Improving the Health of Justice-Involved Individuals: How Medicaid Can Help

Some states are working with their Medicaid managed care organizations and community partners to coordinate care for justice-involved individuals prior to release with the goal of improving continuity of care and smoothing community transitions.

Nearly 2.3 million people are incarcerated in the United States—and approximately 95% of people incarcerated in state prisons will be released back to their communities at some point, according to the National Reentry Resource Center (NRRC). However, a criminal conviction or history can severely limit employment prospects, housing opportunities and access to social services. Justice-involved individuals—i.e. adults serving sentences in prisons and jails, awaiting trial or sentencing, or those under community supervision, such as parole or probation—have a higher risk of HIV and AIDS, tuberculosis, sexually transmitted diseases, and hepatitis B and C, according to the Medicaid and CHIP Payment and Access Commission (MACPAC).

While incarcerated, individuals receive medical care through the prison system. Prior to the Affordable Care Act (ACA), most adults leaving prison or jail were not eligible to enroll in Medicaid, because coverage was not available to childless, low-income adults. However, many states are now expanding their Medicaid eligibility requirements, opening Medicaid to all adults with incomes below 138% of the federal poverty level. This means that more people leaving jail or prison are now eligible to obtain health coverage upon release, explains Nan Sloan, vice president of compliance at Medecision. In fact, many state Medicaid programs start working with incarcerated individuals 30 to 90 days prior to release to provide assistance with enrollment, care coordination and case management so that individuals can start receiving care immediately upon release.

However, health coverage is often not enough to address the complex health and social needs of justice-involved individuals, explains Trina Milling-Hawkins, vice president of government solutions programs at Medecision.

“A justice-involved individual leaving that environment will likely require many resources that health plans can’t manage solely on their own,” Milling-Hawkins says. “Healthcare is, of course, important, but you also have to address social determinants of health such as education, housing, transportation, employment and food security.”

Treating the Whole Person

Social determinants of health (SDOH)—or the conditions of the places where people live, learn, work and play—can drive as much as 80% of health outcomes, according to the Robert Wood Johnson Foundation. Medicaid programs are increasingly looking to improve health, so there is a growing emphasis on strategies to address the social factors that contribute to better outcomes. We see examples of this with other high-risk populations, as healthcare payers and organizations launch programs to address SDOH and fund grants for community programs to approach issues like homelessness, hunger and transportation.

So how can Medicaid-managed care organizations address the SDOH of justice-involved populations?

“It’s important for Medicaid agencies to partner with community-based organizations to provide education and connect justice-involved individuals to local support systems where they can get personalized, ongoing support,” Sloan explains.

Many states are working hard to make the transition back into the community easier for justice-involved individuals by addressing social and economic needs. Here’s a look at how some states are working with these populations.

• In Ohio, eligible inmates are enrolled into Medicaid about 90 days prior to release and are educated on Medicaid-managed care plan options. Each of Ohio’s five plans do “in-reach” with inmates to assess their needs and connect them with a primary care provider to visit after release. Every inmate who is enrolled receives care coordination and, for inmates with serious illnesses, insurers are required to help establish a care plan and set up appointments with a provider.
• Through the use of an 1115 waiver, the New York State Department of Health announced in August 2019 that it will begin providing Medicaid services to eligible incarcerated individuals with chronic illnesses 30 days prior to release. Anthony J. Annucci, department of corrections and community supervision acting commissioner, said, “Approval of this Medicaid waiver would provide incarcerated individuals returning home from prison with a continuity of healthcare, breaking down a significant barrier to a successful reentry and helping to keep our communities healthy and safe.” Care management is provided through New York’s Health Home Program, in which justice-involved individuals are provided with assistance in scheduling appointments for physical and behavioral health providers, finding support for social needs and developing a care plan.
• In New Hampshire, a community re-entry project helps adults with mental health conditions and/or substance abuse disorders maintain their health and recovery after they leave a correctional facility. The program is started prior to release and continues for one year after release. Participants are provided with a support system, care coordination and access to behavioral health services.
• California is working to ease the transition back to the community by linking justice-involved individuals to the necessary social services for housing, employment and education.

“The more support that you can provide around social needs—whether it’s employment, housing or substance abuse—the better chance you’re giving the individual to be successful,” Milling-Hawkins says. “When someone is released from prison, they’re likely not thinking about their healthcare. Though they’re thinking about the day-to-day necessities, they’re likely not going to call Aetna or United Healthcare for those needs. But health plans can work with community organizations like United Way, employment centers or even law enforcement officials such as parole officers to help individuals transition back to their communities and not fall back into their old patterns.”

 What Are the Benefits?

The average annual cost per prison inmate is $33,275, according to research from Vera. Addressing social factors can not only help improve health outcomes, but it can also reduce recidivism, explains Milling-Hawkins. Approximately 77% of individuals released from prison were arrested again within five years, according to a report from the U.S. Department of Justice. But studies show that ensuring people are enrolled in a health plan and have support to address social factors like housing, food and employment can help reduce recidivism.

“A positive support system is critical,” Sloan explains. “Oftentimes, former inmates are seen as a ‘sore spot’ in society. But when health plans partner with community organizations and leverage resources like parole or probation officers to make sure healthcare and social needs are being met, we can help justice-involved individuals become active, meaningful members of society.”

Addressing SDOH can also help drive better health outcomes and, in turn, lower the costs of ongoing medical care for high-risk populations. Focusing on SDOH can help health plans understand the whole person and manage the expenses that correlate to the individual’s physical and mental condition—which, in turn, can lead to cost savings from reduced hospital readmissions, limited emergency room visits and improved preventive care.