Corrections-involved populations have higher rates of opioid and substance use disorders (SUD) than the general population, with more than 75 percent of recently released individuals reporting an SUD or a chronic medical and/or psychiatric condition. These individuals face numerous barriers to receiving treatment, including stigma, limited access to medication-assisted treatment (MAT), and disconnected systems of care.
While many states have begun to increase access to MAT in jails and prisons, coordinating continuous treatment following release remains a challenge. This disruption contributes to recidivism, drug use, and poor and costly health outcomes. Researchers in Washington State estimate that the risk of death from overdose was 12-times greater for a recently released individual than among the general public, resulting in high health care costs. Those costs, particularly to treat overdose episodes, are affecting state budgets in multiple ways. Researchers in Kentucky estimated that 12 months of overdoses cost the state $7 million in charity care in addition to $59 million in annual Medicaid expenditures.
To address the range of physical and behavioral health care needs during this critical transition period, states are working to streamline enrollment and re-enrollment in Medicaid, provide care management and supports, and better address social determinants of health for this vulnerable population.
States have implemented various initiatives across agencies to address the need for continuity in coverage post-release. Policymakers are focusing on different entry points and policy levers, all of which are aimed at easing transitions to ensure care across systems, including clinical-level interventions to coordinate care between corrections and community settings. While health care in the corrections system is subject to internal procedures and regulations, providing continued coverage upon release requires significant coordination at both policy and clinical levels.
Care Management and Supports for Continued Medicaid Coverage
Application and enrollment assistance: States are dedicating staff to conduct screenings and help complete and process Medicaid applications to address individuals’ literacy and access challenges. States may mandate Medicaid enrollment within legislation or may include such requirements in their state Medicaid plan.
A 2015 New Mexico law states that incarcerated individuals must be allowed to submit a Medicaid application. In 2018, the state expanded this when it passed an additional legislative directive to enhance data-sharing activities among state agencies in support of Medicaid eligibility and care coordination for corrections-involved populations. This legislation also mandates that correctional facilities must:
- Facilitate Medicaid eligibility determinations during an individual’s incarceration or upon re-entry, and
- Require that county jails be provided with technical assistance, training, and certification of county jail presumptive eligibility determiners upon written request.
Suspension – rather than termination – of Medicaid during incarceration: In 2016, the Centers for Medicare & Medicaid Services (CMS) clarified that states may suspend rather than terminate Medicaid on incarceration. Suspension – rather than termination – allows for quicker reinstatement of coverage after incarceration and may be a cost-saving option for both Medicaid expansion and non-expansion states. Examples of states moving in this direction include:
- California passed legislation in 2014 to suspend rather than terminate Medicaid benefits upon incarceration. Benefits may be suspended for up to one year of incarceration.
- Washington State passed SB 6430 in 2016, which allows for indefinite suspension of Medicaid benefits during incarceration.
Managed care contracting: States are exploring ways to establish routine and robust care transition processes by leveraging managed care organization (MCO) contracts to support care coordination.
Arizona contractually requires MCOs, Regional Behavioral Health Authorities, and community-based behavioral health entities to provide “reach in” care coordination services in correctional settings. Detailed “reach in” plans must be submitted to the Arizona Health Care Cost Containment System (AHCCCS).
Health homes: Health homes are integrated, team-based clinical approaches through which providers coordinate care for people with serious or multiple chronic conditions. States, through state plan options within Medicaid, may have multiple health home models, serving beneficiaries with different types of chronic conditions and/or beneficiaries in different geographic areas. States may draw down a 90 percent federal match for specified care coordination services for two years for each health home.
- Through an 1115 waiver, New York policymakers want to implement a prerelease, in-reach transitional service in order to ensure corrections-involved populations receive needed care management and critical social supports on release into the community. A large part of this waiver includes criminal justice health home pilots to provide integrated, person-centered care for Medicaid enrollees with chronic conditions.
Data sharing and exchange to support care continuity: Research indicates that disruption in care for this vulnerable population can be especially detrimental to recovery. States are creating processes to share and use data to ease the transition from incarceration to community settings:
- Ohio developed the Medicaid Pre-Release Enrollment Program, a pre-enrollment system for corrections-involved populations not already enrolled in Medicaid. The program requires data to be shared between the Medicaid agency and the Ohio Department of Rehabilitation and Correction to coordinate efforts and ensure direct enrollment into manage care plans upon release.
- Arizona’s Data Exchange System is an automated data-exchange system that identifies when a Medicaid beneficiary is released from jail, developed through intergovernmental agreements between counties and the Arizona Department of Corrections and administered by the Arizona Medicaid agency, AHCCCS. The data within this system is also used by managed care plans to better provide support to recently released individuals.
Areas to Explore
Recovery support innovations: State officials are interested in implementing collaborative strategies that can support recovery and address re-entry-related social determinants of health as part of comprehensive case management.
- The Pennsylvania Department of Corrections has established a program that allows qualifying incarcerated individuals to become certified peer support specialists to help others in the facility identify and meet recovery goals. Such initiatives provide incarcerated individuals with a potential career path and build in recovery supports on re-entry into their communities, dramatically decreasing the risk of recidivism.
As state policymakers explore strategies to provide treatment (medical/psychological interventions) and support (non-medical, recovery activities) to corrections-involved populations, they may consider:
- Policies to ensure the continuation of coverage;
- Cross-sector collaboration; and
- Comprehensive, patient-centered approaches.
For more information about how states can promote treatment coverage and continuity for justice-involved populations, explore the National Academy for State Health Policy’s State Strategies to Enroll Justice-Involved Individuals in Health Coverage Toolkit.