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Adam Swanson

Senior Policy Associate, National Council for Behavioral Health

Justice-Involved Individuals: New Options for Health Coverage

May 1, 2014 | Justice | Medicaid | Comments
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A new report from Health Affairs details options for states to provide health insurance coverage for formerly incarcerated persons, affording behavioral health providers new opportunities to serve these newly eligible individuals. Health Affairs outlines how states can significantly increase the availability of services for these individuals and ultimately reduce recidivism rates. The report highlights the overlap between people with prior jail involvement and those eligible for Medicaid expansion coverage, the common behavioral health needs for persons that have interacted with the justice system, and opportunities for states to support their enrollment.

As individuals exit the justice system, their access to care traditionally falls by the wayside, despite the fact that more than 60 percent exhibit symptoms of a behavioral health condition. In fact, people involved in the justice system experience considerably higher rates of chronic and acute health disorders compared to the general population. According to the Center for Health Care Strategies, alcohol plays a role in more than 50 percent of incarcerations, and illicit drugs in more than 75 percent.

What actions is your agency taking to ensure justice-involved individuals properly enroll into care? Is your state taking advantage of new opportunities to coordinate care when individuals are released from prison or local jails? Share your community’s experience in the comments section of this post.

The Affordable Care Act directly effects enrollment and coverage for justice-involved individuals. Of the nearly 17 million Americans newly eligible for Medicaid coverage under the Affordable Care Act (ACA), up to 30 percent have had prior interactions with the criminal justice system. The ACA’s expansion of Medicaid increases eligibility for Americans with incomes up to 138 percent of the federal poverty level. At present, the expansion is in effect in 25 states and Washington, D.C. According to the U.S. Department of Justice, 60 percent of justice-involved individuals had incomes less than 138 percent of the federal poverty line prior to being arrested, and the Health Affairs report details how the characteristics of the justice-involved population closely mirror those of the Medicaid expansion population.

The expansion of Medicaid for justice-involved individuals poses some challenges to states. Health Affairs article, “Medicaid Expansion: Considerations For States Regarding Newly Eligible Jail-Involved Individuals” identifies some challenges states might face as they restructure publically financed healthcare services. For example, states may not use federal Medicaid funds to provide services for incarcerated people, except for hospital inpatient stays that last longer than twenty-four hours, which causes states to either terminate or suspend Medicaid enrollment for people entering jail that were previously covered.

Medicaid’s coverage of substance abuse treatment services has varied from state to state throughout the years. But the ACA requires states that expand Medicaid to include mental health and substance use treatment at parity with comparable medical benefits. Given the justice-involved populations need for high quality behavioral health services upon release, it is imperative for states to structure plans that allow for access to high quality treatment services while also coordinating with local jail systems. A few states have already taken steps to coordinate with prisons and local jails and guarantee newly released inmates are released with Medicaid coverage. States also face challenges when looking to finance the healthcare of justice-involved populations. Financing is a tricky topic to navigate – for more information regarding state financing options for this population, please read the Capitol Connector’s previous post on this issue.

Health policy experts expect the Medicaid expansion will help to reduce recidivism.  The report declares that by enrolling persons previously involved in the justice system into care, states have the potential to reduce recidivism rates. According to the Council of State Governments Justice Center, at least 70 percent of the roughly 10 million people released from prison or jail each year are uninsured. Without proper interventions, most of these individuals behavioral and chronic health conditions go untreated, resulting in increased usage of emergency rooms and greater instances of justice-related interactions. A 2013 study published in Psychiatric Service In Advance points out that with routine outpatient treatment, the likelihood of subsequent arrest for adults with behavioral health conditions, such as schizophrenia and bipolar disorder, is reduced. By enrolling justice-involved individuals into Medicaid or Marketplace plans, their ability to locate and pay for services increases, improving overall health status while addressing many of the root causes of incarceration.