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By Monica E. Oss

Recently, I wrote about the growing number of female prisoners and the policy shift requiring gender-specific programming (The Next Growing Justice-Involved Population: Women). Following up on that research, I looked at some of the other recent trends reshaping the interface between corrections and health care. Four new developments got my attention.

Falling incarceration and reincarceration rates—Across the country, incarceration rates are falling. In 2016, the U.S. incarceration rate fell to its lowest level in 20 years, at about 860 prison or jail inmates for every 100,000 U.S. adults (see America’s Incarceration Rate Is At A Two-Decade Low). And the reincarceration rate is decreasing at the same time. The greatest reincarceration reduction was in Massachusetts, where the reincarceration rate per 100 released inmates dropped from 44 per 100 in 2005 to 31.6 per 100 in 2014.

PEW credits this change to falling crime rates and to changes in community reentry programs. On one hand, there was a 74% reduction in violent crime between 1993 and 2017—from 747.1 violent crimes per 100,000 people, to 382.9 per 100,000 people (see 5 Facts About Crime In The U.S.). At the same time, Florida, Illinois, Massachusetts, Ohio, West Virginia, and Wisconsin each reduced three-year prison reincarceration rates by 20% or more between 2004 and 2015, thanks to community reentry reform (see Community Reentry Reform In Six States Cut Three-Year Return-To-Prison Rates By 20%). Reform programs focused on education and employment, housing, treatment for addiction and mental health disorders, and family support. Some programs focus on the needs of specific populations by age, race, ethnicity, gender, or geographic location.

Rising prison length-of-stay—Nationwide, the length of prison terms has been rising in recent decades and getting longer. PEW reported that the average length of stay (LOS) served by federal inmates rose from 17.9 months in 1988 to 37.5 months in 2012 (see Prison Time Surges for Federal Inmates), and the Urban Institute reports that LOS has increased by five years from 2000 to 2014 (see Matter of Time: The Causes and Consequences of Rising Time Served in America’s Prisons).

The good news is that some states are seeing reforms reduce LOS. In Idaho, the average LOS for prison stays for non-violent offenses has decreased by 21% since 2010 due to reforms that strengthened probation and parole supervision, improve community-based substance use and cognitive behavioral treatment programs, provide structure to the parole decision-making process, and monitor the impact of recidivism-reduction strategies (see Idaho Justice Reinvestment Reforms Cut Average Length Of Prison Stay For Non-Violent Offenses By 21% Since 2010).

New solutions to complaints of poor health care—Then there is the questionable state of corrections health care. A look through the headlines finds a long list of lawsuits (see Judge Again Orders Arizona Corrections To Comply With Health Care Lawsuit, Settlements In Prison Doctor Lawsuits Top $3 Million; Could Go Higher, and Illinois Officials Agree To Settle Prison Health Lawsuit) and cancelled contracts (see After Corizon’s Contract Cancellation, What Happens To Prison Health Employees?). Most states continue to struggle to provide adequate care for prisoners either during incarceration or when prisoners are released back to the community (see Providing Healthcare In The Prison Environment). Change is afoot, however, as we’ve seen in Illinois where the state agreed to an overhaul of the health care system at prisons (see Accused Of Preventable Inmate Deaths, State Agrees To Sweeping Health Care Reforms, Oversight At All Prisons), as well as the female-specific services and programming referenced earlier (see Illinois Implements Two Laws To Require Gender-Specific Programming For Female Prisoners).

And as of last summer, 33 states and the District of Columbia had expanded Medicaid and allowed the opportunity to provide coverage to ex-offenders-and many enroll eligible ex-offenders into Medicaid before they transition out of prison or jail for immediate coverage (see State Strategies For Establishing Connections To Health Care For Justice-Involved Populations: The Central Role Of Medicaid).

Other ways communities are bridging the health care gap that exists between incarceration and release? One example is the Los Angeles County Sheriff’s Department (LASD) and Los Angeles County agreeing to provide all newly discharged offenders with mental illness or dementia with discharge services that include a release plan, a 14-day supply of medication and connections to services; and offenders needing medication were given a prescription to fill at a community pharmacy (see Los Angeles County Agrees To Provide Newly Discharged Offenders With Mental Illness Or Dementia With Medications & Connections To Services).

Pay-for-success and performance-based contracts—Correctional contracting is seeing the slow proliferation of contracts with either a pay-for-success or a performance-based component. In 2018 there were at least 20 social impact bonds in a total of ten states, including four with a jail/prison component-New York, California, Colorado, Utah (see Social Impact Bonds: Over $166 Million In Funding & 20 Programs: An OPEN MINDS Market Intelligence Report).

The newest addition to this lineup of contracts was in California, where the Alameda County District Attorney is operating a pay-for-success justice restoration project to provide services to young adults ages 18 to 34 with a prior conviction for a low-level felony and who are on felony probation or who have been charged another low-level felony crime. Services include individualized coaching and intensive case management, and if re-arrest rates for participants are lower than for a comparison group of felony offenders, the Reinvestment Fund will be repaid, possibly with an outcome bonus (see Alameda County District Attorney Launches Pay-For-Success Justice Restoration Project). In Arkansas, the Arkansas Department of Human Services (DHS) announced in November announced plans to implement performance-based contracts in upcoming procurements for juvenile treatment centers and for aftercare programs. Aftercare programs will receive a one-time additional funding increase of $750,000 (see Arkansas DHS Juvenile Justice Transformation To Focus On Youth’s Treatment & Aftercare).

These developments in the corrections system, and its intersection with health care, will continue to be fertile ground for innovation as the high costs and poor outcomes get more attention. For more serving the justice-involved populations, check out these resources from the OPEN MINDS Industry Library:

  1. A New Opportunity To Serve Justice-Involved Consumers
  2. Are Medicaid Managed Care Plans Ready For The Justice-Involved Consumer?
  3. A “New” Justice Involved Population
  4. ‘Smart Justice’
  5. Judging, Not Judging: Trauma-Informed Courts
  6. New York Sued Over Practice Of Keeping Offenders With Mental Illness Incarcerated Past Their Release Dates
  7. Reincarceration Four Times Higher At Private Community Corrections Facilities In Pennsylvania
  8. Lane County, Oregon Launches Pay-For-Success Project For Forensic Housing & Re-Entry Services
  9. Virginia Department Of Corrections Launches The Building Family Bridges Project For Offenders With Minor Children
  10. Missouri Launches Justice Reinvestment Initiative

Not sure how to link market trends to your strategy and new service lines? Join me at The 2019 OPEN MINDS Strategy & Innovation Institute from June 3-6, 2019, in New Orleans, where we will take a deep dive into the strategies (and strategic planning) necessary to meet the challenges and opportunities in the market today.

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