Toolkit: State Strategies to Enroll Justice-Involved Individuals in Health Coverage

Source: Sarabeth Zemel, Anita Cardwell and Chiara Corso, National Academy for State Health Policy, November 16, 2015

From the summary:
Under the Affordable Care Act (ACA), many individuals involved in the criminal justice system are now eligible for Medicaid, including many young, low-income males who did not previously qualify.

States confront considerable costs associated with addressing the complex health care needs of individuals involved in the criminal justice system—in fiscal year 2011, states spent $7.7 billion on correctional health care. Health insurance options available through the ACA offer new opportunities to enroll individuals involved in the criminal justice system into coverage and provide access to physical and behavioral health services critical to their successful reentry into the community. Additionally, states and localities have the potential to benefit from cost savings from enrolling this population in health coverage because of possible reductions in uncompensated care costs and the potential for reduced recidivism rates.

Of the approximately 10 million individuals released annually from prisons or jails, 70 to 90 percent are estimated to lack health insurance. Without health coverage, these individuals are much less likely to receive the services or treatment they need to improve and maintain their health and well-being. Lacking coverage and a regular source of care, these individuals may seek treatment in hospital emergency departments, which shifts health care costs to states and localities. Additionally, for individuals with mental illness or substance use disorders in particular, a lack of access to health care is correlated with increased recidivism rates.

Although individuals are not permitted to receive Medicaid benefits while incarcerated, Medicaid enrollment processes can begin prior to an individual’s release from incarceration. In some states, prisons and jails have taken steps to implement procedures to begin the Medicaid application process as individuals are nearing their incarceration release dates. NASHP conducted a series of interviews with state officials and found strategies states are using that have made these efforts successful:
– Identifying simple and streamlined ways to integrate Medicaid enrollment procedures with existing correctional institution processes, such as incorporating enrollment efforts into existing discharge planning activities or centralizing application processing functions
– Developing strong partnerships between state Medicaid agencies and correctional authorities to support enrollment efforts, characterized by effective communication and backing from organizational leadership
– Implementing flexible approaches that can be adapted and improved over time, such as moving from a paper Medicaid application for incarcerated individuals to an electronic process

Implementing processes to enroll justice-involved individuals in health coverage on a large scale is a new endeavor for states and their efforts are in the early stages. Given this, many states are currently working through various policy and operational challenges. For example, some state officials noted the challenge of identifying an individual’s specific release date, especially for the jail population. However state officials reported that overall they viewed these efforts as successful considering the large number of enrollments that have occurred.

For detailed information on selected states’ efforts to enroll justice-involved individuals in health coverage, click through the toolkit below.