We pay a high price for incarceration. There’s a $182 billion annual price tag attached to the 2.3 million people in prison and jails (see How Many People Are Locked Up In The United States?) —and $12.3 billion of that is attributed to health care (see Following The Money Of Mass Incarceration and Over Half Of State & Federal Prisons Uses Contractors–OPEN MINDS Releases Reference Guide To Correctional Health Care Landscape) And recidivism rates are estimated at 49% within eight years of release (see USSC Recidivism Among Federal Offenders: A Comprehensive Overview).
The reason costs are so high? Approximately 50% of inmates have chronic health conditions such as heart problems, diabetes, or hepatitis, and 64% of inmates have a mental health illness (see Federal Policy Impacts On County Jail Inmate Healthcare & Recidivism and Serious Mental Illness Prevalence in Jails and Prisons), there are high rates of substance use disorders (SUD), and co-occurring disorders (see State Policy On Medicaid Benefits For State Prison Inmates: A State-By-State Review). Our data shows that inmates released to the community seek emergency care, are hospitalized more frequently, their mortality rates are 12 times higher than the general public (see Medicaid & Justice-Involved Populations: Strategies To Increase Coverage & Care Coordination).
To address these issues, states are testing ways to improve the system. California debuted a program to screen for and treat inmates with SUDs. Rollout began in January and offers participants medicated assisted treatment (MAT), comprehensive cognitive behavioral interventions, and safe, therapeutic housing. It will focus on whole-person treatment from incarceration through return to the community (see California Prisons Rollout Integrated Addiction Treatment Programs and California Correctional Health Care Services: Treatment To Reduce The Burden Of Disease & Deaths From Opioid Use Disorder).
Other states—including New York—have proposed extending Medicaid coverage for individuals with complex health issues, such as two or more chronic conditions, mental health and substance use disorders, and human immunodeficiency virus prior to release. The goal is to ensure that incarcerated individuals connect with provider organizations in the community after release. This need to “facilitate access to covered Medicaid services prior to and after a stay in a correctional institution” prompted the Centers For Medicare & Medicaid Services to publish a frequently asked question guide to help state health officials use Medicaid for this population (see CMS FAQ Sheet To Facilitate Successful Re-Entry For Individuals Transitioning From Incarceration). The New York proposal, submitted through a Medicaid Redesign 1115 Demonstration Amendment, would extend Medicaid to a specific population 30-days prior to release. The state also proposed a pilot for specialized treatment in a therapeutic residential environment for individuals with mental health or substance use disorders that are accused, but not convicted, of a felony. The residential treatment would be a voluntary alternative to incarceration (see New York To Extend Medicaid Coverage To Incarcerated Individuals 30 Days Prior To Release).
California and Utah are using waivers under Section 1115 of the Social Security Act to address chronic health issues of inmates (see California Health Care System Landscape: An OPEN MINDS State Profile and Utah Health Care System Landscape: An OPEN MINDS State Profile); and Arizona, Connecticut, and Massachusetts are establishing connections with community providers, obtaining referrals for health care, and—in some instances—scheduling appointments (see Connecting The Justice-Involved Population To Medicaid Coverage And Care: Findings From Three States).
What does this mean for health and human service provider organizations? In states that are adopting more expansive policies to address the health and social support needs during the reentry process, programs that are tailored to these populations will resonate. Specialized supported housing programs, specialized care coordination models, and “in reach” services should all increase. Some of the recent contract awards illustrate the options: Wyoming Awards In-Prison Substance Abuse Treatment Services Contract to Gateway Foundation, Inc., Benton County, Oregon Launches Criminal Justice System Improvements Project, and Lane County, Oregon Launches Pay-For-Success Project For Forensic Housing & Re-Entry Services. For more on the opportunities related to the corrections system, check the OPEN MINDS Circle Library:
- What’s Happening In Reentry Contracting?
- The Community Reentry Mess – Who’s Contracting?
- The Community Reentry Mess – What Works?
- Correctional Reentry Strategies More Important With Growing Plans for Early Release
- State Policy On Medicaid Benefits For State Prison Inmates: A State-By-State Review
- The Face Of The Criminal Justice System Is Increasingly Female
- A New Opportunity To Serve Justice-Involved Consumers
- A “New” Justice Involved Population
- ‘Smart Justice’
- Are Medicaid Managed Care Plans Ready For The Justice-Involved Consumer?
And to hear from an entrepreneurial executive whose organization has mapped a strategic course by responding to these challenges, join us June 2 for “Innovation By Design: Capturing Value In Health Care” keynote session with Carl Clark, M.D., chief executive officer of the Mental Health Center of Denver, during the OPEN MINDS Strategy & Innovation Institute in New Orleans.