U.S. Department of Justice

Browse for More by Subject

  • Health Services
  • Federal Legislation
  • Juveniles
  • Jails
  • Inmate Sexual Assault
  • Criminal Justice Statistics
  • Corrections
  • Drug Courts
  • Management Controls

Author(s)

Source(s)

Sponsor(s)

Affordable Care Act

In March 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA). In a recent brief, the Council of State Governments (CSG) outlines the opportunity the ACA can provide for individuals involved with the criminal justice system.

The majority of this population is currently uninsured, low-income, and has high rates of chronic and communicable illnesses, as well as mental health and substance use disorders. Under the provisions of the ACA, more than half of the 730,000 federal and state prisoners reentering the community each year are estimated to be newly eligible for either Medicaid or for federal subsidies to help buy health insurance from state health insurance exchanges (HIX). Large numbers of individuals in jail and on probation and parole will also be newly eligible for health insurance.

This CSG brief and additional resources on the Affordable Care Act can be found below.


Resources Guide

The following are a list of "top-shelf" resources that have been hand-picked by our library team around this topic. If you're wanting some additional research assistance on this topic, please contact our help desk. They have access to specialized databases and thousands of resources you won't find online. Click on a heading below to browse resources in that section.

Enrollment - 12 items(s)

Resources
Toolkit: State Strategies to Enroll Justice-Involved Individuals in Health Coverage (2015). Health insurance options available through the Affordable Care Act (ACA) offer new opportunities to enroll individuals involved in the criminal justice system into coverage and provide access to physical and behavioral health services critical to their successful reentry into the community. Many individuals involved in the criminal justice system are now eligible for Medicaid under the ACA, including many young, low-income males who did not previously qualify for Medicaid. With one exception, federal law prohibits using federal Medicaid funds to pay for medical care provided to incarcerated individuals. However, Medicaid enrollment processes can begin prior to an individual’s release from incarceration, as there is no federal prohibition on incarcerated individuals being enrolled in Medicaid and federal law requires states to permit individuals to apply for the program at any time. Drawing on interviews with state officials, this toolkit highlights the efforts of selected states [Colorado, Illinois, New Mexico, Ohio, Rhode Island, Washington, and Wisconsin] to enroll in health coverage individuals involved with the criminal justice system. The toolkit is designed to provide state officials with actionable information about policies and practices available to connect justice- involved individuals to health care coverage through Medicaid." Access is provided to the sections of the Toolkit: the ACA, Medicaid, and justice-involved individuals; policy and process changes; enrollment as part of pre-release planning; post-release outreach; beyond eligibility and enrollment strategies; cross-agency coordination and partnerships; looking forward—future issues to address; state-specific strategies; Webinar: "Corrections and Medicaid Partnerships: Strategies to Enroll Justice-Involved Populations--Efforts in Colorado, New Mexico and Wisconsin"; and links to additional resources. Also presented is the interactive chart "Enrollment Process" which explains where, when, who, how, and whether individuals leave the facility with a Medicaid card. This resource is also available as a PDF chart.
Image
Linking Low-Income Men to Medicaid and the Health Insurance Marketplace (2016). Office of the Assistant Secretary for Planning and Evaluation (ASPE)

Passage of the Affordable Care Act has created an unprecedented opportunity to respond to the unmet health needs of justice-involved men. To succeed, the work underway in many jurisdictions to enroll justice-involved persons during incarceration must be accompanied by an equally concerted effort to engage them in coverage and care in the community, including building effective collaboration among agencies that work with justice-involved men; implementing coverage and coordinated care models that better meet the specific needs of the justice-involved population; and offering relevant, effective messages about health, health coverage, and care—delivered by a variety of messaging channels, including “messengers” with similar life experiences.
Image
New Medicaid guidance improves access to health care for justice-involved Americans reentering their communities (2016). New Medicaid guidance released today updates decades-old policy and clarifies that individuals who are currently on probation, parole or in home confinement are not considered inmates of a public institution. It also extends coverage to Medicaid-eligible individuals living in community halfway houses where they have freedom of movement, improving access to care for as many as 96,000 individuals in Medicaid expansion states over the course of the year.
Image
RE: To Facilitate successful re-entry for individuals transitioning from incarceration to their communities (2016). Department of Health & Human Services. "The purpose of this letter and its attachment is to provide guidance on facilitating access to covered Medicaid services for eligible individuals prior to and after a stay in a correctional
institution. This State Health Official Letter with attached Questions and Answers (Qs & As) describes how states can better facilitate access to Medicaid services for individuals
transitioning from incarceration to their communities."
Image
Health Coverage and County Jails: Suspension vs. Termination (2014). "Medicaid allows for—and the federal government encourages—continued eligibility for coverage for a person who is incarcerated. Although the ACA [Affordable Care Act] did not address suspension versus termination, for states that are expanding Medicaid the number of inmates eligible for coverage will increase dramatically and the benefits to counties of suspending instead of terminating their coverage will be substantial" (p. 1). This brief addresses issues associated with suspending Medicaid coverage for prisoners. Sections cover: why ensuring access to Medicaid post-release is important to counties; access to treatment positively impacts public safety; what the difference is between suspension and termination of Medicaid coverage; states that suspend rather than terminate; what counties can do with highlights from Maricopa County (AZ), Salt Lake City (UT), California, and Oregon.
Image
Steps to Maximize Healthcare Reform for Justice Systems. Two documents on enrolling Newly-Eligible Participants (for Courts and Corrections Systems).
Image
County Jails and the Affordable Care Act: Enrolling Eligible Individuals in Health Coverage (2012). “In 2014 the Patient Protection and Affordable Care Act (ACA) will provide new health insurance coverage options for millions of individuals through an expansion of Medicaid eligibility and the establishment of state-based health insurance exchanges. This brief will examine ways that counties may be involved in eligibility determination and enrollment processes for these newly eligible individuals, focusing particularly on issues related to enrolling qualified individuals held in county jails as pre-adjudicated detainees and inmates preparing to reenter the community” (p. 2). Sections of this brief include: introduction; Affordable Care Act (ACA) coverage expansion and potential effects on county jails; Medicaid inpatient billing for incarcerated individuals; enrollment processes and procedures for newly eligible individuals; issues related to enrolling county jail inmates eligible for health coverage; potential model eligibility and enrollment systems and processes; key local criminal justice stakeholders to involve in planning for 2014 health system changes; steps ones county can pursue to prepare for enrolling justice-involved individuals; and conclusion.
Image
Facilitating Access to Health Care Coverage for Juvenile Justice-Involved Youth (2013). Anyone dealing with the provision of services to justice-involved youth should read this publication. “This report outlines federal and state eligibility, enroll¬ment, and outreach strategies that can help facilitate seamless coverage for system-involved youth. Adoption of these initiatives has the potential to improve the lives of juvenile justice-involved youth and their families, increase their ability to remain in the community, and ultimately, reduce recidivism. Key to the success of these strategies will be ongoing collaboration between the multiple state and federal agencies that interact with the juvenile justice population” (p. 7). Sections of this publication discuss: Medicaid eligibility options to ease community reentry—suspending eligibility, continuous eligibility, presumptive eligibility, and special enrollment procedures (Oregon, Colorado, and Texas); implications of health reform for juvenile justice-involved youth—eligibility and enrollment policies; emerging issues—transitions in coverage between Medicaid, CHIP (Children's Health Insurance Program) and exchanges; and evidence based practices for meeting the needs of juvenile justice-involved youth.
Image
Maximizing Medicaid: An Innovative Approach to Finance Health Care for Criminal Justice Populations [Webinar] (2014). "This webinar explains and clarifies the issues related to allowable uses of federal Medicaid funds for incarcerated individuals, and provides an example of how corrections departments can leverage cost savings as a result. The discussion focuses on the challenges related to implementation and establishment of cross-agency collaboration, and the subsequent successes and cost savings that can be achieved." The agenda of this webinar is: "Introduction" by Fred Osher; "Financing Health Care for Individuals Involved in the Criminal Justice System" by Gabrielle de la Gueronniere; "An Introduction to Medicaid Eligibility and the Application Process" by Terri L. Catlett, Larry Huggins, and William Appel; and "Moderated Q&A Session" moderated by Osher.
Image
Facilitating Health Care Coverage for Juvenile Justice-Involved Youth (2013). “As states and juvenile justice stakeholders work to facilitate health coverage and access for system-involved youth, they can draw upon the experiences of their counterparts across the country to improve eligibility, enrollment, and outreach processes. Medicaid eligibility strategies in several states have already facilitated seamless coverage for juvenile justice-involved youth, and consumer assistance programs created by the Affordable Care Act (ACA) will provide additional resources to support continuity of care. Collaboration among Medicaid and juvenile justice systems and stakeholders will be essential to fully realizing the opportunities presented by health care reform.” Sections of this brief cover: the issue of Medicaid coverage for justice-involved youth; innovations—Medicaid eligibility options (suspending eligibility, continuous eligibility, and presumptive eligibility), expedited Medicaid enrollment, and outreach; lessons learned; and looking forward.
Image
Medicaid: Information on Inmate Eligibility and Federal Costs for Allowable Services (2014). "Financing health care for inmates can be a significant portion of state correctional spending for some states with health care costs ranging from an estimated 6 percent to 33 percent of institutional corrections spending in 2008, the most recent estimate available. The combination of expanded Medicaid eligibility and enhanced funding for those newly eligible as allowed under PPACA [Patient Protection and Affordable Care Act] gives states additional incentives to enroll inmates in Medicaid and obtain federal matching funds, and increases the federal responsibility for financing allowable services for inmates. Questions exist about the potential costs to the federal government, because little is known about how many inmates are eligible for Medicaid or the extent to which states are obtaining federal matching funds for allowable services … In this report, we provide information on the proportion of inmates eligible for Medicaid, and state efforts to enroll inmates in Medicaid and obtain federal matching funds for allowable services" (p. 2). While a large percentage of inmates will be eligible for Medicaid in the 27 states that have expanded Medicaid eligibility, only a very small percentage will be eligible for federal Medicaid funds. The impact to federal spending will be extremely limited.
Image
Presumptive Eligibility: New Options in 2014. This Factsheet discusses Presumptive Eligibility: what it is, options to use, key facts, and FAQs.
Image

Funding and Budgets - 8 items(s)

Resources
Medicaid in an Era of Health & Delivery System Reform: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2014 and 2015 (2014). "Medicaid has long-played an important role in the US healthcare system, accounting for one in every six dollars of all US health care spending while providing health and long-term services and supports coverage to over 66 million low-income Americans. However, the years 2014 and 2015 will stand out as a time of significant change and transformation. With the economy improving from the lingering effects of the Great Recession, Medicaid programs across the country were focused primarily on: implementing a myriad of changes included in the Affordable Care Act (ACA); pursuing innovative delivery and payment system reforms to help assure access, improve quality and achieve budget certainty, and continuing to administer this increasingly complex program. This report provides an in depth examination of the changes taking place in state Medicaid programs across the country" (p. 1). Following an executive summary, sections of this publication cover: eligibility and enrollment; delivery system reforms—use of managed care, other delivery system and payment reform, and balancing institutional and community based long-term services and supports; provider rates and taxes; benefits changes; premiums and cost-sharing; prescription drug utilization and cost control initiatives; program integrity initiatives; and Medicaid administration and priorities.
Image
Meaningful Use and Corrections: Unknown Opportunities (2014). "Meaningful use is the linchpin of the Medicare and Medicaid EHR Incentive Programs, established under the Health Information Technology for Economic and Clinical Health (HITECH) Act to provide incentive payments to eligible providers that adopt and demonstrate “meaningful use” of certified EHR [electronic health record] technology. Providers demonstrate meaningful use by “attesting” to certain criteria for different stages of meaningful use … This article provides an overview of the meaningful use landscape, emphasizing the applicability of meaningful use to health care provided in jails, as well as exploring the benefits and difficulties of participating in this program for jail health care providers. It also describes the steps that jail health care systems must pursue in order to participate in meaningful use" (p. 1). Sections of this paper cover: issue introduction; what meaningful use is; benefits of meaningful use for correctional health services; obstacles to jail participation in meaningful use; correctional institutions participating in meaningful use; steps toward eligibility; impact of meaningful use on correctional health systems; and concluding observations.
Image
Medicaid and Financing Health Care for Individuals Involved with the Criminal Justice System. This brief outlines opportunities for states and local jurisdictions to improve public health and safety outcomes, and reduce spending on corrections and health care services by maximizing the appropriate use of Medicaid coverage for people involved with the criminal justice system.
Image
The 2013-2014 Budget: Maximizing Federal Reimbursement for Parolee Mental Health Care. In California, mental health treatment is available through the Medi–Cal Program. In addition, mental health treatment services are available to individuals on state parole supervision through programs provided by CDCR. In this report, the author describes these programs in more detail and identifies how federal health care reform could provide for increased federal reimbursements for CDCR’s mental health treatment services
Image
The 2013-14 Budget: Obtaining Federal Funds for Inmate Medical Care—A Status Report. Since 1997, federal policy has made it possible to draw down federal Medicaid reimbursement for off-site inpatient health care services for eligible state prison inmates. Most recently, the Patient Protection and Affordable Care Act and the associated Low-Income Health Program (LIHP) created as part of the state’s “Bridge to Reform Waiver” have expanded the number of inmates eligible for the state’s Medicaid program (known as Medi-Cal) and have increased the total amount of reimbursements the state can receive. Our research finds that while the state has recently developed a process for obtaining federal funds for such services, the state has been unable to maximize the available federal funding.
Image
Managing Prison Health Care Spending. This report by The Pew Charitable Trusts examines state spending on inmate health care and the factors driving costs higher. Nationwide, spending on health care and corrections is putting serious pressure on state budgets. The report also reviews strategies that some states have used to control these expenses, while protecting public safety and maintaining or improving the quality of care that inmates receive.
Image
Game Changer: The Potential of the Affordable Care Act to Improve Public Health, Increase Public Safety, and Save Taxpayer Dollars. Remarks from a two-day symposium on October 21-22 entitled “Health Behind Bars—What Obamacare Means for Courts, Prisons, Jails and Justice-Involved Communities.”
Image
How Medicaid Expansion Can Lower Prison Costs, Recidivism. From Governing Magazine: Expansion states are taking advantage of the chance to cover outside hospitalizations that cost their states millions, as well as the opportunity to enroll parolees in Medicaid. Studies show health care keeps them from returning to prison.
Image

General - 21 items(s)

Resources
The Importance of Medicaid Coverage for Criminal Justice Involved Individuals Reentering Their Communities (2016). Howard, Jhamirah, Madeleine Madeleine, Jessica Neptune, et. al. ASPE Issue Brief. "The purpose of this issue brief is to highlight the importance of health insurance coverage for criminal justice involved individuals, particularly the importance of the expansion in Medicaid coverage made available through the Affordable Care Act. This issue brief explains why Medicaid and access to the health benefits the program covers can play a key role in improving the health not only of justice involved individuals, but also of their communities. The brief focuses on the characteristics of the justice involved population, how they access care, and it discusses how this population can benefit from Medicaid expansion to low income adults."
Image
Medicaid Expansion and the Alaska Department of Corrections (2015). In Alaska, inmate health care comprises approximately 13% of the Alaska Department of Corrections (ADOC) budget and is largely funded through General Fund expenditures.
Image
State Medicaid Eligibility Policies for Individuals Moving Into and Out of Incarceration (2015). The Affordable Care Act’s (ACA) Medicaid expansion offers a new opportunity for states to connect individuals in prisons and jails to coverage. However, Medicaid eligibility policies for incarcerated individuals vary in both expansion and non-expansion states.
Image
The Affordable Care Act: Implications for Public Safety and Corrections Populations (2012). “The Affordable Care Act (ACA) signed into law by the President in 2011 potentially can aid individuals who are at risk for incarceration and those who have been incarcerated through provisions that allow states to expand eligibility for Medicaid. The ACA creates new mechanisms for uninsured people to obtain coverage for physical and behavioral health care” (p. 1). This report discusses: what the ACA entails; health issues and correctional populations—cycling in and out of correctional facilities, the ACA and correctional health care, and the ACA and incarceration disparities; and prospects for improved access to health care.
Image
Key Elements of the Affordable Care Act: Interface with Correctional Settings and Inmate Health Care (2012). 'Understanding the key elements of the Affordable Care Act and how it will affect corrections and correctional health care is critical as planning and implementation progress ' Several provisions of the act have direct and indirect effects on the corrections profession, inmate health care and reentry provisions, thereby making it essential that correctional leaders carefully engage their state governments and community partners ' This document provides an overview of the key elements of the Affordable Care Act that affect correctional organizations and inmate health care, now and in the future ' While state-specific considerations will affect planning and implementation of the Affordable Care Act, this document provides basic information that correctional leaders should understand' (p. 1). Sections address: the Affordable Care Act coverage expansions--coverage for children up to age 27, Medicaid expansion, and subsidized non-group coverage; health insurance exchanges; and implications for corrections organizations'reentry objections, contracting with health care vendors, budget and fiscal considerations, engaging in state-based exchange planning, changes in work processes, and health care work force challenges.
Image
Healthcare Not Handcuffs: Putting the Affordable Care Act to Work for Criminal Justice and Drug Policy Reform (2013). “The Affordable Care Act (ACA) sets the stage for a new health-oriented policy framework to address substance use and mental health disorders. By dramatically expanding and funding healthcare coverage to millions of currently uninsured people, the ACA represents a remarkable opportunity for criminal justice and drug policy reform advocates to advance efforts for policies promoting safe and healthy communities, without excessive reliance on the criminal justice solutions that have become so prevalent under the War on Drugs. This paper is intended as a starting framework for criminal justice and drug policy advocates to navigate the ACA, and to take advantage of the conceptual and practical opportunities it offers for shifting the conversation and the landscape” (p. 2). This report is divided into two parts. Part One--Basics Of The Affordable Care Act For Advocates: Insurance; Medicaid Expansion--Healthcare Insurance for Poor and Low-Income; What is Covered? Essential Health Benefits; and Healthcare Access and Coordinated Care Models Under the ACA. Part Two--Putting the ACA to Work for Criminal Justice and Drug Policy Reform: Support Expansion of Medicaid and Other Forms of Healthcare Coverage; Increase Insurance Enrollment of People Currently in the Criminal Justice System; Maintain Active Medicaid Enrollment During Periods of Incarceration; Expand Use of Alternatives to Incarceration; Push for Use of Pre-Booking Diversion Programs (i.e. Front-End Diversion); Promote Changes in the Care Delivery System to Improve Outcomes for People Who Use Drugs; and Advocate for the Decriminalization of Drug Possession and Drug Paraphernalia. Also included is an executive summary.
Image
Frequently Asked Questions (FAQ): The Affordable Care Act (ACA) and Justice-Involved Populations (2013). The answers to the eleven most asked questions about providing health care in a correctional setting as directed by the Affordable Care Act (ACA) are given. This is important information for correctional agencies trying to address the costs they incur in the provision of inmate health services.
Image
Health Care Reform and County Criminal Justice Systems: An Introduction to Health Care Reform and the Opportunities and Challenges for County Criminal Justice Systems (2013). “This course provides an overview of how upcoming changes to California’s health care system will impact local criminal justice systems. Speakers compare and contrast health care in the county corrections systems today with health care in the years to come under the Affordable Care Act. A framework for providing health care to the criminal justice population is presented to facilitate preparations at the county level that can help to maximize criminal justice resources. Highlights include: How improving access to health care can reduce recidivism; Health care for the criminal justice population today and tomorrow--How it will work in 2014 and beyond; [and] Laying out a framework: An overview of the steps criminal justice systems can take to take advantage of health care reform opportunities.” The home website provides access to: course materials including slides from the following presentations: “Public Health and Public Safety: Explaining the Critical Intersection of Healthcare and Recidivism” by Community Oriented Correctional Health Services (COCHS); “Covered California: Understanding Health Benefits” by David Panush; “Counties and Medi-Cal for Inmates: Current Rules – Future Considerations” by Cathy Senderling-McDonald; “Health Care Reform and Medi-Cal: Looking to 2014” by Leonard J. Finocchio; “Covered California: Understanding Health Benefits” by California Health Benefit Exchange; “Public Health and Public Safety: Explaining the Critical Intersection of Healthcare and Recidivism” by Community Oriented Correctional Health Services (COCHS); and “Counties and Medi-Cal for Inmates: Current Rules – Future Considerations” by Cathy Senderling-McDonald; links to course related materials about public health and public safety, healthcare for today and tomorrow, and framework development; and links to other resources.
Image
Medicaid and Financing Health Care for Individuals Involved with the Criminal Justice System (2013). “This brief outlines opportunities for states and local jurisdictions to improve public health and safety outcomes, and reduce spending on corrections and health care services by maximizing the appropriate use of Medicaid coverage for people involved with the criminal justice system.” Sections discuss: federal Medicaid rules on coverage of criminal justice populations; what Medicaid entails; allowable uses of Medicaid for incarcerated persons; understanding Medicaid enrollment, suspension, and termination; the ACA’s (Affordable Care Act’s) Medicaid expansion—opportunities to increase health coverage for individuals involved with the criminal justice system; opportunities to maximize Medicaid enrollment; state approaches to utilizing Medicaid for justice-involved individuals—North Carolina, New York, and Colorado; special benefits considerations for the Medicaid expansion population; and four opportunities and recommendations for state policymakers.
On-site use only
Image
The Patient Protection and Affordable Care Act and the Pretrial System: A "Front Door" to Health and Safety (2014). "The Patient Protection and Affordable Care Act (ACA) provides an historic opportunity for millions of low-income individuals to obtain insurance coverage for their physical and behavioral health care needs. For the last several years, diverse behavioral health advocates, health care providers and community-based prevention organizations, have worked to understand the implications of the ACA on the justice-involved population. Much of the conversation has been centered on the disproportionately high rates of physical and behavioral health care needs amongst this previously uninsured population … Access to treatment services through the ACA at pretrial decision points creates a notable opportunity to interrupt the cycle of crime exacerbated by chronic physical and behavioral health issues" (p. 1). This publication provides a general idea of what the ACA entails and explains how it can be used with pretrial detainees. Sections contained in this document include: an overview of the ACA; the major opportunities it can provide for pretrial justice; ACA as the front door to coverage; and a call to action for pretrial services—actively represent pretrial in collaborative planning efforts, develop a plan for screening and enrollment, and begin addressing larger policy questions.
Image
Resources on the Impact of the Affordable Care Act [ACA] on the Criminal Justice System (2014). If you are looking for information on how the Affordable Care Act (ACA) will impact your agency, you need to visit this website. "On March 23, 2010 President Barack Obama signed into law the Patient Protection and Affordable Care Act, more commonly known as the Affordable Care Act (ACA). Since that time there has been great speculation on how implementation would impact not only the many uninsured; but how access to health care services might impact our criminal justice system. With an estimated 14 percent of men and 31 percent of women in jail and state prison suffering from chronic and persistent mental illness and an even higher percentage with a diagnosable substance abuse disorder, the need for increased treatment services is well established. Despite this, individual offenders and criminal justice systems have lacked the resources to access intensive in/outpatient treatment, treatment alternatives to incarceration or the medically tailored reentry services needed to improve personal and public safety outcomes. While the ACA promises to provide millions of indigent and working poor with access to medical and behavioral health services, there is still great uncertainty around how justice populations will be able to take advantage of this expanded coverage. With ACA implementation unfolding differently in every state, understanding how this new law may impact state and local justice populations is complicated. In addition, with every state standing up health insurance exchanges and more than half expanding Medicaid eligibility (as of October 2013) there is the added complexity of each system’s eligibility and coverage options. Information provided [at this website] is intended to help keep justice system stakeholders informed on how ACA implementation may impact justice systems and client populations." Resources are organized into four areas: general sources; criminal justice sources; webinars and presentations; and state by state information on ACA implementation.
Image
On Life Support: Public Health in the Age of Mass Incarceration (2014). This report is an excellent introduction to the relationship between incarceration and public health and its significance for society. It is essential reading for anyone working within the fields of corrections and public health. Sections cover: the burden of disease behind bars—mental health, substance use and addiction, infectious disease, chronic disease, violence and self-harm, greater health disparities for women, and geriatric health; conditions of confinement and health—overcrowding, solitary confinement, sexual victimization, and quality of care; the health of communities--family structure, education and employment opportunities, housing stability and social entitlements, health insurance, and political capital; a political landscape ripe for reform; and the potential of the Affordable Care Act (ACA)—bolstering community capacity, strengthening front-end alternatives to arrest, prosecution, and incarceration, bridging health and justice systems, enabling outreach and care coordination, enrolling across the criminal justice continuum, granting Medicaid waivers and innovation, advancing health information technology, and regional challenges with the ACA.
Image
Health Coverage and Care for Youth in the Juvenile Justice System: The Role of Medicaid and CHIP (2014). "This brief provides an overview of the health and mental health needs of girls and boys in the juvenile justice system and the role of Medicaid in addressing those needs. It focuses on the circumstances of those girls and boys who are placed in juvenile justice residential facilities, the discontinuity of Medicaid coverage for those youth, and the options for improving coverage, continuity of care and access to needed services post-discharge, including new opportunities provided by the Affordable Care Act" (p. 1). Sections of this publication cover: profile of youth in the juvenile justice system; types of juvenile justice residential placements; health needs of girls and boys in the juvenile justice system; health services for youth in juvenile justice residential placements; the roles of Medicaid and the Children's health Insurance Program (CHIP); and key issues looking forward. Also includes are these appendixes: "Girls and Boys in the Juvenile Justice by State, 2010" (table); "Girls Health Screen (GHS)"—description; and "Origins of Medicaid's Inmate Exclusion".
Image
Questions & Answers: The Affordable Care Act and County Jails (2014). "The implementation of the Affordable Care Act (ACA) has set off reforms in health care systems across the country, including in county jails … Many of those who cycle in and out of county jails may now be able to obtain health insurance through the Health Insurance Marketplace or expanded Medicaid. County jails are therefore in a unique position to connect those in their custody with health insurance during pretrial detention or prior to discharge. Evidence suggests this could contribute to reduced health care and criminal justice costs to the county and lower jail operating costs. This brief will answer some of the most commonly asked questions about the ACA and how it relates to county jails" (p. 1). Answers provided cover: which offenders are eligible for coverage under the ACA; whether jails can bill Marketplace insurance plans for pretrial detainees; whether jails can bill Marketplace insurance plans for sentenced inmates; whether jails can bill Medicaid for pretrial detainees or sentenced inmates; whether Medicaid or Marketplace insurance plans will pay for court-ordered services; the 10 categories of items and services that are considered Essential Health Benefits; what to do if the open enrollment period has closed for the year; the number of inmates a jail can enroll; the differences between suspending and terminating Medicaid coverage; the states that suspend rather than terminate Medicaid; whether individuals can enroll if your state did not expand Medicaid; and how you can find out what your state and county are doing to implement the ACA.
Image
Health Policy Reforms and the Criminal Justice System. The Council of State Governments (CSG) website on the Affordable Care Act. Resources from CSG and external health care publications are available.
Image
Ten Ways to Link Individuals Involved with the Criminal Justice System to Health Insurance: New Resources from the Health Insurance Marketplace. A series of fact sheets designed to help criminal justice stakeholders link individuals in the system to health insurance coverage by offering 10 concrete steps. These materials address basic information about health coverage eligibility and enrollment, as well as special rules that apply to inmates and parolees.
Image
The Implications of the Affordable Care Act for the Criminal Justice System. This Webex recording, sponsored by the Vera Institute, features Steve Rosenberg, President of the Community Oriented Correctional Health Services. The presentation focuses on both the Affordable Care Act and how behavioral health and recidivism are related.
Image
Leveraging National Health Reform to Reduce Recidivism & Build Recovery. This presentation from the TASC Institute for Consulting and Training addresses three areas:
Why should you pay attention to health care reform? What is health reform? Examples of proactive planning going on now in Cook County (Chicago) and New York State.
Image
The Unseen Provider: Health Care in Our Jails. This 8-minute video presents the case for implementing electronic health information exchanges (HIEs) that bridge the gap between jails and public health agencies, with the twin goals of cost savings and improving services to vulnerable populations. With Camden, New Jersey, as a backdrop, the video features local and national experts in community and jail-based health care, who discuss the HIE solution.
Image
The ACA & Vulnerable Americans. This series of articles from Health Affairs covers topics such as ACA implementation and ACA in jails. March 2014.
Image
Resources on the Impact of the Affordable Care Act on the Criminal Justice System. National Criminal Justice Association. This National Criminal Justice Association (NCJA) webpage provides reports, webinars and presentations on the Affordable Care Act and criminal justice.
Image

Health Reform and Public Safety: broadcast materials - 3 items(s)

Resources
Health Reform and Public Safety: New Opportunities, Better Outcomes [Internet Broadcast] (2014). Research shows that there are a disproportionate number of justice involved individuals suffering from chronic illness and/ or mental health and substance abuse disorders. We also know that a majority of the justice-involved individuals are young adults and unemployed or earn an income that is well below the federal poverty line leaving them without the ability to obtain health care. There is now an opportunity to enhance collaboration between the criminal justice/corrections and healthcare systems.
Early estimates indicate a significant number of justice-involved individuals may be eligible for provisions under the Patient Protection and Affordable Care Act (ACA), specifically; enrollment in Medicaid or the ability to purchase health care coverage through state health insurance exchanges. Because of the many health care expansion possibilities for this population we are witnessing an unprecedented opportunity to help connect the justice population to healthcare coverage and the associated healthcare services.

Federal, state and local criminal justice systems are poised to change the way they do business with the advent of the ACA. It is now possible for millions of low income, justice- involved individuals to obtain healthcare or insurance coverage for their physical and behavioral health needs. This far reaching system change will impact every decision point in the criminal justice system from arrest to individuals returning to the community upon release.

Presented on June 18, 2014, this program informed and increased awareness around this historic healthcare expansion opportunity. The broadcast highlighted promising practices by providing resources and strategies to expand healthcare coverage to justice-involved individuals. During this national discussion and broadcast by the National Institute of Corrections, presenters:

• Established the relevance of the Affordable Care Act to the criminal justice system.

• Provided concrete examples for collaboration and system linkages between the criminal justice system and healthcare system.

• Provided healthcare enrollment strategies to increase informed decision-making between criminal justice and healthcare stakeholders.
Image
Healthcare Enrollment Intercepts in the Criminal Justice System: Sample Decision Points. Mapping and Identifying the Intercept Points. The NIC Sample Decision Points Map divides the justice system into five “intercepts” or decision points where individuals will have contact with health and justice personnel who can connect them with coverage:
• Intercept 1: Law Enforcement/ Emergency Services
• Intercept 2: Pre-Arraignment & Court Hearings
• Intercept 3: Jails/Courts
• Intercept 4: Prisons/Jails/Reentry
• Intercept 5: Community Corrections
Image
Mapping the Criminal Justice System to Connect Justice-Involved Individuals with Treatment and Health Care under the Affordable Care Act (2014). "By working together to build a visual portrait of how individuals progress through the criminal justice system, health and justice stakeholders gain better understanding of their respective policies and practices. In addition, mapping allows jurisdictions to consider decision points throughout the entire criminal justice system when exploring opportunities to enroll criminal justice-involved individuals in insurance coverage. This guide is for states and local jurisdictions interested in using system mapping to maximize opportunities for criminal justice and health care system integration and efficiency through the ACA " (p. 3). Sections comprising this document include: the Affordable Care Act (ACA) at a glance; the need for a systems mapping process; the NIC Sample Decision Points Map; and the seven steps of the criminal justice/ACA mapping process. "General health and behavioral health issues with criminal justice-involved individuals intersect. Hence, it is critical that the needs of the population are considered as jurisdictions develop policies and processes to implement the ACA at state and local levels. Bringing together stakeholders from criminal justice, health care, and behavioral health care systems for dialogue around these issues builds increased understanding and collaboration across systems. Using the ACA to do a better job of delivering health care and behavioral health care services to this population not only improves the health of our communities, but makes them safer" (p. 11). Appendixes provide: Sample Intercept Map for ACA Eligibility/Enrollment Priorities; Completed Intercept Map for ACA Eligibility/Enrollment Priorities in Connecticut; and Action Plan Template.

For addtional information on this topic contact NIC Correctional Program Specialist Katie Green at k2green@bop.gov.


Image

Implementation - 4 items(s)

Resources
Development of a Performance-Based RFP for Correctional Health Care Services in Vermont. In March 2013, the DOC contracted with Community Oriented Correctional Health Services (COCHS) to help the Vermont Department of Corrections (DOC) determine how best to design a contract for correctional health care services, in alignment with ongoing federal and state health reforms. This case study describes the policy environment that prompted the Vermont DOC’s health care system, in partnership with community-based organizations, to develop the first statewide performance-based Request for Proposals (RFP) and subsequent contract for correctional health care services.
Image
Engaging with the Affordable Care Act: Implications and Recommendations for Adult Drug Court Professionals (2014). "The Patient Protection and Affordable Care Act (hereafter ACA) will affect your adult Drug Court operations and participants whether you work in a state that elected to expand Medicaid and open a state-run health care marketplace under the ACA or are in one that has left Medicaid unchanged and elected to rely on the federal exchange … This bulletin outlines some of the key provisions of the ACA and provides guidance to state administrators and Drug Court team members about where to find information, the most critical questions to ask, and recommendations for action" (p. 1). Sections cover: brief primer on the ACA—health insurance marketplaces, the ten essential health benefits, Medicaid expansion, non-Medicaid expansion, mental health and substance use/abuse dependency treatment and parity, and key agencies working to implement ACA; challenges and cautions for all drug courts—medical necessity, residential treatment, Medicaid billing, more provider choice, less provider choice, changes to the State Substance Abuse Prevention and Treatment Block Grant, treatment provider participation in staffings, defining and achieving parity, and defining coverage; and the top ten things drug court practitioners can do.
Image
The Affordable Care Act and County Jails: A Practical Guide to Strategies and Steps for Implementation. Denver Sheriff Department - This guide is meant to help Sheriffs and County Jail Administrators consider practical strategies and suggests steps that support cost savings while producing other benefits through the implementation of healthcare enrollment protocols, education of the inmate population, enrollment assistance and facilitation of the application process upon inmate release.
Image
Post-Release MassHealth Utilization. This is a study of the MassHealth/DOC Prison Reintegration Pilot Program. The Program began in 2005 and involved 18 DOC facilities enrolling inmates in MassHealth (Medicaid) prior to their release.
Image

Mental Health - 1 items(s)

Resources
Guidelines for the Successful Transition of People with Behavioral Health Disorders from Jail and Prison. [These] guidelines promote the criminal justice partnerships that are necessary to develop successful approaches for identifying individuals in need of services, determining what services those individuals need, and addressing these needs during transition from incarceration to community-based treatment and supervision.
Image

National Institute of Corrections - 3 items(s)

Resources
ACA Mapping Initiative. Affordable Care Act Mapping Initiative
Image
Proceedings of the Large Jail Network Meeting Aurora, Colorado, September 15 – 17, 2013 (2014). Sections of these proceedings are: about this meeting; meeting highlights; “The Affordable Care Act: Health Care Reform and Jails” by Donna Strugar-Fritsch; “Handling Corrections Staff Wellness/Performance Issues: From Corrections Fatigue to Fulfillment” by Caterina G. Spinaris and Micheal D. Denhof; “Prison Rape Elimination Act: The Outlook for Facility Audits” by Joshua C. Delaney and Dee Halley; PREA Panel Discussion by Don Pinkard, Jeffery Newton, and Art Wallenstein; “Legal Issues in Jails—2013: PREA Enforcement, Freedom of Religion (Staff Attire and Inmate Diets and Sincere Religious Beliefs), and Bits and Pieces” by William C. Collins; Open Forum (“Hot Topics”)—tactical teams, inmate telephone calls, media access to inmates, identification of visual markers, medical care contracts, use of restricted housing, and male inmate underwear (boxers or briefs); Association Updates for the American Jail Association and the American Correctional Association; and Future Meeting Topics.
Image
Environmental Scan 2013: 8th Edition (2014). “Beginning in the late 1990’s, the National Institute of Corrections (NIC) Information Center began scanning social, economic and corrections issues to inform the development of programs and services offered by NIC. This report, now in its 8th edition, has continued to evolve into a popular tool corrections practitioners also use to inform their work in jails, prisons and community corrections. Since there are many issues beyond what is addressed in this environmental scan that potentially will influence corrections, this report is intended to give a broad overview of selected current and anticipated trends and not intended to be comprehensive” (p. 3). Sections of this report are: introduction; international developments; demographic and social trends; the workforce; technology; public opinion; the economy and government spending; criminal justice trends; corrections populations and trends; and the Affordable Care Act (ACA).
Image

Policies and Legal Issues - 4 items(s)

Resources
Consumer Rights Come to Jail: How the Affordable Care Act Changes the Rights of Individuals Pending Disposition. Historically, health care policy in the United States has not considered the special needs of individuals who cycle in and out of jails. The reason is obvious: consumer-oriented issues related to choice and protection have been the primary drivers of health care policy, and until very recently, few people in jail could afford health insurance. They were not consumers.

The ACA has expanded affordability of, and access to, health care and granted rights and responsibilities specifically to individuals in jail pending disposition. It is only a matter of time before correctional settings must incorporate the consumer-based insurance mechanisms and assurances established by the ACA. Recognition of serious, widespread deficiencies in the physical and mental health care services provided in jail underscores the urgency of this need.
Image
The ACA and the Criminal Justice Reentry Population: Opportunities & Challenges. The Affordable Care Act (ACA) offers several avenues to improve health coverage and outcomes for the reentry population, including those on community supervision.
Image
Reinstatement of Medicaid for Public Institution Recipients. State of Ohio, Deparment of Rehabilitation and Correction, policy relating to ACA standards.
Image
Nursing Home Release. State of Connecticut, Department of Correction, administrative directive 8.16.
Image


[+] feedback