Reentry and the Affordable Care Act

This post is courtesy of Associate Attorney General Tony West

Earlier this month, at a conference hosted by the Community Oriented Correctional Health Services and the journal Health Affairs, I had the opportunity to speak with a distinguished group of policymakers, researchers and health care and criminal justice professionals about the implications of the Affordable Care Act (ACA) for those under correctional supervision. The fact is that the Affordable Care Act holds the promise of expanding health care coverage to uninsured Americans, and potentially opens Medicaid enrollment to some 15 million low-income adults, including the millions of individuals who come into contact with our criminal justice system, of whom upwards of 90 percent are uninsured. This moment is an opportunity, uniquely positioned at the intersection of public health and public safety, to reform correctional health care, to improve the health of our communities and to enhance public safety.  It is an opportunity born of necessity, as leaders across the political spectrum seek ways to better align our criminal justice investments with outcomes that actually make us safer. At the Department of Justice, we understand that public health and public safety often walk hand-in-hand; that the public policy investments we make yield the greatest returns when they reflect the importance of that connection; and that key to making our communities safer is reducing recidivism by improving reentry, which in turn means focusing on the physical and mental health of incarcerated and formerly incarcerated individuals. We know that the incarcerated population carries substantially higher rates of medical, psychiatric and substance abuse problems than the general population.  Rates of communicable diseases are higher among inmates; an estimated 39 to 43 percent suffer from one or more chronic health conditions; and men and women in this population suffer three times the rate of mental illness and four times the rate of substance abuse problems as compared to the general public. Fortunately, we have a path forward. We know that health care coverage and access to adequate health services can decrease the risk of individuals becoming involved with the criminal justice system in the first place.  Moreover, when individuals do come into contact with the justice system, we can dramatically improve the odds for successful reentry if we address their health and mental health needs once they enter correctional facilities and ensure continuity of care once they leave.  The Affordable Care Act, primarily through its Medicaid expansion provisions and parity for mental health and substance abuse treatment, provides us with this unique opportunity to reduce recidivism while improving public health.  Access to these benefits can be a critical factor in the success or failure of incarcerated persons upon their release. Much of the work being done by the Federal Interagency Reentry Council, which is chaired by the Attorney General, focuses on reducing the collateral consequences of incarceration and increasing access to employment, treatment and civic participation.  With our Reentry Council partners at the Department of Health and Human Services, we are jointly supporting a three-year pilot project to test the efficacy of enrolling prison and jail inmates in Medicaid prior to release, and we're tracking usage, employment and recidivism outcomes along the way. At the Department of Justice, we will require halfway houses in the federal system—known as residential reentry centers (RRCs)—to offer standardized treatment to prisoners with mental health and substance abuse issues.  Once fully-implemented, these services will be available to the approximately 30,000 inmates who are released through halfway houses each year, helping to promote consistency and continuity of care between federal prisons and community-based facilities. This month, our Office of Justice Programs’ Bureau of Justice Assistance released a new solicitation requesting proposals to help states and local jurisdictions maximize Medicaid and marketplace resources on behalf of justice-involved individuals.  We are looking for innovative ideas to aid in all aspects of health care planning, from diversion alternatives and intake screening at the front-end, to reentry programs at the back end.  We want to be able to provide in-depth assistance to select jurisdictions on implementation of the Affordable Care Act, as well as policy guidance for all states and localities. Of course, we must do more. We must make it standard practice to assess the health care needs of individuals as soon as they come into the criminal justice system, being thoughtful about our options and basing decisions on individual needs. We should be willing to consider detention alternatives such as drug and mental health courts, and we should make health care enrollment part of the intake and discharge processes for all inmates. We must develop partnerships between correctional facilities and community health programs to promote information exchange and ensure continuity of care. And we must target our actions to those who need services the most.  The Affordable Care Act gives us the chance to provide those with the highest risks and the greatest needs access to quality health care in a way that promotes public health and safety while strengthening community and respecting individual dignity.