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For people leaving jail or prison, the first weeks after release are often the most dangerous, and for many, the difference between staying in recovery and relapsing comes down to one thing, whether they leave with Medicaid coverage already in place.
Free Addiction Treatment Behind Bars Faces New Hurdles
Nineteen states have been building programs that turn on Medicaid coverage before someone is released from incarceration, giving people access to free or low-cost addiction treatment and medications the moment they walk out the door.
Four states, California, Washington, Montana, and New Hampshire, already have these programs running, screening tens of thousands of people for substance use disorder and connecting them to care before release.
Cody Coughenour, who cycled through Washington state jails for years tied to alcohol and methamphetamine use, is one example of how this can work.
When he was released in December 2025 with his Medicaid card already active, he went straight to a treatment facility instead of back to old habits. He has been in therapy and sober since.
But H.R. 1, the federal budget law also known as the One Big Beautiful Bill, is now forcing state Medicaid agencies to implement new work requirements, tighter eligibility checks, and deep budget cuts, all at the same time these reentry Medicaid programs are trying to get off the ground.
Oregon, Rhode Island and Michigan have already paused their plans, citing insufficient funding and competing priorities created by the new law.
Who Qualifies for Free or Low-Cost Treatment Now
Louisiana became the first state approved under the Trump administration to bring Medicaid into its jails and prisons, but with a much narrower scope than earlier approved states.
Louisiana’s plan covers mental health care, medications for addiction treatment, infectious disease screening, and basic medical equipment, but not the full range of primary care services some states had previously offered.
Duke University researcher Lauren Brinkley-Rubinstein, who studies incarceration and health, says the services Louisiana is covering, especially medications for opioid use disorder, are among the most effective at keeping people alive after release.
Her concern is that people leaving jail or prison with other chronic health conditions will now have to find that care on their own, on top of finding housing, food, and work.
How to Access These Resources
If you or a loved one is leaving incarceration, Medicaid coverage for addiction treatment may already be available depending on your state, even as these programs continue to change.
Ask about Medicaid enrollment before release. States with active reentry programs screen for substance use disorder and can connect people to medications and treatment appointments before they walk out.
Check if your state offers Medicaid coverage for rehab. Even outside reentry-specific programs, Medicaid remains one of the largest funders of addiction treatment in the country.
Contact SAMHSA’s national helpline at 1-800-662-4357 for free, confidential referrals to treatment programs, regardless of insurance status.
Finding Affordable Treatment
Rehabs.org lists free and low-cost treatment options nationwide, including programs that work with people navigating Medicaid, reentry, or uncertain insurance status.
Call
800-914-7089
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to find affordable care regardless of where you are in the process.
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