships or through securing new resources. Included are comprehensive overviews of three options: Becoming a Medicaid Billable Agency; Collaborating to Increase Services and Capacity; and Contracting with an Administrative Services Organization.

This material is based upon work supported by the Corporation for National and Community Service (CNCS) under Social Innovation Fund Grant No.16PSHNY002. Opinions or points of view expressed in this document are those of the authors and do not necessarily reflect the official position of, or a position that is endorsed by, CNCS.