Coming home after incarceration
Recently released from jail or prison?
If you have Medi-Cal — or think you might qualify — Atlas may be able to help you reconnect with a doctor, medications, mental health or recovery support, and community resources. One care team, no cost to you, and you can start right after you are released.
Are you eligible?
You may qualify if…
- You are leaving — or have left within the past 12 months — a jail, prison, or youth correctional facility in California.
- You have Medi-Cal, or you may be able to get Medi-Cal. Not sure? We can help you check.
- Adults may also need certain health or support needs. This can include mental health, substance use, ongoing health conditions, disability, or pregnancy and postpartum needs.
- Different requirements may apply to younger members. Members under 21 and certain former foster youth may qualify without an additional health condition.
- Participation is always your choice. You can say yes, say no, or change your mind later.
How Atlas can help
What support can look like
Medi-Cal coordination
We help check your Medi-Cal status and work with the facility, county, and your health plan so your coverage is ready when you get out.
Medical care
Connections to a doctor, clinic visits, lab work, and imaging — plus follow-up so appointments actually happen.
Behavioral health
Support for mental health and substance use, including connections to counseling and treatment in your community.
Medications
Coordination of medications you need — including medications for substance use disorder — and prescribed medical equipment.
Benefits
Help understanding and requesting the benefits and services you may be eligible for, with someone to answer questions.
Transportation
Rides to covered health appointments can be arranged so getting there is not the reason care gets missed.
Housing & community resources
Requests for authorized supports like housing navigation, food, and recovery resources, subject to your health plan's approval and what is available locally.
Reentry care planning
One care manager builds a plan with you before release and stays with you after, so you are not starting over with strangers.
How it works
From preparing for release to ongoing support
- 1
Before release
At facilities that offer CalAIM pre-release services, a care manager can begin working with you up to 90 days before your expected release date to look at your health needs and build a plan with you.
- 2
Connecting with Atlas
Your plan is handed off to your Atlas care team. We coordinate with the facility, county, and your Medi-Cal health plan so nothing has to be explained from scratch.
- 3
Coming back to the community
We help line up the first things that matter — a doctor, behavioral health, medications, and rides — and answer the questions that come up in those first weeks.
- 4
Ongoing care coordination
If you are eligible for Enhanced Care Management, your care team keeps coordinating medical care, behavioral health, pharmacy, benefits, and approved community supports for as long as you need it.
Pre-release services are available at facilities that have implemented California's CalAIM Justice-Involved Reentry Initiative. Eligibility, approval, and covered services are determined by your Medi-Cal managed care plan.
What to expect
What the first weeks can look like
- Confirming your Medi-Cal is active and knowing which plan you are with.
- Getting a first appointment on the calendar — and a ride to it if you need one.
- Making sure medications continue without a gap.
- One phone number to call when something changes.
Two minutes, no paperwork
Let's find out if Atlas can help you.
For providers, partners & anyone who wants the details
Detailed Eligibility & Program Information
Program overview
California’s CalAIM Justice-Involved Reentry Initiative allows eligible adults and youth to receive a targeted set of Medi-Cal services for up to 90 days before their expected release from participating state prisons, county jails, and youth correctional facilities. After release, eligible Medi-Cal managed care members may receive Enhanced Care Management through the Individuals Transitioning from Incarceration Population of Focus. Atlas works with correctional facilities, Medi-Cal managed care plans, county agencies, health care providers, and community organizations to help carry each member’s reentry care plan into the community and reduce gaps in care.
Formal eligibility criteria
- Adults transitioning from a prison, jail, or youth correctional facility—or released from one within the past 12 months—who have at least one qualifying condition, including mental illness, substance use disorder, a chronic or significant clinical condition, intellectual or developmental disability, traumatic brain injury, HIV/AIDS, or pregnancy or postpartum status.
- Children and youth under age 21 transitioning from a youth correctional facility or an adult jail or prison—or released within the past 12 months. No additional clinical condition is required for this group.
- Former foster youth ages 18–26 transitioning from a youth correctional facility or an adult jail or prison—or released within the past 12 months. No additional clinical condition is required for this group.
- Medi-Cal-eligible individuals who meet the Justice-Involved Reentry Initiative criteria may receive covered pre-release services for up to 90 days before their expected release. Individuals who receive qualifying pre-release services may transition into Justice-Involved ECM upon reentry when enrolled in Medi-Cal managed care.
- Enhanced Care Management is voluntary. Final eligibility, enrollment, authorization, and service availability are determined through the applicable correctional facility, county, and Medi-Cal managed care plan processes.
Medi-Cal enrollment and eligibility coordination
We coordinate with correctional, county, and managed care partners to verify Medi-Cal status, support required referrals, and help reduce coverage gaps as the member approaches release.
Pre-release assessment and reentry planning
A care manager can assess physical health, behavioral health, medications, and health-related social needs, then develop a person-centered reentry care plan with the member and involved care teams.
Connections to covered health services
We help coordinate covered clinical consultations, behavioral health services, laboratory and radiology services and, when applicable, age-appropriate medical, dental, vision, hearing, developmental, mental health, and substance use screenings for youth.
Medication and equipment coordination
Reentry planning may include medications for substance use disorder, other clinically appropriate medications, medication administration, and prescribed durable medical equipment. Covered outpatient medications may be provided at release in accordance with applicable clinical and program requirements.
Warm handoff to community-based care
Before release, the pre-release care manager can coordinate with the assigned community-based Justice-Involved ECM provider, share the reentry care plan as permitted, and arrange connections to primary care, behavioral health, pharmacy, and other needed services.
Whole-person ECM and Community Supports
After release, Atlas provides or coordinates eligible ECM services and helps members request authorized supports addressing housing, food, transportation, recovery, benefits, and other needs that affect health and stability. Community Supports are subject to eligibility, Medi-Cal managed care plan authorization, local availability, and member choice.
Eligibility, authorization, covered services, and local availability are determined through the applicable correctional facility, county, and Medi-Cal managed care plan. Community Supports are optional benefits subject to plan authorization, local availability, and member choice.
For referral partners
Refer someone preparing for release
- Correctional facilities
- Probation & parole
- Hospitals & emergency departments
- Behavioral health providers
- Community organizations
- Medi-Cal health plans
Partners can also reach the Atlas team directly to discuss workflows, referral coordination, and data sharing agreements. Partner information
Other populations of focus
Pregnancy & Postpartum Support
Pregnant or recently had a baby? We can help coordinate your healthcare and connect you with additional support during pregnancy and after delivery.
Experiencing Homelessness or Unstable Housing
If you're without stable housing or worried about where to stay, we can help coordinate your care and connect you with available housing and community resources.
Mental Health & Recovery Support
If you're managing serious mental health or substance use needs, we can help bring your healthcare, behavioral health, recovery services, and everyday support together.
Frequent ER Visits or Hospital Stays
If you've been to the ER or hospital several times, we can help coordinate follow-up care, medications, appointments, and other support to help you stay well at home.