State Strategies for Establishing Connections to Healthcare for Justice-involved Populations: The Central Role of Medicaid

Guyer J, Serafi K, Bachrach D, Gould A
Publication Year: 2019
Patient Need Addressed: Behavioral health, Food insecurity, Homelessness/housing, Substance Use
Population Focus: Medicaid eligible, Vulnerable/disadvantaged
Demographic Group: Adult
Intervention Type: Best practices, Service redesign, Staff design and care management, Technology/innovation
Study Design: Other Study Design, Review
Type of Literature: Grey
link: https://www.commonwealthfund.org/publications/issue-briefs/2019/jan/state-strategies-health-care-justice-involved-role-medicaid
Abstract

ISSUE: With many states expanding Medicaid eligibility, individuals leaving jail or prison are now often able to enroll in health coverage upon release. It is increasingly clear, however, that coverage alone is insufficient to address the often complex health and social needs of people who cycle between costly hospital and jail stays.

GOALS: To identify emerging trends in the care delivery models that state Medicaid programs use for former inmates.
Methods: Literature review and interviews with state officials, plans, and providers.

KEY FINDINGS: The care delivery models for individuals leaving jail or prison provide comprehensive primary care, typically including: data exchange to ensure providers are notified when someone is leaving jail or prison; “in-reach” to help inmates establish a relationship with a primary care provider prior to release, identify health conditions, and set up community-based care; strategies for addressing housing issues and other social determinants of health; use of a peer-support specialist who has experienced incarceration; and specialized training for primary care providers and specialists who work with the formerly incarcerated.

CONCLUSION: With a foundation of insurance coverage, states have developed a range of promising, replicable approaches to providing care to people leaving jail or prison.

Insights Results

Overview of article

  • This issue brief first discusses the impact of Medicaid expansion on coverage and then describes the latest developments in comprehensive primary care delivery models for people leaving jail or prison and the role that Medicaid can play in financing and supporting such models
  • To take full advantage of the opportunity created by Medicaid expansion, it is important to determine how to effectively deliver care to people leaving prison, especially given their high rates of mental illness, substance use disorders, and physical health problems, as well as the numerous barriers to securing housing, food, and other social supports that affect health outcomes. Ohio, New Mexico, and New York have a relatively long track record of focusing on the care provided to people leaving incarceration

Methods of article

  • The authors conducted a literature review and interviews with state officials, plans, and providers

Results

  • The models are designed to improve health outcomes and reduce unnecessary costs associated with people cycling in and out of hospitals, homelessness, and jails. Often they are part of broader efforts in Medicaid to better manage the cost of high-cost, high-risk individuals. The models include the following key elements: 1) Data exchange to identify when someone is leaving jail or prison to prepare the plan or provider for their release to the community (e.g., Arizona’s Data Exchange System and Data Exchange with Health Homes in New York City); 2) Jail or prison “in-reach” to help inmates before release establish a relationship with a PCP (Some states, including Florida, New Mexico, and Ohio, use their Medicaid managed care contracts to require plans to conduct “in-reach” into jails or prisons to connect the people released with comprehensive primary care); 3) Strategies for addressing housing issues and other social determinants of health after release (e.g., New York’s Brooklyn Health Home network, operated by Maimonides Medical Center, serves Medicaid beneficiaries with significant behavioral health issues and chronic conditions, including a large population of people with a history of incarceration); 4) Use of a peer support specialist who has been incarcerated to help the beneficiary navigate healthcare and related social service resources (e.g., community health workers find patients who would be well-served by a Transitions Clinic by reaching out to parole officers, hospital emergency rooms, drug treatment programs, and faith-based organizations, as well as visits to homeless encampments); 5) Use of PCPs and specialists with training and expertise working with individuals who have been incarcerated (e.g., Care managers who go into the Albuquerque jail to conduct in-reach on behalf of Molina Healthcare are provided with the same training as correctional officers and in San Francisco, where the first Transitions Clinic was established, the Network collaborated with a local community college to develop a post-prison community health worker certificate program)

Key takeaways/implications

  • States are deploying a range of tools to ensure that individuals have Medicaid coverage immediately upon release from jail or prison: 1) When individuals enter prison or jail, states are suspending or reclassifying coverage instead of cancelling; 2) If an individual is not enrolled in Medicaid when incarcerated, he or she can be enrolled at any time prior to release, including at initial intake into the jail or prison; 3) Enrollment may be part of the release planning process. Many states begin enrolling individuals 30 to 45 days before their release date; and 4) States can use application assistors to help uninsured individuals apply for and enroll in Medicaid prior to release
  • The challenge going forward is to solidify coverage upon discharge, maintain it, and connect people leaving the prison system with the comprehensive healthcare, social supports, and care management they need
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