We’ve written before about how the Patient Protection and Affordable Care Act (PPACA) now mandates change in covering people newly discharged from prisons and jails (PPACA & Medicaid Enrollment Post Incarceration, A New Opportunity To Serve Justice-Involved Consumers and The ROI Of Recidivism Prevention). Essentially, the rule, effective on January 1, 2014, means an estimated seven million ex-offenders can qualify for Medicaid as soon as they are released back into the community, as part of the Medicaid expansion population (see Health Care Reform Regs Streamline Medicaid Eligibility For State Prison Inmates).
But recent coverage of this rule change from the managed care perspective leads me to believe there is a big opportunity here for organizations that can develop a model for coordinating health, behavioral health, education, employment, and housing services for this population. This isn’t simple – it will involve innovation in terms of restructuring current service offerings, creating an infrastructure for cross-systems individual consumer record, and assuming financial risk. But for some intrepid, entrepreneurial management team, this is a big opportunity.
Why do I say that? About 30% of people in the Medicaid expansion population will be former inmates (see Federal Estimates Indicate Former Inmates & Detainees Will Constitute About 30% Of People In The Medicaid Expansion Population). At least 70% of the roughly 10 million people released from prison or jail each year are uninsured, according to the nonpartisan Council of State Governments (see Medicaid & Financing Health Care For Individuals Involved With The Criminal Justice System). Add to this picture that 80% of prisoners have a history of substance abuse (see Drugs and Crime in America), and 16% are estimated to have a mental illness, or an addictive disorder (35%), or both (45%) (see Addiction & The Criminal Justice System). And, then there are the “quotable quotes” in the Managed Care article, Managed Medicaid Braces for Influx of Ex-Inmates:
- Paul Jarris, MD, MBA, executive director of the Association of State and Territorial Health Officials (ASTHO) was quoted as saying “There are very high rates of chronic physical illnesses and substance disorders among this population….It is essential that when the prisoners are released, there is a transition of care available to them in their community.”
- Anne Peak, a social services planner at the Kentuckiana Regional Planning & Development Agency (KIPDA) was quoted as saying, “When we first started working in the Louisville Metro Department of Corrections, we found we had to work with identifying the release times. Releases happen throughout the day, every day….Opening the safety net on time depends on the system.”
- Brett Edelson, Vice President, Product Strategy & Management, UnitedHealthcare was quoted as saying, “Two of the biggest issues are housing and employment….Transition planning should reflect ex-inmates’ psychosocial needs.”
It appears that initial experiments with coordinated care models for justice-involved consumers are working, including reduced recidivism by linking newly released prisoners to a medical home, and the increased likelihood that the prison SMI population would access community mental health and substance abuse services if enrolled in Medicaid while incarcerated (see Health Coverage and Care for the Adult Criminal Justice-Involved Population). This is a population (and payers) that need the expertise that traditional behavioral health and social service organizations have to offer. The question is, who will become the leader of this market niche? In 2015, we’ll be devoting an issue of our monthly management newsletter to programs in this market space. If you have a program that we can include in our profiles, let us know at firstname.lastname@example.org.