Maine Wins Federal Approval to Start Addiction Treatment Before People Leave Jail

Maine has won federal approval to change when addiction and mental health care can begin for people leaving incarceration. On October 1, 2026, the Maine Department of Health and Human Services (DHHS) announced that the Centers for Medicare & Medicaid Services (CMS) approved the state's Whole Person Care Waiver. The most consequential piece: for the first time, MaineCare — Maine's Medicaid program — will be able to cover certain health services up to 60 days before an eligible person is released from jail or prison.

The waiver also renews federal funding for residential addiction treatment and adds two new authorities: short-term inpatient care for adults with serious mental illness, and, for the first time in the state, a pathway for MaineCare to reimburse traditional healing services delivered through Tribal health programs.

Why the weeks around release are the danger zone

For families, the point of the pre-release component is easy to miss and important to understand. The period immediately after leaving jail or prison is one of the highest-risk windows in a person's life — and it is exactly when coverage, prescriptions and treatment connections most often fall apart.

The clearest evidence is a landmark study in the New England Journal of Medicine: Binswanger and colleagues followed 30,237 people released from Washington State prisons and found that in the first two weeks after release, the risk of death was 12.7 times that of other state residents, and the relative risk of death from drug overdose was 129 times higher. Drug overdose was among the leading causes of death, alongside cardiovascular disease, homicide and suicide.

Maine's numbers make the scale concrete. According to DHHS, roughly 30,600 people are released from Maine prisons and county jails each year, and typically about 70 percent are eligible for MaineCare. Beginning health care and transition planning before release — rather than after — is how the state hopes to keep people connected to medication, mental health care and community providers "during a period of significant vulnerability," as the department put it.

What CMS actually approved

The approval has four major components — one continued and three new.

Continued: residential substance use disorder treatment. Maine can keep using federal Medicaid funds for residential SUD treatment in facilities with more than 16 beds — the larger facilities that the federal "IMD exclusion" normally blocks from Medicaid payment. The renewal also continues services that go beyond clinical treatment, including coverage for certain parents who might otherwise lose eligibility when a child is removed from the home, parenting supports, and home-based skills development aimed at daily living skills, community integration and housing stability.

New: pre-release MaineCare services. Beginning up to 60 days before release, MaineCare will be required to cover case management and reentry planning, medication treatment for substance use disorder, certain clinical consultation services for youth, and medications provided at the time of release. Additional services — adult clinical consultations, diagnosis and treatment of priority conditions such as HIV and hepatitis C, and family planning — will be phased in based on each facility's capacity.

New: traditional healing services. The waiver creates a pathway for MaineCare reimbursement of eligible traditional healing services provided through Indian Health Service, Tribal and other eligible Tribal health organizations — a first for the state, developed with the Wabanaki Nations, and intended to support care consistent with members' cultures, traditions and communities.

New: serious mental illness (SMI) services. MaineCare can cover short-term inpatient treatment — stays of up to 60 days — for eligible adults ages 21 to 64 with serious mental illness in selected facilities that meet the federal definition of an Institution for Mental Disease, focused on stabilization and transition back to community-based care.

The IMD exclusion, briefly

Maine's waiver belongs to a class of federal agreements known as Section 1115 demonstrations, which give states flexibility to test new approaches within Medicaid. The provision at the center of the SUD piece — the Institution for Mental Disease (IMD) exclusion — has long restricted federal Medicaid payment for inpatient care in facilities with more than 16 beds. Because many residential addiction treatment programs operate at that size, the exclusion has historically been one of the biggest obstacles to funding residential treatment through Medicaid. SUD-focused 1115 waivers are how states work around it.

How Maine got here

DHHS describes the waiver as the product of years of work among the department, the Department of Corrections, the Wabanaki Nations, county correctional facilities, the Maine Sheriffs' Association, health care providers, advocates and people with lived experience. The reentry component traces back to LD 1204, "An Act to Improve the Health of Maine Residents by Closing Coverage Gaps in the MaineCare Program for Incarcerated Persons," which was signed into law in 2023. The department says its staff have since visited jail and prison facilities in every county, and that it applied for the waiver in March 2025.

One clear lesson from that outreach, DHHS notes, is that implementation cannot be one-size-fits-all — so Maine plans a phased approach developed with correctional facilities, counties, providers and community organizations.

When it starts — and what is still pending

Approval is a milestone, not an overnight switch. DHHS's anticipated timelines:

• Residential SUD treatment: already effective and now renewed.
• Traditional healing services: October 1, 2027.
• Pre-release services: phased across Maine's jails and prisons beginning July 1, 2028.
• SMI-IMD services: July 1, 2028.

DHHS cautions that these dates are tentative and may shift as planning continues. Three other proposals from the original application remain under CMS review: Food is Medicine (medically tailored meals and produce prescriptions), Recuperative Care (short-term care and clinical support for people experiencing homelessness who are recovering from hospitalization or illness), and Contingency Management (an evidence-based SUD approach that uses incentives to support treatment participation and recovery).

MaineCare members and the public do not need to take any action right now. The newly approved services will require additional planning, rulemaking and public comment before they become available, and DHHS says it will share updates as eligibility and access details are settled.

Where to get help

If you or someone you love is struggling with substance use or a mental health condition:

• 988 Suicide & Crisis Lifeline — call or text 988, 24 hours a day.
• SAMHSA National Helpline — 1-800-662-4357, free, confidential treatment referral and information, 24/7.
• findtreatment.gov — search for treatment by location and payment type.

Families preparing for a loved one's release can also ask the facility's reentry or medical staff what coverage and medication will be in place on the day of release — the kind of continuity the new waiver is designed to make easier to answer.