Oregon quietly halted a new Medicaid program for people leaving prison. Whether it goes forward may be up to the Trump administration.

More than two years ago, faced with a growing addiction crisis in the state, Oregon health officials began work on an innovative program that would help people about to be released from jail or prison receive targeted health services through Medicaid.

Federal rules make it hard for people to access benefits until their sentence is up, meaning most leave uninsured. Officials hoped the $64 million Medicaid expansion would smooth the often difficult transition for people exiting the prison system by providing them basic care — like drug prescriptions, behavioral health and addiction counseling and doctor’s visits — three months before their release.

The reentry benefits program appeared to be on track to launch in late 2025 for juveniles and early 2026 for adults, with state funds earmarked for it in Gov. Tina Kotek’s two-year budget proposal released in December.

But this summer, the program was quietly delayed. Kristen Lambert, a spokesperson for the Oregon Health Authority, told InvestigateWest in an email that the program was put on pause in anticipation of sweeping changes to Medicaid funding under President Donald Trump’s signature tax and spending cuts package, referred to as his “Big Beautiful Bill.”

The agency says it is revisiting the project plan and timeline to ensure the entities tasked with implementing it would be “properly resourced and supported.”

But with no new launch date in sight and Oregon’s federal authorization for the program due to expire in 2027, the program’s fate is now likely to fall into the hands of the Trump administration — and it is unclear what they might do. The Centers for Medicare and Medicaid (CMS), which authorized Oregon’s experimental program under the Biden administration, did not respond to InvestigateWest’s questions about whether it will reauthorize such pre-release benefits programs. 

Despite this uncertainty, Lambert said the health agency remains committed to implementing a benefits program “that supports successful community reentry for youth and adults,” adding that staff members are actively working with partners in Oregon and the federal government to do so. She declined a phone interview to answer additional questions about where the program stands.

The setback in any event has left incarcerated people who would have benefited from these new services feeling left in the lurch, said Angela Kim, a former critical care nurse who spent nearly two decades incarcerated at Coffee Creek Correctional Facility in Wilsonville, Oregon — the state’s only women’s prison. Kim now works with the Oregon Justice Resource Center, supporting its advocacy on health care inside the justice system.

“It’s pretty devastating for people,” Kim said. “This is not about luxury health care. … This is about making sure people who are leaving prison don’t overdose or end up in a psychosis or even go back to prison.”

Oregon’s reentry benefits program was authorized by CMS last year under what’s called a Section 1115 demonstration waiver. These waivers act as a permission slip for states to pursue new, experimental approaches to Medicaid that differ from what is required by federal law, so long as officials believe the initiative is likely to “promote the objectives of the Medicaid program.”

Historically, these waivers have been used by states to expand coverage or implement tailored health programs for specific populations, institute work requirements, and restructure financing for their Medicaid program.

In the case of pre-release benefits, Oregon needs a waiver to get an exemption from longstanding Medicaid policies that substantially limit Medicaid benefits for people living in certain facilities, like in-patient psychiatric hospitals and prisons.

These exclusion policies, according to criminal justice reform advocates and health experts, have created lapses in access to critical health care for people who have or may be especially vulnerable to developing chronic conditions like diabetes, asthma or a substance use disorder.

When people are incarcerated, the state typically suspends or ends their Medicaid coverage to comply with the federal policy. Upon release, their eligibility is supposed to be immediately reinstated, but there is often a delay in receiving benefits because of onerous paperwork or waiting periods.

Even for the most well-supported and well-resourced individuals, this difficulty resuming  coverage once out of prison can translate to a higher risk of death or other negative outcomes. 

One study by Oregon Health and Science University, Oregon State University and the Department of Corrections published in 2023 found formerly incarcerated Oregonians are 10 times more likely to experience an opioid overdose — both fatal and nonfatal — in their first two weeks outside prison compared to the general public, driven in large part by barriers to accessing care.

Congress opened the door for states to introduce pre-release benefits in 2018, when lawmakers passed the bipartisan SUPPORT for Patients and Communities Act, which directed CMS to create rules for how states can use Section 1115 waivers for reentry initiatives. 

“[Pre-release benefits] allows them to hit the ground running, which isn’t the case now,” said Aliza Kaplan, a Lewis and Clark Law School professor who specializes in criminal defense and prison law.

“Almost every single person in Oregon’s prison system is going to get out at some point,” she continued. “If they don’t have the services they need, the treatment they need, the housing they need, then they’re not going to be successful.”

But all initiatives implemented under Medicaid waivers have an expiration date, typically around three to five years after their initial approval. If a state wants a program to continue, the federal government would need to sign off on it again.

This dynamic gives quite a bit of latitude to presidential administrations to shape how waivers can be used, according to Amaya Diana, a Medicaid expert at the Kaiser Family Foundation. Administrations can approve or rescind permission for programs based on how it may fit into their policy goals.

Oregon applied to introduce the reentry initiative in 2023 as an amendment to its existing Section 1115 waiver for the Oregon Health Plan, its Medicaid program. 

The application was granted in 2024 under President Joe Biden, who made expanding access the crux of his Medicaid policy. The Biden administration approved similar reentry programs in states like California, Utah, Kentucky and Washington.

But the approval for Oregon’s reentry program is only good through the end of the Oregon Health Plan’s waiver period, in 2027. Next fall, the state will need to go back to CMS to renew, and it will be up to the Trump administration whether to keep the reentry benefits program.

Diana said it is too soon to say what the Trump administration’s waiver priorities will be, but early signs have pointed to a stark reversal from those in the Biden era. 

Over the past few months, CMS has rescinded a more expansive framework allowing for waivers to be used to cover “health-related social needs” like food and housing for low-income people. It has also moved to phase out one of the key mechanisms states have to use Medicaid funding to finance health programs that are typically not eligible for other federal funding.

Though it is unclear how the administration will approach reentry benefits initiatives like Oregon’s, those who advocate for and work with people involved in the justice system are worried. 

“All of the vital needs that people have in their lives are in chaos after they’re released from custody,” said Wanda Bertram with the Prison Policy Initiative, a nonprofit that has studied the impact of mass incarceration on health. “When you have so many unmet needs in your life, the importance of getting those needs met is more urgent.”

Whether someone is able to successfully transition back into the community after incarceration can largely depend on how they are set up by prison officials or who their parole officer may be. Even then, a lot of the bureaucratic heavylifting to connect with services like Medicaid or food stamps still rests on the individual — tasks that can be unmanageable for someone in the throes of a behavioral health crisis.

Oregon’s reentry benefits program would have created some stability in this period by connecting people with health care services before they leave prison. According to Oregon’s waiver application, 90 days before their release, eligible people would be able to consult with providers to identify their physical and behavioral health needs, get access to addiction counseling and a short-term supply of any prescription medications, and other services.

Kim, the former critical care nurse, has seen just how difficult that transition can be without this assistance firsthand. 

When she was first incarcerated at Coffee Creek Correctional Facility in 2009, she was healthy. But just three years into her sentence, she said the difficulties maintaining her health in that environment due to changes in her diet and her physical activity regime led her to develop Type 2 diabetes.

When she was released, Kim didn’t have one of the medications she had been taking to manage her diabetes. But she was fortunate, and a nonprofit helped her connect to a provider who was able to fill the prescription. Other people she has known were not so lucky.

“There have been so many women who have left Coffee Creek and we hear that they’ve overdosed,” Kim said. “And I think that this would have helped alleviate those kinds of issues.”

She also believes the reentry benefits program would encourage the state to take a closer look at the quality of health care people receive while they’re still in prison.

“[Reentry benefits] was going to make a change,” Kim said. Now, she went on, “the delay just continues.”