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Providing Health Care at Reentry Is a Critical Step in Criminal Justice Reform

Geneva Cooley, 72, learns how to use the internet and sets up a gmail account with the help of re-entry coordinator Donna Collins at the Aid to Inmate Mothers house two days after getting released from a life sentence without parole.

Geneva Cooley, 72, learns how to use the internet and sets up a gmail account with the help of reentry coordinator Donna Collins at the Aid to Inmate Mothers house two days after being released from a life sentence without parole in Montgomery, Ala., on October 10, 2019. Improving health care continuity for people leaving prison and jail is another critical piece to successful reentry. Photo: Lynsey Addario via Getty Images

Geneva Cooley, 72, learns how to use the internet and sets up a gmail account with the help of reentry coordinator Donna Collins at the Aid to Inmate Mothers house two days after being released from a life sentence without parole in Montgomery, Ala., on October 10, 2019. Improving health care continuity for people leaving prison and jail is another critical piece to successful reentry. Photo: Lynsey Addario via Getty Images

Authors
  • John Sawyer headshot
    John Sawyer

    Senior Advisor, Waxman Strategies

  • Vikki Wachino headshot
    Vikki Wachino

    Principal, Viaduct Consulting LLC

  • Abby Walsh headshot
    Abby Walsh

    Vice President for Strategy and Operations, Council on Criminal Justice

  • Silicia Lomax Headshot
    Silicia Lomax

    Senior Associate of Health Policy, Waxman Strategies

Authors
  • John Sawyer headshot
    John Sawyer

    Senior Advisor, Waxman Strategies

  • Vikki Wachino headshot
    Vikki Wachino

    Principal, Viaduct Consulting LLC

  • Abby Walsh headshot
    Abby Walsh

    Vice President for Strategy and Operations, Council on Criminal Justice

  • Silicia Lomax Headshot
    Silicia Lomax

    Senior Associate of Health Policy, Waxman Strategies

Toplines
  • Current law prohibits Medicaid from covering most health care for incarcerated people, even though having continuous coverage is key to better behavioral health outcomes and a reduced likelihood of returning to jail or prison

  • Health care models that help justice-involved people return to their communities should include enhanced primary care, connections to behavioral health, active patient engagement, and trauma-informed approaches

Record-breaking overdose deaths and increasing mental health challenges highlight the urgent need for stronger behavioral health policies and systems. Policymakers are trying new approaches, including the 988 suicide and crisis lifeline launched this year and new mobile crisis services under Medicaid.

Recognizing that the justice system has become a default mental health provider, policymakers should also look to proposals to improve health care continuity as people leave prison and jail, including allowing Medicaid to cover services prior to release. Current law prohibits Medicaid from covering most health care for incarcerated individuals. Providing continuous coverage has the potential to improve behavioral health outcomes and make it less likely that people return to prison and jail. These approaches have bipartisan support and have advanced at the federal and state levels. They are driven by failings in the current system and are supported by an unlikely coalition of health care providers, patient advocates, law enforcement, and criminal justice reformers.

The proposals that amend Medicaid’s longstanding inmate exclusion have advanced along two pathways:

  • Federal legislation. Several bipartisan proposals are under consideration by Congress, most notably the Medicaid Reentry Act (S. 285; H.R. 955). This bill would allow Medicaid to cover health care services in the 30 days preceding release from prison or jail. The Medicaid Reentry Act has passed the House as part of several different legislative packages but has not passed the Senate.
  • Medicaid waivers. Nine states have submitted requests for waivers to the federal government under Medicaid’s demonstration authority, Section 1115. Each of the nine waivers would modify (or waive entirely) Medicaid’s inmate exclusion to allow for coverage of certain health services provided to incarcerated people pre-release. The specifics of these proposals, including the coverage period, available services, and eligibility categories, vary by state. Congress has required the Centers for Medicare and Medicaid Services to issue guidance on how states can use 1115 waivers to strengthen reentry transitions.

Making these reentry policies a reality will require bridging gaps between the health and criminal justice systems. To inform policy and potential implementation, the Health and Reentry Project (HARP)1 convened government officials, key stakeholders, and people who have been incarcerated. The full findings from this project are available online and summarized here.

Reentry’s North Star: Building a New Health Care Model to Meet People’s Needs

Stakeholders convened by HARP expressed strong support for efforts to allow Medicaid to cover prerelease services, which they believe will improve continuity of care and equity, and support people in successfully returning to communities.

They set a “north star” to guide the way in which potential Medicaid policy changes are carried out: a reentry health care model that helps people return to communities “healthy and whole.” It should include:

  • Enhanced primary care and connections to behavioral health. Primary care that facilitates access to mental health and substance use services can reduce barriers to treatment, improve outcomes, and promote care coordination.
  • A commitment to active patient engagement. Understanding and supporting patients’ needs through direct, patient-centered engagement can help build trust, which is an essential but largely missing element for people who have experienced incarceration. Health care models that build trust between patients and providers can help people access services and meet their health care needs. The Transitions Clinic Network, which operates in 14 states and Puerto Rico, is one such model.
  • Service coordination and navigation. Health professionals, such as community health workers, and correctional officials, such as probation officers, can support individuals in navigating reentry. Professionals and paraprofessionals who have been incarcerated themselves may be particularly effective in supporting people leaving prisons and jails.
  • Trauma-informed approaches. Trauma-informed care can be an important service for some people post-incarceration, mitigating the effect of past trauma on individual functioning and health.
  • Integrated social and health supports. Smooth connections to services like housing, nutrition, and transportation can improve the health of people post-release.

The Nuts and Bolts of Reentry: Operational and Policy Considerations

To carry out new policies, connections between the health and criminal justice systems must be strengthened. One key challenge will be making sure that the requirements and standards of care that apply to Medicaid-covered services in the community are effectively translated into the correctional setting. Establishing the cross-sector collaboration will require financial investments in infrastructure. Policy and operations will need to accommodate differences between prisons and jails. Continuing to expand access to community behavioral health services will promote access to services after people are released and can make it less likely that people become incarcerated in the first place. Finally, evaluation will be needed to measure the impact of new policies on health and public safety and fine tune them, if necessary.

The Path Forward

Expanding Medicaid’s role at reentry can be a powerful lever to help address national mental health and substance use challenges and improve public safety. Potential policy changes create an opportunity to build reentry services that support people’s health and success in rejoining their families and communities. Cross-sector collaboration, stakeholder engagement, and prioritizing the input of people with lived experience can help realize the full potential of these changes.

NOTES
  1.  HARP, a collaboration between the Council on Criminal Justice, former deputy administrator for Medicaid and CHIP Services Vikki Wachino, and Waxman Strategies, was formed to help states, the federal government, local governments, and relevant stakeholders maximize the benefits of proposed Medicaid policy changes for public health and public safety through effective implementation. Support for the initiative is provided by the Commonwealth Fund, the California Health Care Foundation, the Rx Foundation, and the Charles and Lynn Schusterman Family Philanthropies.

Publication Details

Date

Contact

John Sawyer, Senior Advisor, Waxman Strategies

Citation

John Sawyer et al., “Providing Health Care at Reentry Is a Critical Step in Criminal Justice Reform,” To the Point (blog), Commonwealth Fund, Sept. 9, 2022. https://doi.org/10.26099/g765-7947