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Corrections says 1115 reentry waiver is live but billing, methadone access and reporting remain pending
Summary
New Mexico Corrections Department told the committee its 1115 Medicaid waiver program launched July 1, 2025, but confirmed no Medicaid billing has occurred yet because the state's billing methodology and CMS reporting requirements remain pending; methadone provision is planned but not yet operational statewide.
Officials from the New Mexico Corrections Department told the Legislative Finance Committee on Jan. 28 that the 1115 Medicaid waiver reentry program went live July 1 but key operational pieces remain incomplete.
"The 1115 waiver commenced within the corrections department July 1," NMCD Health Service Administrator Wen Tsungai said. He added that eligibility determinations are made by the Health Care Authority and that NMCD has been completing applications for incarcerated individuals who do not refuse. NMCD also said it continues to provide 30 days of medication on release as part of current practice while the 1115 waiver enables future Medicaid reimbursement.
NMCD cautioned that no Medicaid billing has occurred yet. "No actual billing is happening for two reasons," Tsungai said: the state is finalizing an accounting methodology proposed to Medicaid (direct claim vs. certified public expenditure) and NMCD is waiting for prerelease dates and finalized reporting requirements from HCA and CMS. He said billing will be retrospective on a quarterly basis once approved.
On methadone access, NMCD said methadone was not yet offered as a correctional treatment option because it requires use of an opioid treatment program (OTP) or narcotic treatment program (NTP) with specific certification. NMCD said it has identified a partner OTP and expects to begin offering methadone in the weeks ahead and to meet timelines that aim to have services in place by the end of the calendar year. Gene Ryan, director of pharmacy for Medicaid, added that "there is an oral option" commonly used and an injectable option, and cautioned the injection must often be administered in a clinic or pharmacy setting, which may limit scale.
Committee members probed continuity of care after release. Tsungai said prescriptions provided in custody typically last about a month; on release NMCD can provide up to 30 days of medication and will refer people to DOH or community providers. Members expressed concern that typical wait times to see community providers can exceed 30 days, creating a potential gap in care.
NMCD said the 1115 waiver will support more coordinated reentry case management and better information exchange with managed care organizations (MCOs), but officials acknowledged CMS has not yet finalized the data points states must report and that establishing causal links between in‑custody interventions and recidivism requires improved statewide data infrastructure.
What’s next: NMCD committed to provide activity and output data (number served, services provided, duration and missed appointments) and to follow up in writing on billing methodology and prerelease scheduling. CMS and HCA approvals will determine when Medicaid billing and more comprehensive reporting begin.
