"HIPAA (Health Insurance Portability and Accountability Act of 1996) and 42 CFR Part 2 (Title 42: Public Health, Part 2—Confidentiality of Substance Abuse Patient Records) are two of the most commonly cited barriers to cross-domain information sharing" (p. 1). This brief takes the ten most common myths about justice-health information sharing and explains the realities behind them.
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 Lousiville 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.
If you want an update on how the American with Disabilities Act (ADA) impacts disabled offenders then this webinar is a must view. "While there is still a significant gap regarding our knowledge about people with disabilities and Deaf people involved in the justice system, we do know there is a great need to increase access to justice for these people. People with disabilities and Deaf people experience violent victimization at rates three times higher than people without disabilities, making them one of the groups at highest risk of harm in the country. Despite these high rates of victimization, they continue to experience significant barriers to services and the justice system. These barriers not only exist for victims of violent crime but for people with disabilities and Deaf people who are incarcerated. Research reflects that 36 percent of state and 24 percent of federally incarcerated adults report having at least one disability. These individuals experience accessibility barriers from the time of arrest and through incarceration" (Vera website). "With America in the midst of substantial criminal justice reform and celebrating the 25th Anniversary of the Americans with Disabilities Act (ADA), this summit will bring these two issues together. Leaders from both the disability and criminal justice fields will explore the impact the ADA has had on people with disabilities with disabilities who have had involvement with the justice system, either as victims or suspects/offenders. Panelists will also share their visions for justice for people with disabilities for the next 25" (YouTube website). This website provides links to presentations by Senator Harkin and the five panelists. It also has a link to a Fact Sheet (from July 2015) that covers the impact of ADA in disabled offenders. This document has sections about: what we know about justice-involved people with disabilities and deaf people—suspects and offenders, and victims and survivors; the ADA's impact on justice-involved people with disabilities and deaf people—victim service organizations, law enforcement agencies, the courts, and prisons and jails; opportunities at the intersection of access and justice involvement; and additional information about the ADA's five titles, the ADA Amendments Act (ADAAA) of 2008, and Olmstead V L.C. 527 U.S. 581 of 1999.
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.
<p>Instructions are provided to state governors on how to show their state is in compliance with the Prison Rape Elimination Act (PREA). The two attached forms are to be used to indicate their state’s compliance with PREA or the state’s intent not to use more than 5% of certain federal grants to achieve full compliance. The grants involved are the Edward Byrne Memorial Justice Assistance Grant Formula Program, the Juvenile Justice and Delinquency Prevention Act Formula Grant Program, and the STOP (Services, Training, Officers, and Prosecutors) Violence Against Women Formula Grant Program. Attached are copies of the “Certification Regarding Adoption and Full Compliance with the National Standards to Prevent, Detect, and Respond to Prison Rape” and the “Assurance to Utilize Department of Justice Grants to Achieve Full Compliance with the National Standards to Prevent, Detect, and Respond to Prison Rape”.</p>
This webinar explains: what health literacy has to do with accessing health care; what literacy is; what health literacy is; the five steps of health literacy—find health information, understand it, evaluate it, communicate it, and use it; the health literacy of U.S. adults; health literacy is disproportionate; barriers to good health literacy; what needs to be done; prevalence of disease; health risks following release; transitional care—continuity of care; barriers to care; Transitions Clinic Program—patient centered and culturally competent care for returning prisoners; strategies to successful engagement post-release; the need for referrals to the community by criminal justice providers; how to make connections between criminal justice providers and the community; referrals to the community from the jail or prison; referrals to the community; and electronic linkages.
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.
"Sharing health information across correctional boundaries presents many challenges. Three such projects in Connecticut may be of value in informing other jurisdictions of similar opportunities. This article describes the development and implementation of an interagency release of information (ROI) document and process, a voucher program to provide discharge medications at the time of release, and a statewide research-oriented health information network" (p. 1). Sections of this article include: introduction; interagency release of information (ROI) document and process; the Medicaid prescription voucher program; Connecticut Health Information Network (CHIN)—distributed system, security, record linkage, and governance; and conclusion.
"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.
This webinar will: define roles that criminal justice professionals play in Medicaid Administrative Claiming (MAC) and Targeted Case Management (TCM); define service needs of justice involved individuals; highlight community corrections and criminal justice agency examples of resource utilization; explain strategies for meeting increased demand for healthcare services under the Affordable Care Act; and differentiate between MAC and TCM. The webinar aims to: demonstrate that MAC and TCM are excellent fits with day to day activities that Probation Officers and Parole Agents provide; and walk through the process to assist interested individuals in getting MAC/TCM up and running in their locales.