ACA Mapping Initiative

Why ACA Mapping Now?

State and local criminal justice systems are poised to change the way they do business. With the Patient Protection and Affordable Care Act (ACA), it is now possible for millions of low-income individuals in the criminal justice system to obtain insurance coverage for their physical and behavioral health care needs. This far-reaching system change will affect every decision point of the criminal justice system, from pretrial to reentry, and every partner, from correctional health to behavioral health.

A large number of individuals in the criminal justice system struggle with chronic health problems and mental health and substance abuse disorders. Of these individuals, it is expected that four to six million (roughly one-third) of the newly insured Medicaid population in 2016 will include people who will have been booked into jails during the year.

As states begin to implement the ACA and the criminal justice-involved population begins to receive care through Medicaid and marketplace insurance coverage, criminal justice agencies must be part of the planning and implementation conversations.

ACA Mapping Activities

NIC's ACA Mapping Initiative began in early 2013 with the development of the Healthcare Enrollment Intercepts map (shown below) and the creation of the ACA Mapping Process. On December 2-3, 2013, the NIC sponsored a two-day mapping work session in Cheshire, Connecticut. During the two-day work session, participants developed a map of criminal justice system decision-points, discussed existing ACA enrollment activities, and identified and prioritized opportunities for increasing enrollment.

Results of this technical assistance to date include expanded Medicaid enrollment at Intercept 2: the Public Defender’s Office has offered enrollment services to medically ill individuals and individuals with substance abuse disorders and the Department of Corrections is in the process of developing a Medicaid enrollment program in their jails.

A second two-day mapping session followed in October 2014, which focused on the specific opportunity of improving information flow of health care data between agencies. This responsive technical assistance event focused on mapping the bi-directional current flow of data from point of initial detention and hearings with a focus on identifying opportunities for increased efficiency (standardization), sharing information and reducing duplication of information and services to enhance continuity of care. An outcome of the mapping meeting was the rollover of the priorities identified in the mapping session into a statewide improvement initiative (LeanCT) allowing for the continued analysis on how Medicaid and other entitlement applications are processed with the goals of addressing duplication and inefficiencies inherent in the current process to include enabling suspension versus termination of Medicaid during incarceration; increasing continuity of care opportunities and reducing duplicative work across agencies.

Systems mapping creates opportunities for dialogue and relationship building between health and justice stakeholders. 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.

During and ACA Mapping session, participants work together to map the decision points across the entire criminal justice system, from arrest to jail, prison, parole, and beyond where they might integrate health care enrollment or assessment in existing criminal justice processes. In addition, they will identify existing activities and opportunities for enhanced or new activities associated with health coverage enrollment, service referral, and other integration. The mapping process is a launching point for enhancing system efficiency and effectiveness related to the ACA.

Additional Technical Assistance Activities

• Kentuckiana Regional Planning & Development Agency (January 2015)
• NIC sponsored a two- day planning session in Louisville, KY with Kentuckiana Regional Planning & Development Agency (KIPDA) and their partners Healthy Reentry Coalition of KY, Louisville Metro Criminal Justice Commission, Louisville Metro Department of Corrections, and the KY Voices of Health. The two- day work session facilitated discussion between justice and health professionals, identifying existing opportunities and challenges related to the Affordable Care Act and Medicaid eligibility and enrollment. Additionally, work session participants and discussed how the existing infrastructure can be improved and expanded to advance the work of the Louisville Metro Dual Diagnosis/Cross Functional Team, the Lexington Department of Corrections, the KY State Department of Corrections and the Federal Bureau of Prisons, Mid-Atlantic Region.
• Commonwealth of Massachusetts - Office of Medicaid and Massachusetts Sheriffs Association (February 2015)
• NIC currently working with the National Criminal Justice Association and several MA state agencies developing a training session and works sessions to improve Medicaid enrollment practices for justice-involved populations and improve the suspension process for Medicaid benefits. Goals identified include increasing continuity of care, reducing recidivism and identifying cost reduction strategies.
• NORCOR Corrections, The Dalles, OR
• NIC will assist the regional jail facility develop a coordinated process to connect justice-involved individuals to appropriate medical and mental health service to reduce costs and achieve better outcomes.