The system: About 1,422 people leave custody in Louisville every month. 24.7% visit an emergency department within 30 days and 44.2% within 90 days, and about half have a traumatic brain injury or an intellectual or developmental disability that calls for medication support and a primary care connection. Release is a treatment cliff: no pathway to a primary care provider, no tracking, limited access to corrections before release, and housing gaps in the first 60 days and again at 90 to 120 days. Kentucky's Medicaid 1115 demonstration covers health-related social needs, but it had no reentry care pathway.
The cost to MB3: Coordinating care for high-need people after release with no Medicaid pathway to pay for it, while emergency care for this group cost an estimated $1.7M to $3.06M a month in Louisville.
Proposed adding comprehensive reentry care management to Kentucky's Medicaid 1115 demonstration, with Mission Behind Bars & Beyond (MB3) as the community operator. The proposal set four objectives:
The model runs in four phases: pre-screening (medication in hand, disability screening), partner flow (validated primary care connections, data and reporting), systems and data (intake system and a heuristic triage algorithm built on the IORNS risk heuristic), and condition groupings (traumatic and acquired brain injury, intellectual and developmental disability, substance use disorder and incarceration-related PTSD). Next steps: a joint briefing with the Cabinet for Health and Family Services and the Department of Corrections, approval for demonstration inclusion or contracting, and onboarding in January 2026.
Release volume from the Louisville Metro Department of Corrections fact sheet (2022); post-release emergency department use from published research; health and disability prevalence from the National Health Care for the Homeless Council (2024), Coelho, Davis and Key-DeLyria (2024), Dickson, Tillson, Leukefeld et al. (2024) in the Journal of Health Care for the Poor and Underserved, and Dague, McNamara and Westergaard (2025).
Emergency care costs were estimated at $1.7M to $3.06M a month for Louisville releases, about $28.6M a year. Nationally, about 600,000 releases a year imply roughly $2.9B in Medicaid emergency costs; a 10% reduction would be about $293M a year. Demonstration deliverables: a recidivism assessment of behavioral needs, the medications most often needed, condition groupings with prevalence, minimal viable primary care pathways for each grouping, validated primary care connections, best practices, a scoring rubric and a research report.
Proposal stage, presented October 2025; inclusion depends on state approval, and Kentucky's 1115 waiver is in its demonstration phase. Cost figures are planning estimates, not measured savings.
Q: What stood between release and care?
A: Limited access to the Department of Corrections before release, no established partnership pathways with primary care, housing gaps after release, and no shared tracking system, which is the gap Med Vault is designed to fill.